摘要
目的评价低热量和/或低氮肠外营养对外科重症患者预后和费用的影响。方法检索中国生物医学文献数据库、Cochrane图书馆、Medline光盘数据库,鉴定有关随机对照试验(RCTs),采用RevMan4.1进行Meta分析。结果纳入6个研究。不同热卡肠外营养(PN)比较,低热卡组死亡率和感染率的OR分别为2.14和0.36,95%CI为犤0.32,3.73犦(P=0.3)和犤0.16,0.80犦(P=0.01);低热卡PN使一个患者避免感染所需要治疗的患者数(NNTb)为5。与对照组比较,低热卡组血糖和住院时间的加权均数差值分别为-36.25和-0.32,95%CI为犤-47.19,-25.85犦(P<0.00001)和犤-6.21,5.57犦(P=0.9)。仅1个研究比较了低氮低热卡PN和葡萄糖输注对患者预后的影响,两组在终点指标方面无差异。结论外科术后和危重症患者,低热卡PN支持较“标准”热量摄入能更好控制血糖,有可能减少感染相关并发症,并有缩短住院时间的倾向。但尚无直接证据表明,低氮PN对改善手术患者临床结局有益。此外,迄今未有研究对低热卡或/和低氮PN的经济学价值进行分析。
Objective To examine the relationship between low nitrogen and/or hypocalori c parenteral nutrition and the outcome of the surgical or the critically illed patients.Methods Following electronic databases were searched:MEDLINE,EMBASE ,SCI,Cochrane Library and Chinese Biomedicine database.Data were extracted by two reviewers.Applied RevMan4.1for statistical analyse.Results We review ed sixty-five titles,abstracts and papers,six trials met all the included crit eria.When the data of these trials were aggregated,the results showed there wa s no significant different exist on mortality between hypocaloric and standard PN(odds ratio2.14,95%CI 0.32,3.73P=0.3).The infec tious complications were lower in hypocaloric PN(Odds ratio0.36,95%CI 0.16,0.80,P=0.01).Compared with standard intervention,the weighted mean difference of blood glucose and hospitalization of hypocaloric PN are-36.25(95%CI-6242.79,-873.05,P<0.0000 1),-0.32(95%CI-6.21,5.57,P=0.9)respectively). Only one study compared the formula contents both low calorie and nitrogen PN wi th dextrose intravenously.There was no significant difference on outcomes betw een these two interventions.Conclusions In the surgical and critically illned patients, hypocaloric parenteral nutrition might have benefit on blood glucose contro l,decreasing the inf ectious complications events,and shorten the period of ho spitalization.Although there was no direct evidence to prove the outcome benef its of low nitrogen PN in post operative patient.So far no study analyzed the c ost between two groups.
出处
《中国临床营养杂志》
2003年第1期19-23,共5页
Chinese Journal of Clinical Nutrition
基金
中国循证医学中心(200121)资助
关键词
低热卡
低氮
肠外营养
术后
影响
随机对照研究
系统评价
hypocaloric
low nitrogen
parenteral nutr it ion
Meta-analysis
Evidence-based Medicine
