混合营养与肠外营养对食管癌术后患者临床疗效比较的Meta分析
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摘要
目的:系统评价混合营养(MN)与肠外营养(PN)支持对食管癌术后患者的临床疗效。方法:计算机检索英文数据库PubMed、EMbase、The Cochrane Library;中文数据库中国知网、维普、万方等,查找关于MN对比PN支持的食管癌术后患者的随机对照试验(RCT),检索时限截至2018年5月。由2位研究者按标准独立筛选文献、提取资料并评价偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入15个RCT,共1 514例患者。Meta分析结果显示:与PN相比,MN能提高食管癌患者术后白蛋白、前白蛋白、转铁蛋白水平,缩短术后肛门恢复排气时间、住院时间,降低肺部感染和切口感染的发生率;但吻合口瘘的发生率、消化道症状发生率,两组差异无统计学意义(P>0.05)。结论:与PN相比,MN能提高食管癌术后患者的营养状况,降低并发症的发生率。
Objective: To evaluate the clinical efficacy of multi-nutrition(MN) and parenteral nutrition(PN) for perioperative esophagus cancer patients by meta-analysis. Methods: Published randomized controlled trials(RCTs) on comparison between MN and PN for esophagus cancer patients after esophagectomy were retrieved by searching PubMed,EMbase, the Cochrane Library, Web of Science, WanFang Data and CNKI. The retrieval period was from the database construction to May 31, 2018. Two reviewers independently screened literature based on the inclusion and exclusion criteria,extracted data and evaluated bias risks of included studies. Then meta-analysis was performed by using the RevMan 5.3 software. Results: Data from 15 RCTs with 1514 patients were included in this meta-analysis. The results showed that MN could improve postoperative levels of albumin, prealbumin and transferrin compared with PN. Furthermore, the restore time of anal exhaust and postoperative hospital staying were declined with MN. The incidences of pulmonary infection and wound infection after surgery were also decreased with MN. However, there was no significant difference in incidence of anastomotic leakage and gastrointestinal symptoms between the two groups. Conclusion: MN could extensively improve the nutritional level of esophageal cancer patients after esophagectomy, and reduce the incidence of postoperative complications.
Objective: To evaluate the clinical efficacy of multi-nutrition(MN) and parenteral nutrition(PN) for perioperative esophagus cancer patients by meta-analysis. Methods: Published randomized controlled trials(RCTs) on comparison between MN and PN for esophagus cancer patients after esophagectomy were retrieved by searching PubMed,EMbase, the Cochrane Library, Web of Science, WanFang Data and CNKI. The retrieval period was from the database construction to May 31, 2018. Two reviewers independently screened literature based on the inclusion and exclusion criteria,extracted data and evaluated bias risks of included studies. Then meta-analysis was performed by using the RevMan 5.3 software. Results: Data from 15 RCTs with 1514 patients were included in this meta-analysis. The results showed that MN could improve postoperative levels of albumin, prealbumin and transferrin compared with PN. Furthermore, the restore time of anal exhaust and postoperative hospital staying were declined with MN. The incidences of pulmonary infection and wound infection after surgery were also decreased with MN. However, there was no significant difference in incidence of anastomotic leakage and gastrointestinal symptoms between the two groups. Conclusion: MN could extensively improve the nutritional level of esophageal cancer patients after esophagectomy, and reduce the incidence of postoperative complications.
引文
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[23]周飞燕,许勤,陈丽,等.胃癌病人术后早期肠内营养喂养不足及其原因的调查分析[J].肠外与肠内营养,2012,19(1):59-61.
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[26] Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients:frequency,risk factors, and complications[J]. Crit Care Med, 2001, 29(10):1955-61.
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[29] Tomoko T, Hiroya T, Masaharu O, et al. A Prospective Randomized Trial of Enteral Nutrition AfterThoracoscopicEsophagectomy for Esophageal Cancer[J]. Ann Surg Oncol, 2015, 22(3):802-9.
[30] Png J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis[J]. Dis Esophagus, 2016, 29(4):333-41.
[2] Allemann P, Mantziari S, Wagner D, et al. Curative treatment for esophageal cancer:results of a multidisciplinary consensus[J]. Rev Med Suisse, 2016, 12(523):1165-9.
