肠内营养和全胃肠外营养治疗重症急性胰腺炎疗效的荟萃分析

背景：营养支持是重症急性胰腺炎（SAP）的重要治疗措施,然而目前对选择肠内营养（EN）或全胃肠外营养（TPN）治疗SAP仍存在争议.目的：系统性评价EN和TPN治疗SAP/预期SAP患者的临床效果.方法：检索MEDLINE、EMBASE、Cochrane图书馆、万方数据资源系统和中国期刊网（1966年1月～2010年4月）,纳人有关EN和TPN治疗的随机对照试验（RCT）.2名评价者对入选研究的试验设计、研究对象特征、研究结果等内容进行独立摘录,并应用RevMan 4.2软件进行荟萃分析.结果：共纳入14项RCT,包括701例患者.与TPN相比,EN能显著降低感染率（RR=0.43,95%CI：0.28～0.66,P〈0.0001）、外科干预率（RR=0.45,95%CI：0.29～0.70,P=0.0004）、器官衰竭率（RR=0.45,95%CI：0.26～0.78,P=0.004）和死亡率（RR=0.37,95% CI：0.23～0.58,P〈0.0001）.结论：EN治疗SAP优于TPN,若无EN禁忌症,应优先选择EN.

A Meta-analysis of Efficacy of Enteral Nutrition and Total Parenteral Nutrition in Patients with Severe Acute Pancreatitis

Background： Nutrition support is an important treatment measure for severe acute pancreatitis （SAP）, however, there are still debates on which should be used in SAP, enteral nutrition （EN） or total parenteral nutrition （TPN）. Aims： To systematically evaluate the clinical efficacy of EN and TPN on patients with SAP/predicted SAP. Methods： Randomized controlled trials （RCT） comparing EN and TPN were searched in MEDLINE, EMBASE, Cochrane Library, Wanfang Data and China Journal Net from January 1966 to April 2010. Data concerning study design, patient characteristics and outcomes were extracted by two authors independently. Meta-analysis was conducted using RevMan 4.2 software. Results： Fourteen RCT involving 701 patients were included. Compared with TPN, EN was associated with significantly lower incidences of infection （RR=0.43, 95% Ch 0.28-0.66, P〈0.0001）, surgical intervention （RR= 0.45, 95% Ch 0.29-0.70, P=0.0004）, organ failure （RR=0.45, 95% Ch 0.26-0.78, P=0.004） and mortality （RR=0.37, 95% Ch 0.23-0.58, P〈0.0001）. Conclusions： EN is better than TPN in treating patients with SAP. EN should be used preferentially in the absence of contraindications.