脑出血患者术后实施不同肠内营养治疗效果的荟萃分析-东南大学学报医学版

脑出血患者术后实施不同肠内营养治疗效果的荟萃分析

单位：1. 承德医学院附属医院营养科, 河北承德 067000;
2. 承德医学院附属医院神经外科, 河北承德 067000

分类号：R743.34

出版年·卷·期（页码）：2017·36·第三期（394-398）

摘要：

目的：系统评价脑出血患者术后应用肠内营养制剂的治疗效果。方法：检索CNKI、VIP、CBM、万方医学网及PubMed数据库。检索自各数据库建立开始至2016年5月发表的自发性脑出血患者术后给予不同肠内营养治疗的随机对照试验，共187个。双人按照文献纳入与排除标准严格筛选，使用Cochrane协作网推荐的偏倚风险评估工具对文献进行偏倚风险评价，数据录入RevMan 5.3软件中进行Meta分析。结果：最终纳入10个随机对照试验，共953例患者。Meta分析结果示：脑出血患者术后早期应用肠内营养制剂，能够升高患者术后血清白蛋白（ALB）（MD_合并=5.63，95%CI为4.06~7.20，Z=7.03，P<0.000 01）、全血血红蛋白（MD_合并=12.27，95%CI为4.62~19.91，Z=3.14，P=0.002）值，增长体重值（MD_合并=7.19，95%CI为3.42~10.96，Z=3.74，P=0.000 2），降低腹泻发生率（RR_合并=0.46，95%CI为0.33~0.66，Z=4.29，P<0.000 1）和死亡率（RR_合并=0.50，95%CI为0.34~0.73）；Z=3.56，P=0.000 4］。实施干预后，两组患者血总淋巴细胞计数差异无统计学意义（MD_合并=0.61，95%CI为-0.13~1.35，Z=1.61，P=0.11）。结论：目前的研究证据支持自发性脑出血患者术后早期应用肠内营养制剂，在改善术后营养状况、增加体重、降低腹泻发生率及死亡率等方面比混合流食效果更好。但由于纳入文献偏倚风险较高，数量较少，上述结论仍需更多多中心、低偏倚风险的随机对照试验加以证实。

Objective:To analyze the therapeutic effect of different enteral nutrition on patients with cerebral hemorrhage after operation. Methods:We retrieved CNKI, VIP, CBM, Wanfang and PubMed database and searched literatures about randomized controlled trial of different enteral nutrition therapy on patients with spontaneous cerebral hemorrhage after surgery. A total of 187 were found from the establishment of the databases to May 2016. Two reviewers independently screened the trials according to the inclusion and exclusion criteria and used bias risk assessment tools recommended by Cochrane Collabration to assess the risk of bias. Meta-analysis was conducted by using Cochrane Collabration's RevMan 5.3 software. Results:Ten randomized controlled trials were finally included into this study,which involved 953 patients. Meta-analysis results showed that early use of enteral nutrition preparations in patients with cerebral hemorrhage could increase serum albumin[MD_merger=5.63, 95%CI 4.06-7.20,Z=7.03, P<0.000 01], whole blood hemoglobin[MD_merger=12.27,95%CI 4.62-19.91,Z=3.14,P=0.002] and weight[MD_merger=7.19,95% CI 3.42-10.96,Z=3.74,P=0.000 2], and reduce the incidence of diarrhea[RR_merger=0.46,95% CI 0.33-0.66,Z=4.29,P<0.000 1)] and mortality[RR_merger=0.50,95% CI 0.34-0.73,Z=3.56,P=0.000 4]. After intervention, no statistically significant difference of total lymphocyte count was found in two groups[MD_merger=0.61,95%CI -0.13-1.35,Z=1.61, P=0.11]. Conclusion:This study shows that the application of enteral nutrition preparations in patients with spontaneous cerebral hemorrhage after operation had better effect on improving nutritional status, increasing weight and reducing incidence of diarrhea and mortality than that of mixed liquid diets,but it needs much higher quality of randomized controlled trials to confirm.

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