Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis: a Meta-analysis

doi:10.12114/j.issn.1007-9572.2021.02.077

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (24): 3057-3064.DOI: 10.12114/j.issn.1007-9572.2021.02.077

Special Issue: 胰腺炎最新文章合辑；营养最新文章合辑

• Evidence-based Medicine • Previous Articles Next Articles

Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis: a Meta-analysis

¹Nantong Hospital Affiliated to Nanjing University of Chinese Medicine/Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, China
²Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine, Nanjing 210000, China

Received:2021-10-13 Revised:2022-03-16 Published:2022-08-20 Online:2022-05-26
Contact: Guanwen GONG
About author:
WANG Q Q, ZHOU J, JIANG Z W, et al. Efficacy of enteral nutrition within 24 hours of admission in severe acute pancreatitis: a Meta-analysis[J]. Chinese General Practice, 2022, 25 (24) : 3057-3064.

入院24小时内肠内营养治疗重症急性胰腺炎疗效的Meta分析

¹226000　江苏省南通市，南京中医药大学南通附属医院　南通市中医院
²210000　江苏省南京市，南京中医药大学附属医院　江苏省中医院

通讯作者: 龚冠闻
作者简介:
王倩倩，周健，江志伟，等.入院24小时内肠内营养治疗重症急性胰腺炎疗效的Meta分析[J].中国全科医学，2022，25（24）：3057-3064. [www.chinagp.net] 作者贡献：王倩倩负责文章的构思与研究的设计、数据/资料收集和整理、论文撰写与修订；周健、江志伟负责整理数据，指导研究过程中出现的技术问题；龚冠闻负责研究的实施与可行性分析、文章的质量控制及审校，并对文章整体负责。
基金资助:
国家自然科学基金资助项目(81704083)

Abstract

Abstract:

Background

Enteral nutrition (EN) is one important clinical treatment for severe acute pancreatitis (SAP) , but the optimal timing of initiation remains controversial.

Objective

To evaluate the efficacy of EN within 24 hours of admission in the treatment of SAP by applying a Meta-analysis.

Methods

Databases of PubMed, EMBase, the Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data and SinoMed were searched to identify randomized controlled trials (RCTs) about efficacies of usual care and EN within 24 hours of admission (experimental group) versus usual care in combination with EN or oral eating after 24 hours of admission or parenteral nutrition immediately after admission (control group) in SAP patients included from inception to July 2021. Meta-analysis was performed using RevMan 5.4 software.

Results

A total of 13 RCTs involving 1 193 patients were included. Meta-analysis results revealed that, compared to usual care with control interventions, usual care with EN within 24 hours of admission had better effects on reducing the mortality〔RR=0.61, 95%CI (0.39, 0.95) , P=0.03〕, incidence of multiple organ dysfunction syndrome (MODS) 〔RR=0.56, 95%CI (0.36, 0.86) , P=0.009〕and incidence of pancreatic infections〔RR=0.55, 95%CI (0.33, 0.91) , P=0.02〕, and post-treatment APACHE Ⅱ score〔MD=-2.18, 95%CI (-2.55, -1.80) , P<0.000 01〕. Further subgroup analysis indicated that, usual care with EN within 24 hours of admission was superior to usual care with parenteral nutrition immediately after admission in decreasing the mortality〔RR=0.28, 95%CI (0.11, 0.73) , P=0.009〕, incidence of MODS〔RR=0.40, 95%CI (0.20, 0.79) , P=0.009〕and pancreatic infections〔RR=0.50, 95%CI (0.25, 0.98) , P=0.04〕.

Conclusion

Available evidence showed that, EN within 24 hours of admission had better efficacy for SAP, and initiating EN within 24 hours of admission may be beneficial to the treatment of SAP.

Key words: Pancreatitis, Enteral nutrition, Parenteral nutrition, Severe acute pancreatitis, Meta-analysis, Systematic review, Randomized controlled trial

摘要：

背景

肠内营养是临床治疗重症急性胰腺炎（SAP）的重要手段之一，但其最佳启动时机尚存在争议。

目的

通过Meta分析方法评价入院24 h内肠内营养治疗SAP的疗效。

方法

计算机检索PubMed、EMBase、the Cochrane Library、Web of Science、中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统，筛选关于入院24 h内肠内营养治疗SAP疗效的随机对照试验（RCT），检索时限均为建库至2021年7月。在常规治疗基础上，试验组患者入院24 h内进行肠内营养，对照组患者入院24 h后进行肠内营养或经口饮食，或入院后直接进行肠外营养。采用RevMan 5.4软件进行Meta分析。