[3] Bozzetti F, Mariani L, Lo Vullo S, et al. The nutritional risk in oncology:a study of 1,453 cancer outpatients[J]. Support Care Cancer, 2012, 20(8):1919-28.
[4]韩东景,赵楠,李伟,等.食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查[J].临床应用研究,2013,20(16):1274-8.
[5]刘清航,胡伟.肠内营养联合肠外营养对食管癌患者术后营养状况及免疫功能的影响[J].河南医学研究,2018,27(2):219-21.
[6]卓宜盟,王瑞华,李忠,等.食管癌术后早期肠内、外配合营养支持治疗的临床研究[J].国际医药卫生导报,2017,23(3):332-5.
[7]王若琰,沈淑仪.食管癌术后早期肠内营养结合肠外营养的临床效果观察[J].中西医结合护理(中英文),2016,2(7):20-1+24.
[8]龙晓静,孙德强,曾英,等.食管癌术后早期肠内营养联合肠外营养与全肠外营养支持的临床疗效比较[J].中国医药导报,2016,13(5):126-9.
[9]梁吉振,任云,宫心明.早期肠内营养联合肠外营养对食管癌患者术后营养状况及生活质量的影响[J].安徽医学,2018,39(1):110-2.
[10]侯伟.早期肠外营养联合肠内营养对食管癌根治术病人恢复的效果观察[J].全科护理,2016,14(3):300-1.
[11]杨栋,胡雯,杜继宇,等.老年食管癌患者术后不同营养支持方式临床结局的比较[J].中华老年多器官疾病杂志,2017,16(12):894-7.
[12]张吉帅.食管癌术后早期序贯肠内营养的临床评价[D].泰山医学院,2014.
[13]吴志军,林霞,项应明,等.肠内营养对食管癌手术患者营养状况和胃肠道耐受性的影响[J].中国中西医结合消化杂志,2016,24(4):311-3.
[14]华军,薛永生,吴伟.肠内营养制剂瑞能对食管癌手术患者的免疫调理[J].南京医科大学学报(自然科学版),2010,30(11):1664-6.
[15]张连杰.三种营养方式对老年食管癌患者术后早期康复的效果观察[D].吉林大学,2012.
[16]于红.三种不同营养方式在老年食管癌患者术后早期康复中应用效果[J].实用临床医药杂志,2016,20(2):161-2.
[17]郭明发.食管癌病人术后早期肠内营养的疗效观察[J].肠外与肠内营养,2011,18(4):218-20+224.
[18]张毅,谭黎杰,钱成,等.食管癌病人术后早期肠内营养支持的作用[J].肠外与肠内营养,2007,14(5):282-5.
[19]谢家勇,刘胜中,丛伟,等.食管癌术后早期肠内外混合营养价值的临床研究[J].四川医学,2012,33(4):613-5.
[20]林桦,李永辉.食道癌术后早期应用肠内营养的临床观察[J].中国临床营养杂志,2002,10(2):122-4.
[21]朱万坤,姜一真.术后早期肠内营养支持的应用[J].西北国防医学杂志,2001,22(1):68-9.
[22]徐亮,魏仁志,庞明辉,等.胃肠手术后早期肠内营养的临床研究[J].泸州医学院学报,2002,25(2):100-3.
[23]周飞燕,许勤,陈丽,等.胃癌病人术后早期肠内营养喂养不足及其原因的调查分析[J].肠外与肠内营养,2012,19(1):59-61.
[24]于健春.序贯疗法优化手术后早期肠内营养[J].中华临床营养杂志,2011,19(3):140-3.
[25]康维明,于健春,马志强,等.胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床随机对照研究[J].中华临床营养杂志,2011,19(3):148-53.
[26] Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients:frequency,risk factors, and complications[J]. Crit Care Med, 2001, 29(10):1955-61.
[27] Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition[J]. Clin Nutr, 2017,36(1):49-64.
[28] Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer[J]. Eur Surg Res, 2012,48(2):79-84.
[29] Tomoko T, Hiroya T, Masaharu O, et al. A Prospective Randomized Trial of Enteral Nutrition AfterThoracoscopicEsophagectomy for Esophageal Cancer[J]. Ann Surg Oncol, 2015, 22(3):802-9.
[30] Png J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis[J]. Dis Esophagus, 2016, 29(4):333-41.