脑出血患者术后实施不同肠内营养治疗效果的荟萃分析

发布时间：2018-02-22 12:16

本文关键词： 脑出血肠内营养制剂混合流食白蛋白荟萃分析　出处：《东南大学学报(医学版)》2017年03期 　论文类型：期刊论文

【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Pub Med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Rev Man 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,P0.000 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,P0.000 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。
[Abstract]:Objective: to systematically evaluate the therapeutic effect of enteral nutrition preparation on patients with intracerebral hemorrhage after operation. Methods: to search the database of CNKIV VIPCBM, Wanfang Medical Network and Pub Med, and search the spontaneous cerebral exudation published from the establishment of each database to May 2016. A randomized controlled trial of different enteral nutrition therapy for blood patients after operation. A total of 187 documents were screened in strict accordance with the inclusion and exclusion criteria, and the bias risk assessment tool recommended by Cochrane Collaborative Network was used to evaluate the bias risk of the literature. Data were recorded into Rev Man 5.3 software for Meta analysis. Results: ten randomized controlled trials were carried out. The results of meta-analysis showed that enteral nutrition preparations were used in early postoperative patients with intracerebral hemorrhage. It can increase the postoperative serum albumin, ALB, 95, CI = 4.06 / 7.20, P = 0.00001, whole blood hemoglobin / MDM (combined with 12.2795 CI = 4.62n 19.91C = 4.62n 19.91C = 3.14P0.002), increase body weight value (combined with 7.19 / 95CI = 3.42n / 95 / CI = 3.42n / 910.96P0.0002 / 2), reduce the incidence of diarrhea and reduce the incidence of diarrhea / diarrhea (0.33695 CI = 0.33666Z4.29P0.0001) and 0.50rr = 0.350.73Z3.5P0.0000.000 respectively. There was no significant difference in total lymphocyte count between the two groups. Conclusion: the current research evidence supports the early application of enteral nutrition preparation in patients with spontaneous intracerebral hemorrhage, which can improve the nutritional status and increase the weight of patients with spontaneous intracerebral hemorrhage. The effect of reducing diarrhea incidence and mortality was better than that of mixed feeding, but since the risk of bias was higher and the number was less, the above conclusions still needed more centers, and the randomized controlled trials with low risk of bias should be confirmed.
【作者单位】：承德医学院附属医院营养科;承德医学院附属医院神经外科;
【基金】：2014年承德市科技支撑计划项目(201422029)
【分类号】：R459.3;R651.12

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