在重症患者中启动肠道营养的最佳时间:一个网络元分析
Ming Dai1, Hong-Wei Yang2, You Zhou1
1Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Frontiers in nutrition
|February 23, 2026
概括
在24-48小时内早期启动肠道营养 (EN) 可能会降低重症患者的死亡率. 然而,在96小时之后启动EN可能会缩短ICU停留时间. 最佳时机需要进一步进行高质量的试验.
科学领域:
- 关键护理医学 关键护理医学
- 营养科学 营养科学
- 临床研究方法论临床研究方法论
背景情况:
- 肠道营养 (EN) 对于重症患者至关重要,维护肠道功能和免疫平衡.
- 对EN启动的最佳时间进行了辩论,导致了各种各样的临床实践.
- 目前的证据不足以指导EN启动时间建议.
研究的目的:
- 在重症患者中系统比较五个EN启动时间.
- 为了对不同EN启动窗口的有效性进行排名.
- 确定最佳的EN启动窗口,以改善临床结果.
主要方法:
- 随机对照试验 (RCT) 的网络元分析.
- 搜索的主要数据库 (PubMed,Embase,科学网,Cochrane) 截至2024年9月.
- 使用积累性排名曲线下的表面 (SUCRA) 排名的效率.
主要成果:
- 15个RCT分析了5个EN启动时间 (<24小时,24-48小时,48-72小时,72-96小时,>96小时).
- 在死亡率或ICU停留时间之间没有显著差异.
- 24-48小时开始显示死亡率降低的概率最高 (SUCRA 67.0%).
- >96小时启动显示了较短的ICU停留时间的最高概率 (SUCRA 75.2%).
结论:
- 启动EN>96h可能会缩短ICU停留时间;在24-48h内启动EN可能会降低死亡率.
- 24-48小时的窗口似乎是关键护理结果相对最佳的.
- 由于证据质量有限,需要进一步的大型高质量的RCT来验证这些发现.
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