短期ω-3脂肪酸乳剂干预对手术后肠外营养患者临床结局影响的Meta分析

目的 探讨ω-3脂肪酸乳剂对手术后患者临床结局的影响。方法 计算机检索1996年1月至2010年6月PubMed、EMBASE、Cochrane图书馆、Web of Science以及中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方等中文数据库中研究择期手术后补充ω-3脂肪酸对患者临床结局影响的文献，同时进行手工检索和参考文献回溯。采用Jadad量表结合Schulz隐蔽分组评价方法对随机对照研究的质量进行评价。两组人员独立对研究方法详读综合后进行数据提取。采用RevMan 5.1软件进行Meta分析，研究ω-3脂肪酸乳剂对手术后患者感染并发症发生率、病死率、术后住院时间和术后ICU入住时间的影响。结果 共检索到320篇相关文献，大致符合计划要求的有22篇文献，排除数据重复、抄袭和无法获得方法学资料的文摘，最终纳入17个随机对照研究，合计1213例患者。Meta分析结果显示：ω-3脂肪酸乳剂干预能降低患者手术后感染并发症发生率[RR=0.44,95％CI (0.30，0.64)，P＜0.0001]，减少住院时间[MD=-1.65,95％CI（-2.72，-0.58），P=0.003]，对术后ICU入住时间无影响[MD=-0.31,95％CI（-1.20，0.58），P=0.500]。结论 适当剂量和一定干预时间的ω-3脂肪酸乳剂能降低手术后患者感染并发症发生率和减少住院时间。今后需要更多样本量较大、质量较高的随机对照研究，观察ω-3脂肪酸乳剂干预对手术后患者临床结局和成本一效果的影响。

Impact of short-term omega-3 fatty acids supplementation on clinical outcomes in postoperative patients with parenteral nutrition support: a Meta-analysis of randomized controlled trials

Objective To evaluate the impact of omega-3 fatty acids intervention on clinical outcomes in postoperative patients with parenteral nutrition (PN). Methods Literatures relating to the evaluation of the clinical outcomes after supplementation with omega-3 fatty acids after selective surgeries were searched in databases including PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases, China National Knowledge Infrastructure, and Wanfang Database etc. All the eligible studies were randomized controlled trials and their results were published from January 1996 to June 2010. The methodological quality was assessed using Jadad scale, Schulz allocation concealment tool, and methodology review. Meta analysis was conducted using RevMan 5.1 software. The impact was described in terms of complications of infection, case-fatality rate, length of postoperative hospital stay, and length of postoperative ICU stay. Results Totally 320 articles were found and 17 randomized controlled trials ( n =1213 ) entered final meta analysis study. The results showed a significant decrease in the infectious complication rates of postoperative patients receiving omega-3 fatty acids intervention [risk ratio (RR) =0.44, 95％ confidence interval (CI) (0.30, 0.64), P ＜0.0001] ; meanwhile, the length of hospital stay was significantly shortened [mean difference (MD) =- 1.65 ; 95％ CI ( - 2.72, - 0.58), P =0.003]. However,the length of ICU stay showed no significant difference [MD =-0.31,95％ CI ( - 1.20, 0.58), P =0.500].Conclusion Omega-3 fatty acids interventions can benefit postoperative patients by reducing the morbidity of postoperative infectious complications and shortening the length of hospital stay.