消化系统肿瘤患者术后肠内与肠外营养支持对比的Meta分析

目的运用Meta分析方法 ,评价消化系统肿瘤患者术后应用肠内营养(EN)与肠外营养(PN)两种临床营养支持方式的有效性、安全性和经济性。方法检索Medline(Pubmed)、Embase和Cochranedatabase数据库,根据Cochrane系统评价手册对纳入的随机对照试验(RCT)进行质量评价,采用RevMan 5.1软件进行Meta分析。选择血清白蛋白(ALB)、术后并发症发生率、住院天数和治疗费用作为评估指标,得出合并后的均数差值(WMD)或比值比(OR),以及95%可信区间(95%CI)等进行定量综合评估。结果共纳入20篇文献,其中10篇文献用于分析两种营养支持的营养指标,16篇文献分析两种营养支持的安全性,10篇文献分析两种营养支持的住院时间,3篇文献分析两种营养支持的治疗费用。营养指标ALB的合并WMD=1.22,95%CI(1.14,1.30),P<0.05;术后并发症发生率的合并OR=0.74,95%CI(0.63,0.87),P<0.05;住院天数的合并WMD=-1.47,95%CI(-1.90,-1.05),P<0.05;治疗费用的合并WMD=-175.00,95%CI(-213.51,-136.49),P<0.05。结论消化系统肿瘤患者术后采用EN相对于PN支持,可更有效地改善患者营养状况,减少术后并发症,缩短住院时间,降低治疗费用。要得出远期结果需对更多高质量的RCT进行分析。

Comparison with enteral and parenteral nutritional support in gastrointestinal oncology patient undergoing surgery treatment;a Meta-analysis

AIM Internalized the RCT papers which compared enteral nutrition(EN) and parenteral nutrition(PN) support to gastrointestinal oncology patients undergoing surgery treatment,Meta-analysis and evaluates the effectiveness,security and enthusiasm of two clinical nutrition pathways.METHODS Retrieval clinical research literatures which compared EN and PN support to gastrointestinal oncology patients undergoing surgery treatment on Medline(Pubmed),Embase,and Cochrane database.RevMan5.1 was adopted to analyze the data.Assess the indicators of serum albumin,the incidence of postoperative complications,length of hospital stay and treatment costs,obtain the merger mean difference(WMD),odds ratio(OR) and 95% confidence intervals(95%CI),made quantitative comprehensive assessment.RESULTS A total of 20 studies were included in this review:10 studies were Meta-analyzed for nutrition index,16 studies were Meta-analyzed for complication,10 studies were Meta-analyzed for hospital stay,and 3 studies were Meta-analyzed for treatment cost.The merger value WMD of ALB corresponding to 1.22,95%CI(1.14,1.30),P<0.05.The merger value OR of the postoperative complications incidence is 0.74,95%CI(0.63,0.87),P<0.05.The merger value WMD of the hospital stay is -1.47,95%CI(-1.90,-1.05),P<0.05.The merger value WMD of the treatment cost is -175.00,95%CI(-213.51,-136.49),P<0.05.The discrepancy of three index are significant. CONCLUSION Compared with PN,EN support in patients with gastrointestinal oncology undergoing surgery treatment can effectively improve the patients' nutritional status and reduce postoperative complications,make hospital stay shorter and treatment costs lower.Long term results need to analyzed more high quality RCT.