【摘要】 目的:系统评价经小肠内营养和胃内营养对呼吸机相关性肺炎(VAP)的影响。方法:计算机检索数据库Cochrane Library、MEDLINE、EMBASE、ISI、CBM、VIP、CNKI和Wan Fang Data,搜集从建库至2015年2月关于胃内营养与小肠内营养对VAP随机对照试验(RCT),并对纳入研究的参考文献进行手工检索。由2名研究者独立进行文献质量评价和资料提取,采用Rev Man 5.3软件进行Meta分析,使用GRADEpro 3.6.1软件对结果证据进行评价分级。结果:纳入8个英文和9个中文RCT共1 241例病人。Meta分析结果显示,两组病人VAP的患病率[RR=0.55,95%CI(0.46~0.67),P<0.000 01]、机械通气时间[MD=-3.69,95%CI(-5.98~-1.41),P=0.002]和入住ICU天数[MD=-2.89,95%CI(-5.00~-0.78),P=0.007]差异均有显著性统计学意义,而ICU病死率[(RR=0.99,95%CI(0.74~1.33),P=0.95]则无统计学差异。漏斗图显示,纳入研究文献无发表偏倚,VAP患病率,ICU病死率结果证据质量为高证据等级,机械通气时间,入住ICU天数结果证据质量为中等级。结论:证据表明,小肠内营养与胃内营养相比,能降低VAP的患病率,缩短机械通气时间和入住ICU的天数,而对病死率则无影响。更多还原

【Abstract】 Objective: We performed a systematic review of randomized controlled trials evaluating the influence of the stomach or small intestine of the delivery of enteral nutrition ways on ventilatorassociated pneumonia. Methods: Data sources were originated in Cochrane Library, Medline,EMBASE,Ovid CBM,VIP,CNKI,WANFANG data. The study included randomized controlled trials about enteral feeding of the patients with ventilator. Results: There were 17 randomized controlled trials.The incidence of ventilator associated pneumonia rate [RR = 0. 55,95% CI( 0. 46 ~ 0. 67),P <0. 000 01],mechanical ventilation time [MD =- 3. 69,95% CI(- 5. 98 ~- 1. 41),P = 0. 002],and duration of ICU Stay [MD =-2. 89,95% CI(- 5. 00 ~- 0. 78),P = 0. 007]were significantly different between two groups,but ICU mortality rate [RR = 0. 99,95%( 0. 74 ~ 1. 33),P = 0. 95]were not significantly different. Conclusion: The current evidence shows that ventilator-associated pneumonia rate,ventilation day,and length of ICU stay were significantly different between two groups,and ICU mortality rate was not significantly different between two groups.更多还原