经过重大腹部手术的患者的免疫营养:使用GRADE和CINeMA方法进行全面的系统审查和组件网络元分析
Claudio Ricci1, Francesco Serbassi2, Laura Alberici3
1Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Italy; Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, Italy.
Surgery
|September 29, 2023
概括
最佳的免疫营养组合,包括氨酸,谷氨酸和多不和脂肪酸,可以降低主要腹部手术患者的发病率. 需要进一步的研究来澄清对死亡率和感染率的影响.
科学领域:
- 临床营养学 临床营养学
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 在重大腹部手术中免疫营养的好处是众所周知的,但最佳的营养组合仍然不清楚.
- 这项研究旨在确定手术患者最有效的免疫营养素策略.
研究的目的:
- 为了确定对接受重大腹部手术的患者免疫营养素的最佳组合.
- 分析不同免疫营养素配方对患者结局的影响.
主要方法:
- 一个系统的搜索和频率的随机效应组件网络对87项随机临床试验的元分析,涉及8,375名患者.
- 关键终点的评估:发病率和死亡率. 重要的终点包括传染性并发症和住院时间长度.
主要成果:
- 经过手术的肠道/口腔免疫营养,使用阿尔金因,谷氨胺和多不和脂肪酸显著降低了患病率 (OR 0.32;P评分0.93) 具有中等确定性.
- 手术后的肠道免疫营养与RNA,氨酸和多不和脂肪酸显示了降低死亡率的趋势 (OR0.59;P评分0.84),但确定性很低.
- 组件分析表明,术后使用2-3种免疫营养素是降低发病率的关键.
结论:
- 术后的口腔/肠道免疫营养与多个组成部分有效地降低了主要腹部手术患者的发病率.
- 免疫营养对死亡率,感染并发症和逗留时间的影响需要进一步调查.
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