结果

最终纳入13项RCT，包含1 193例患者。Meta分析结果显示，试验组患者病死率〔RR=0.61，95%CI（0.39，0.95），P=0.03〕、多器官功能障碍综合征（MODS）发生率〔RR=0.56，95%CI（0.36，0.86），P=0.009〕、胰腺感染发生率〔RR=0.55，95%CI（0.33，0.91），P=0.02〕、治疗后急性生理学及慢性健康状况评价系统Ⅱ（APACHE Ⅱ）评分〔MD=-2.18，95%CI（-2.55，-1.80），P<0.000 01〕低于对照组。亚组分析结果显示，对照组患者干预措施为入院后直接进行肠外营养时，试验组患者病死率〔RR=0.28，95%CI（0.11，0.73），P=0.009〕、MODS发生率〔RR=0.40，95%CI（0.20，0.79），P=0.009〕、胰腺感染发生率〔RR=0.50，95%CI（0.25，0.98），P=0.04〕低于对照组。

结论

当前研究证据表明入院24 h内肠内营养治疗SAP疗效较好，入院24 h内启动肠内营养对SAP的治疗是有益的。

关键词: 胰腺炎, 肠道营养, 胃肠外营养, 重症急性胰腺炎, Meta分析, 系统评价, 随机对照试验

Qianqian WANG,Jian ZHOU,Zhiwei JIANG, et al. Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis: a Meta-analysis[J]. Chinese General Practice, 2022, 25(24): 3057-3064. DOI: 10.12114/j.issn.1007-9572.2021.02.077.
王倩倩,周健,江志伟等. 入院24小时内肠内营养治疗重症急性胰腺炎疗效的Meta分析[J]. 中国全科医学, 2022, 25(24): 3057-3064. DOI: 10.12114/j.issn.1007-9572.2021.02.077.

Figures/Tables 8

References 52

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序号	检索策略
#1	Randomized Controlled Trial[Publication Type]
#2	Controlled Clinical Trial[Publication Type]
#3	randomized[Title/Abstract]
#4	placebo[Title/Abstract]
#5	drug therapy[Subheading]
#6	randomly[Title/Abstract]
#7	trial[Title/Abstract]
#8	groups[Title/Abstract]
#9	OR #1-#8
#10	（Animals[Mesh]）NOT Humans[Mesh]
#11	#9 NOT #10
#12	Pancreatitis[Mesh]
# 13	severe acute pancreatitis[Title/Abstract]
#14	predicted severe acute pancreatitis[Title/Abstract]
#15	SAP[Title/Abstract]
#16	pSAP[Title/Abstract]
#17	acute severe pancreatitis[Title/Abstract]
#18	predicted acute severe pancreatitis[Title/Abstract]
#19	OR #12-#18
#20	Enteral Nutrition[Mesh]
#21	enteral nutrition[Title/Abstract]
#22	enteral feeding[Title/Abstract]
#23	tube feeding[Title/Abstract]
#24	artificial feeding[Title/Abstract]
#25	nasogastric[Title/Abstract]
#26	nasojejunal[Title/Abstract]
#27	OR #20-#26
#28	#19 And #27
#29	#11 And #28

序号	检索策略
#1	Randomized Controlled Trial[Publication Type]
#2	Controlled Clinical Trial[Publication Type]
#3	randomized[Title/Abstract]
#4	placebo[Title/Abstract]
#5	drug therapy[Subheading]
#6	randomly[Title/Abstract]
#7	trial[Title/Abstract]
#8	groups[Title/Abstract]
#9	OR #1-#8
#10	（Animals[Mesh]）NOT Humans[Mesh]
#11	#9 NOT #10
#12	Pancreatitis[Mesh]
# 13	severe acute pancreatitis[Title/Abstract]
#14	predicted severe acute pancreatitis[Title/Abstract]
#15	SAP[Title/Abstract]
#16	pSAP[Title/Abstract]
#17	acute severe pancreatitis[Title/Abstract]
#18	predicted acute severe pancreatitis[Title/Abstract]
#19	OR #12-#18
#20	Enteral Nutrition[Mesh]
#21	enteral nutrition[Title/Abstract]
#22	enteral feeding[Title/Abstract]
#23	tube feeding[Title/Abstract]
#24	artificial feeding[Title/Abstract]
#25	nasogastric[Title/Abstract]
#26	nasojejunal[Title/Abstract]
#27	OR #20-#26
#28	#19 And #27
#29	#11 And #28

