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Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review
引用本文:Jiang K,Chen XZ,Xia Q,Tang WF,Wang L. Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review[J]. World journal of gastroenterology : WJG, 2007, 13(39): 5253-5260. DOI: 10.3748/wjg.v13.i39.5253
作者姓名:Jiang K  Chen XZ  Xia Q  Tang WF  Wang L
作者单位:Kun Jiang,Qing Xia,Wen-Fu Tang,Lei Wang,Department of Integrated Traditional Chinese and Western Medicine,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China Xin-Zu Chen,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China
摘    要:AIM: To evaluate the effectiveness and safety of early nasogastric enteral nutrition (NGEN) for patients with severe acute pancreatitis (SAP). METHODS: We searched Cochrane Central Register of Controlled Trials (Issue 2, 2006), Pub-Medline (1966-2006), and references from relevant articles. We included randomized controlled trials (RCTs) only, which reported the mortality of SAP patients at least. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration’s RevMan 4.2.9 software was used for statistical analysis. RESULTS: Three RCTs were included, involving 131 patients. The baselines of each trial were comparable. Meta-analysis showed no significant differences in mortality rate of SAP patients between nasogastric and conventional routes (RR = 0.76, 95% CI = 0.37 and 1.55, P = 0.45), and in other outcomes, including time of hospital stay (weighted mean difference = -5.87, 95% CI = -20.58 and 8.84, P = 0.43), complication rate of infection (RR = 1.41, 95% CI = 0.62 and 3.23, P = 0.41) or multiple organ defi ciency syndrome (RR = 0.97, 95% CI = 0.27 and 3.47, P = 0.97), rate of admission to ICU (RR = 1.00, 95% CI = 0.48 and 2.09, P = 0.99) or conversion to surgery (RR = 0.66, 95% CI = 0.12 and 3.69, P = 0.64), as well as recurrence of re-feeding pain and adverse events associated with nutrition. CONCLUSION: Early NGEN is a breakthrough in the management of SAP. Based on current studies, early NGEN appears effective and safe. Since the available evidence is poor in quantity, it is hard to make an accurate evaluation of the role of early NGEN in SAP.Before recommendation to clinical practice, further high qualified, large scale, randomized controlled trials are needed.

关 键 词:肠道营养  鼻胃管  急性胰腺炎  系统分析
收稿时间:2007-05-12

Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review
Jiang Kun,Chen Xin-Zu,Xia Qing,Tang Wen-Fu,Wang Lei. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review[J]. World journal of gastroenterology : WJG, 2007, 13(39): 5253-5260. DOI: 10.3748/wjg.v13.i39.5253
Authors:Jiang Kun  Chen Xin-Zu  Xia Qing  Tang Wen-Fu  Wang Lei
Affiliation:1. Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Abstract:AIM To evaluate the effectiveness and safety of early nasogastric enteral nutrition (NGEN) for patients with severe acute pancreatitis (SAP).METHODS We searched Cochrane Central Register of Controlled Trials (Issue 2, 2006), Pub-Medline (1966-2006), and references from relevant articles. We included randomized controlled trials (RCTs) only, which reported the mortality of SAP patients at least. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration's RevMan 4.2.9 software was used for statistical analysis.RESULTS Three RCTs were included, involving 131 patients. The baselines of each trial were comparable.Meta-analysis showed no significant differences in mortality rate of SAP patients between nasogastric and conventional routes (RR = 0.76, 95% CI = 0.37 and 1.55, P = 0.45), and in other outcomes, including time of hospital stay (weighted mean difference = -5.87,95% CI = -20.58 and 8.84, P = 0.43), complication rate of infection (RR = 1.41, 95% CI = 0.62 and 3.23, P =0.41) or multiple organ deficiency syndrome (RR = 0.97,95% CI = 0.27 and 3.47, P = 0.97), rate of admission to ICU (RR = 1.00, 95% CI = 0.48 and 2.09, P = 0.99) or conversion to surgery (RR = 0.66, 95% CI = 0.12 and 3.69, P = 0.64), as well as recurrence of re-feeding pain and adverse events associated with nutrition.CONCLUSION Early NGEN is a breakthrough in the management of SAP. Based on current studies, early NGEN appears effective and safe. Since the available evidence is poor in quantity, it is hard to make an accurate evaluation of the role of early NGEN in SAP.Before recommendation to clinical practice, further high qualified, large scale, randomized controlled trials are needed.
Keywords:Enteral nutrition  Nasogastric tube  Severe acute pancreatitis  Systematic review  Meta-analysis
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