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中华普通外科学文献(电子版) ›› 2011, Vol. 05 ›› Issue (05) : 425 -431. doi: 10.3877/cma.j.issn.1674-0793.2011.05.016

所属专题： 文献；

调查统计

急性胰腺炎患者肠外营养和肠内营养治疗的Meta分析
谢春玲1, 胡志成2, 唐冰2(), 朱斌2,†(), 郭栋2, 陈斌2, 张凯2, 李晓卉2   
  1. 1. 510080　中山大学附属第一医院胸外科
    2. 510080　中山大学附属第一医院烧伤外科
  • 收稿日期:2011-06-10 出版日期:2011-10-01
  • 通信作者: 唐冰, 朱斌
  • 基金资助:
    广东省科技项目(20078031504003)

Meta-analysis of the effectiveness of parenteral nutrition and enteral nutrition in acute pancreatitis

Chun-ling XIE1, Zhi-cheng HU2, Bin ZHU2,†(), Bing TANG2(), Dong GUO2, Bin CHEN2, Kai ZHANG2, Xiao-hui LI2   

  1. 1. Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2011-06-10 Published:2011-10-01
  • Corresponding author: Bin ZHU, Bing TANG
  • About author:
    Corresponding author: ZHU Bin, Email:
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谢春玲, 胡志成, 唐冰, 朱斌, 郭栋, 陈斌, 张凯, 李晓卉. 急性胰腺炎患者肠外营养和肠内营养治疗的Meta分析[J/OL]. 中华普通外科学文献(电子版), 2011, 05(05): 425-431.

Chun-ling XIE, Zhi-cheng HU, Bin ZHU, Bing TANG, Dong GUO, Bin CHEN, Kai ZHANG, Xiao-hui LI. Meta-analysis of the effectiveness of parenteral nutrition and enteral nutrition in acute pancreatitis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2011, 05(05): 425-431.

目的

探讨急性胰腺炎患者肠外和肠内营养治疗的疗效。

方法

采用Meta分析的方法，检索1966年1月至2011年3月国内外文献数据库，对国内外学者公开发表的有关急性胰腺炎营养治疗的研究文献进行综合定量分析，衡量指标为病死率、感染率、多器官功能衰竭发生率、手术干预率和住院时间。

结果

经筛选有13篇文献入选，与传统肠外营养相比，急性胰腺炎患者采用肠内营养的病死率降低了61%（95% CI = 24%~63%），感染率降低了45%（95% CI = 38%~79%），多器官功能衰竭率降低了69%（95% CI = 20%~48%），手术干预降低了73%（95% CI=18%~42%），而住院时间差异无统计学意义（P = 0.91）。

结论

与急性胰腺炎患者肠外营养相比，肠内营养可以降低病死率、感染发生率、多器官衰竭发生率和手术干预率，建议早期采用肠内营养。

关键词: Meta分析, 急性胰腺炎, 肠道营养, 胃肠外营养
Objective

To analyze the effects of total parenteral nutrition (TPN) and enteral nutri- tion (EN) in patients with acute pancreatitis.

Methods

Electronic databases from January 1966 to March 2011 about randomized controlled trial of nutrition therapy in patients with acute pancreatitis were enrolled and Meta-analysis of these randomized controlled trial was used, the measurement index were morbidity, infection rate, multiple organ failure (MOF) rate, surgery intervention rate and length of stay.

Results

A total of 13 trials was included. Compared with conventional parenteral nutrition, morbidity of enteral nutrition in patients with acute pancreatitis reduced by 61% (95% CI = 24%~63%, P = 0.0001) , and infection rate reduced by 45% (95% CI = 38%~79%, P < 0.01) , and the multiple organ failure reduced by 69% (95% CI = 20%~48%, P < 0.01) , and the surgery intervention reduced by 73% (95% CI = 18%~42%, P < 0.01) . However, there was no statistically significant about the length of stay between EN and PN.

Conclusions

In patients with acute pancreatitis, enteral nutrition significantly reduced mortality, infections, multiple organ failure and surgery intervention compared to those who received TPN. This data suggests that EN should be considered the better way for patients with acute pancreatitis requiring nutritional support.

