本文關(guān)鍵詞： 腦出血 腸內(nèi)營(yíng)養(yǎng)制劑 混合流食 白蛋白 薈萃分析　出處：《東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年03期 　論文類(lèi)型：期刊論文

【摘要】：目的:系統(tǒng)評(píng)價(jià)腦出血患者術(shù)后應(yīng)用腸內(nèi)營(yíng)養(yǎng)制劑的治療效果。方法:檢索CNKI、VIP、CBM、萬(wàn)方醫(yī)學(xué)網(wǎng)及Pub Med數(shù)據(jù)庫(kù)。檢索自各數(shù)據(jù)庫(kù)建立開(kāi)始至2016年5月發(fā)表的自發(fā)性腦出血患者術(shù)后給予不同腸內(nèi)營(yíng)養(yǎng)治療的隨機(jī)對(duì)照試驗(yàn),共187個(gè)。雙人按照文獻(xiàn)納入與排除標(biāo)準(zhǔn)嚴(yán)格篩選,使用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險(xiǎn)評(píng)估工具對(duì)文獻(xiàn)進(jìn)行偏倚風(fēng)險(xiǎn)評(píng)價(jià),數(shù)據(jù)錄入Rev Man 5.3軟件中進(jìn)行Meta分析。結(jié)果:最終納入10個(gè)隨機(jī)對(duì)照試驗(yàn),共953例患者。Meta分析結(jié)果示:腦出血患者術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)制劑,能夠升高患者術(shù)后血清白蛋白(ALB)(MD合并=5.63,95%CI為4.06~7.20,Z=7.03,P0.000 01)、全血血紅蛋白(MD_(合并)=12.27,95%CI為4.62~19.91,Z=3.14,P=0.002)值,增長(zhǎng)體重值(MD_(合并)=7.19,95%CI為3.42~10.96,Z=3.74,P=0.000 2),降低腹瀉發(fā)生率(RR合并=0.46,95%CI為0.33~0.66,Z=4.29,P0.000 1)和死亡率(RR合并=0.50,95%CI為0.34~0.73);Z=3.56,P=0.000 4]。實(shí)施干預(yù)后,兩組患者血總淋巴細(xì)胞計(jì)數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義(MD_(合并)=0.61,95%CI為-0.13~1.35,Z=1.61,P=0.11)。結(jié)論:目前的研究證據(jù)支持自發(fā)性腦出血患者術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)制劑,在改善術(shù)后營(yíng)養(yǎng)狀況、增加體重、降低腹瀉發(fā)生率及死亡率等方面比混合流食效果更好。但由于納入文獻(xiàn)偏倚風(fēng)險(xiǎn)較高,數(shù)量較少,上述結(jié)論仍需更多多中心、低偏倚風(fēng)險(xiǎn)的隨機(jī)對(duì)照試驗(yàn)加以證實(shí)。
[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.
【作者單位】： 承德醫(yī)學(xué)院附屬醫(yī)院營(yíng)養(yǎng)科;承德醫(yī)學(xué)院附屬醫(yī)院神經(jīng)外科;
【基金】：2014年承德市科技支撐計(jì)劃項(xiàng)目(201422029)
【分類(lèi)號(hào)】：R459.3;R651.12

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