营养支持路线对急性胰腺炎死亡率的影响:随机对照试验的网络元分析
Ping-Han Hsieh1, Tsung-Chieh Yang1,2, Enoch Yi-No Kang3,4,5
1Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Journal of internal medicine
|April 1, 2024
概括
鼻胃 (NG) 和鼻 (NJ) 食可降低急性胰腺炎 (AP) 的死亡率. 建议在24小时内进行NJ养,特别是严重的AP,提供最佳的营养支持.
科学领域:
- 胃肠病学 胃肠病学
- 临床营养学 临床营养学
- 医学统计 医学统计
背景情况:
- 在急性胰腺炎 (AP) 中的营养管理是有争议的,因为从元分析中得到的死亡率数据相互矛盾.
- AP患者营养支持的最佳途径尚不清楚.
- 这项研究通过比较AP中不同营养管理途径的死亡率来解决这种不确定性.
研究的目的:
- 在被诊断患有急性胰腺炎的患者中,比较各种营养管理途径之间的死亡率.
- 为AP管理提供基于证据的营养支持建议.
主要方法:
- 在四个主要数据库中对相关的随机对照试验 (RCT) 进行了系统的文献搜索.
- 数据提取和质量评估由两位作者独立进行.
- 使用随机效应网络元分析计算风险比率 (RR) 和95%置信区间 (CI),并对AP严重程度和营养支持时间进行子组分析.
主要成果:
- 这项分析包括27个RCT,涉及1594名患者.
- 鼻胃 (NG) 和鼻 (NJ) 养显著降低死亡率,相比于零人均 (NPO).
- 在NG和NJ两种养中,死亡风险都低于全方位营养 (TPN) 的死亡风险. 在24-48小时内开始NJ食时,显著降低了死亡率,特别是在严重的AP病例中.
结论:
- 对于严重的AP,NG和NJ养都是有效的营养策略.
- 为获得最佳结果,建议在入院后24小时内启动NJ食.
- 这些发现指导了AP患者营养干预措施的优化.
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