Key words: Meta-analysis, Acute pancreatitis, Enteral nutrition, Parenteral nutrition
表1 纳入分析研究文献的基本信息
第一作者 年份 国家 肠内营养
患者数（例） 住院时间（d） 死亡数（例） 感染数（例） 多器官功能衰竭数（例） 手术介入数（例）
Abou-Assi[6] 2002 USA 26 14.20 ± 13.83 8 1 7 1
Casas[7] 2007 Spain 11 30.20 ± 32.00 0 3 0 1
Gupta[9] 2003 UK 8 7 0 1 0 0
Louie[8] 2004 Canada 10 - 0 1 7 14
Doley[10] 2009 India 25 42 5 16 5 -
Petrov[11] 2006 Russia 35 - 2 11 10 5
Windsor[12] 1998 UK 16 12.5 0 0 0 1
McClave[13] 1997 USA 16 9.70 ± 7.35 0 4 0 0
Eckerwall[14] 2006 Sweden 24 7 1 3 2 1
Olah[15] 2002 Hungary 41 - 2 5 2 8
Kalfarentzos[16] 1997 Greece 18 40.00 ± 17.20 1 5 1 2
Vieira[17] 2010 Brazil 15 25.47 ± 5.55 0 2 0 4
Wu[18] 2010 China 53 - 6 12 8 12
第一作者 年份 国家 肠外营养
患者数（例） 住院时间（d） 死亡数（例） 感染数（例） 多器官功能衰竭数（例） 手术介入数（例）
Abou-Assi[6] 2002 USA 27 18.40 ± 13.83 6 9 0 8
Casas[7] 2007 Spain 11 30.70 ± 23.50 2 6 5 2
Gupta[9] 2003 UK 9 10 0 2 3 4
Louie[8] 2004 Canada 18 - 3 7 15 13
Doley[10] 2009 India 25 36 4 15 - 3
Petrov[11] 2006 Russia 34 - 12 27 11 23
Windsor[12] 1998 UK 18 15 2 3 4 5
McClave[13] 1997 USA 16 11.90 ± 14.70 0 5 0 0
Eckerwall[14] 2006 Sweden 26 9 0 0 2 2
Olah[15] 2002 Hungary 48 - 4 13 25 5
Kalfarentzos[16] 1997 Greece 20 39.00 ± 17.34 2 10 4 2
Vieira[17] 2010 Brazil 16 22.25 ± 11.07 3 4 4 1
Wu[18] 2010 China 54 - 23 39 43 35
图1 肠内营养与肠外营养的死亡率森林图
图2 肠内营养与肠外营养的感染率森林图
图3 肠内营养与肠外营养的多器官衰竭发生率森林图
图4 肠内营养与肠外营养的手术干预情况森林图
图5 肠内营养与肠外营养的住院时间比较森林图
1
Curtis CS，Kudsk KA. Nutrition support in pancreatitis. Surg Clin North Am，2007，87(6):1403-1415.
2
Pezzilli R，Zerbi A，Di Carlo V，et al. Practical guidelines for acute pancreatitis. Pancreatology，2010，10(5):523-535.
3
Marik PE，Pinsky MR. Death by total parenteral nutrition. Intensive Care Med，2003，29(6):867-869.
4
Ayúcar Ruiz de Galarreta A，Pita Gutiérrez F，Mosteiro Pereira F，et al. Parenteral periferic nutrition：non surgical indications. Nutr Hosp，2011，26(1):194-200.
5
Scolapio JS，Malhi-Chowla N，Ukleja A. Nutrition suppleme-ntation in patients with acute and chronic pancreatitis. Gastroenterol Clin North Am，1999，28(3):695-707.
6
Abou-Assi S，Craig K，O'Keefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis：results of a randomized comparative study. Am J Gastroenterol，2002，97(9):2255-2262.
7
Casas M，Mora J，Fort E，et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev Esp Enferm Dig，2007，99(5):264-269.
8
Louie BE，Noseworthy T，Hailey D，et al. 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis：a randomized controlled trial and health technology assessment. Can J Surg，2005，48(4):298-306.
9
Gupta R，Patel K，Calder PC，et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic，inflammatory and oxidative markers in patients with predicted severe acute pancreatitis（APACHE Ⅱ≥6）. Pancreatology，2003，3(5):406-413.
10
Doley RP，Yadav TD，Wig JD，et al. Enteral nutrition in severe acute pancreatitis. JOP，2009，10(2):157-162.
11
Petrov MS，Kukosh MV，Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg，2006，23(5-6):336-344.
12
Windsor AC，Kanwar S，Li AG，et al. Compared with parenteral nutrition，enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut，1998，42(3):431-435.
13
McClave SA，Greene LM，Snider HL，et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN J Parenter Enteral Nutr，1997，21(1):14-20.
14
Eckerwall GE，Axelsson JB，Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis：a clinical randomized study. Ann Surg，2006，244(6):959-965.
15
Oláh A，Pardavi G，Belágyi T，et al. Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition，2002，18(3):259-262.
16
Kalfarentzos F，Kehagias J，Mead N，et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis：results of a randomized prospective trial. Br J Surg，1997，84(12):1665-1669.
17
Vieira JP，de Araújo GF，de Azevedo JR. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cir Bras，2010，25(5):449-454.
18
Wu XM，Ji KQ，Wang HY，et al. Total enteral nutrition in prevention of pancreatic necrotic infection in severe acute pancreatitis. Pancreas，2010，39(2):248-251.
19
Talukdar R，Vege SS. Recent developments in acute pancreatitis. Clin Gastroenterol Hepatol，2009，7(11 Suppl):S3-9.
20
van Santvoort HC，Besselink MG，Bakker OJ，et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med，2010，362(16):1491-1502.
21
Götze T，Schütte K，Malfertheiner P. Nutritional support in patients with acute pancreatitis. Eksp Klin Gastroenterol，2009，(2):170-177.
22
Kalfarentzos FE，Karavias DD，Karatzas TM，et al. Total parenteral nutrition in severe acute pancreatitis. J Am Coll Nutr，1991，10(2):156-162.
23
中华医学会消化病学分会. 肠屏障功能障碍临床诊治建议. 中华消化杂志，2006，26(9):620.
24
Roberts PR. Nutritional support in acute pancreatitis：an update on management issues. Semin Respir Crit Care Med，2001，22(1):29-34
25
Derven is C. Enteral nutrition in severe acute pancreatitis：future development. JOP，2004，5(2):60-63.
26
Zhong Y，Cai D，Cai W，et al. Protective effect of galactooligo- saccharide-supplemented enteral nutrition on intestinal barrier function in rats with severe acute pancreatitis. Clin Nutr，2009，28(5):575-580.
27
Petrov MS，Loveday BP，Pylypchuk RD，et al. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg，2009，96(11):1243-1252.
28
Bakker OJ，van Santvoort HC，van Brunschot S，et al. Pancrea- titis，very early compared with normal start of enteral feeding（PYTHON trial）：design and rationale of a randomised controlled multicenter trial. Trials，2011，10(12):73.
29
Petrov MS，Pylypchuk RD，U chugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis. Br J Nutr，2009，101(6):787-793.
30
Koretz RL. Enteral nutrition：a hard look at some soft evidence. Nutr Clin Pract，2009，24(3):316-324.
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