第一作者	发表年份	例数（对照组/试验组）	性别（男/女）		年龄（岁）		干预措施		结局指标
第一作者	发表年份	例数（对照组/试验组）	对照组	试验组	对照组	试验组	对照组	试验组	结局指标
许健^[15]	2018	29/26	14/15	14/12	40.8±2.1	41.5±2.6	入院24~72 h给予鼻肠管营养	入院24 h内给予鼻肠管营养	①②
姚红兵^[16]	2014	32/32	17/15	18/14	35.2±5.5	35.8±6.2	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
王颖^[17]	2021	30/30	15/15	14/16	49.2±9.8	49.2±8.9	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	②④
陈远忠^[18]	2019	40/40	29/11	28/12	48.5±3.8	48.3±3.3	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
WANG^[19]	2021	63/64	40/23	38/26	47.3±9.9	46.4±9.7	入院72 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
STIMAC^[20]	2016	107/107	57/50	53/54	26.0~90.0	28.0~88.0	入院第3天给予经口饮食	入院24 h内给予鼻肠管营养	①②
BAKKER^[21]	2014	104/101	59/45	55/46	65.0±15.0	65.0±16.0	入院72 h后给予经口饮食	入院24 h内给予鼻肠管营养	①②③
张弛^[22]	2020	50/50	27/23	29/21	45.2±8.9	45.6±8.5	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	②
LOUIE^[23]	2005	18/10	9/9	6/4	59.0±15.3	65.3±18.3	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①③
ECKERWALL^[24]	2006	25/23	—	—	60.0~80.0	58.0~80.0	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①②③
PETROV^[25]	2006	34/35	24/10	27/8	41.0~70.0	42.0~67.0	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①②③
GUPTA^[26]	2003	9/8	3/6	4/4	38.0~86.0	56.0~89.0	入院后直接进行肠外营养	入院24 h内给予鼻肠管营养	①
刘广裕^[27]	2016	63/63	—	—	44.2±0.7	42.5±1.9	入院后直接进行肠外营养	入院24 h内给予鼻肠管营养	①

第一作者	发表年份	例数（对照组/试验组）	性别（男/女）		年龄（岁）		干预措施		结局指标
第一作者	发表年份	例数（对照组/试验组）	对照组	试验组	对照组	试验组	对照组	试验组	结局指标
许健^[15]	2018	29/26	14/15	14/12	40.8±2.1	41.5±2.6	入院24~72 h给予鼻肠管营养	入院24 h内给予鼻肠管营养	①②
姚红兵^[16]	2014	32/32	17/15	18/14	35.2±5.5	35.8±6.2	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
王颖^[17]	2021	30/30	15/15	14/16	49.2±9.8	49.2±8.9	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	②④
陈远忠^[18]	2019	40/40	29/11	28/12	48.5±3.8	48.3±3.3	入院48 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
WANG^[19]	2021	63/64	40/23	38/26	47.3±9.9	46.4±9.7	入院72 h后给予鼻肠管营养	入院24 h内给予鼻肠管营养	④
STIMAC^[20]	2016	107/107	57/50	53/54	26.0~90.0	28.0~88.0	入院第3天给予经口饮食	入院24 h内给予鼻肠管营养	①②
BAKKER^[21]	2014	104/101	59/45	55/46	65.0±15.0	65.0±16.0	入院72 h后给予经口饮食	入院24 h内给予鼻肠管营养	①②③
张弛^[22]	2020	50/50	27/23	29/21	45.2±8.9	45.6±8.5	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	②
LOUIE^[23]	2005	18/10	9/9	6/4	59.0±15.3	65.3±18.3	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①③
ECKERWALL^[24]	2006	25/23	—	—	60.0~80.0	58.0~80.0	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①②③
PETROV^[25]	2006	34/35	24/10	27/8	41.0~70.0	42.0~67.0	入院24 h内给予肠外营养	入院24 h内给予鼻肠管营养	①②③
GUPTA^[26]	2003	9/8	3/6	4/4	38.0~86.0	56.0~89.0	入院后直接进行肠外营养	入院24 h内给予鼻肠管营养	①
刘广裕^[27]	2016	63/63	—	—	44.2±0.7	42.5±1.9	入院后直接进行肠外营养	入院24 h内给予鼻肠管营养	①

第一作者	随机方法	结局测量者盲	患者盲、医生盲	分配隐藏	结果数据完整性	选择性报告研究结果	其他偏倚来源
许健^[15]	不清楚	不清楚	无	不清楚	完整	否	不清楚
姚红兵^[16]	不清楚	不清楚	无	不清楚	完整	否	不清楚
王颖^[17]	不清楚	不清楚	无	不清楚	完整	否	不清楚
陈远忠^[18]	不清楚	不清楚	无	不清楚	完整	否	不清楚
WANG^[19]	不清楚	不清楚	无	不清楚	完整	否	不清楚
STIMAC^[20]	计算机	不清楚	无	中心随机	完整	否	不清楚
BAKKER^[21]	计算机	是	无	中心随机	完整	否	不清楚
张弛^[22]	随机数字表	不清楚	无	不清楚	完整	否	不清楚
LOUIE^[23]	计算机	不清楚	无	密封信封	完整	否	不清楚
ECKERWALL^[24]	不清楚	无	无	密封信封	完整	否	不清楚
PETROV^[25]	计算机	不清楚	无	不清楚	完整	否	不清楚
GUPTA^[26]	不清楚	不清楚	无	密封信封	完整	否	Nutricia资助
刘广裕^[27]	就诊顺序	不清楚	无	不清楚	完整	否	不清楚

Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis: a Meta-analysis

入院24小时内肠内营养治疗重症急性胰腺炎疗效的Meta分析

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