早期肠道营养和临床结果在重病儿科人群:一个系统的审查和元分析
Nicole Gilbert1,2, Emma Schalm3, Krista Wollny4
1Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
Critical care medicine
|September 17, 2025
概括
重症儿童的早期肠道营养 (EEN) 与更好的结果有关,包括降低死亡率. 然而,由于研究的局限性,证据质量非常低.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 临床营养学 临床营养学
- 基于证据的医学是基于证据的医学.
背景情况:
- 目前的指导方针提倡在重症儿童中提供早期肠道营养 (EEN).
- 对EEN的临床益处和潜在风险需要进一步调查,特别是当根据疾病严重程度进行调整时.
研究的目的:
- 为了确定在重症儿童中EEN是否与延迟肠道营养 (DEN) 相比,与改善的临床结果有关.
- 根据疾病严重程度调整的关联优先考虑,以提供可靠的证据.
主要方法:
- 随机对照试验 (RCT),准实验,观察性队列和病例对照研究的系统审查和元分析.
- 在MEDLINE,Embase,CINAHL和CENTRAL数据库中搜索到2024年10月.
- 数据提取和偏差风险评估由两位独立审稿人进行.
主要成果:
- 对13项研究 (1个RCT,12个队列) 的元分析表明,经疾病严重程度调整后,EEN与死亡率降低有关 (aOR 0.36;95% CI,0.14-0.91).
- 对18项研究 (n=9829) 的定性审查表明,EEN与更短的住院时间,减少呼吸支,改善营养充足度和更少的感染有关.
- 经过对混变量进行调整后,没有发现EEN的有害影响.
结论:
- 在重症儿童中,EEN与有益的临床结果有关.
- 证据的确定性非常低,原因是队列研究占主导地位,混调整有限,研究异质性,样本大小小.
- 需要进一步的高质量研究来证实这些发现.
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