重症患者允许营养不良的有效性:更新的系统性审查和试验顺序的元分析
Han-Yang Yue1, Wei Peng1, Jun Zeng1,2
1Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
Journal of intensive care
|January 23, 2024
概括
在重症监护室 (ICU) 允许的营养不良可能会降低ICU死亡率和机械通风持续时间. 然而,这种营养策略并没有改善重症患者的整体死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 营养支持 营养支持
- 基于证据的医学基于证据的医学.
背景情况:
- 之前的研究表明,允许的营养不良可能会改善接受肠道营养的患者的结果.
- 2011年的一项小型研究的初步结论需要进一步调查.
- 这项研究更新了关于重症监护室 (ICU) 患者允许营养不良的证据.
研究的目的:
- 系统地审查和分析关于ICU患者容许性营养不良的随机对照试验 (RCT).
- 评估允许的营养不良对死亡率,停留时间和不良事件的影响.
- 进行试验顺序分析 (TSA) 以进行可靠的死亡结果评估.
主要方法:
- 对七个主要数据库进行了系统搜索.
- 包括23个RCT,涉及11,444名重症患者.
- 使用ROB 2评估偏差风险,并使用RevMan软件与TSA合成数据.
主要成果:
- 允许性营养不良显著降低了ICU死亡率 (RR 0.90; 95% CI [0.81, 0.99]) 和胃肠道不良事件 (RR 0.79; 95% CI [0.69, 0.90]).
- 机械通风的持续时间平均缩短了1.85天 (MD -1.85天;95% CI [-3.44, -0.27]).
- 在整体死亡率,住院死亡率,住院时间长度或整体感染发病率方面没有发现显著差异.
结论:
- 允许的营养不良似乎降低了ICU死亡率,并减少了重症患者的机械通风持续时间.
- 这种营养方法并没有显著改善整体死亡率.
- 由于样本大小和患者异质性,需要进一步的大规模,精心设计的RCT来证实这些发现.
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