添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局影响的Meta分析

Meta-analysis of effects of early enteral nutrition supplemented with probiotics on clinical outcomes in patients with severe head injury

摘要:

目的：评价添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局的影响。方法：电子检索PubMed、Cochrane Central Register of Controlled Trials（CENTRAL）、中国知网（China National Knowledge Infrastructure，CNKI）、万方及中国生物医学文献数据库（Chinese Biomedical Literature Database，CBM）中有关添加益生菌的早期肠内营养对重型颅脑损伤患者临床结局影响的随机对照研究，并手工检索合格研究及主题相关综述的参考文献。2位研究者独立筛查文献、提取资料、评价合格研究的偏倚风险后，采用STATA 12.0软件行Meta分析。结果：纳入18篇合格文献，包括研究对象1 016人。Meta分析表明，益生菌组患者的感染风险低于对照组人群（RR=0.53，96%CI=0.44～0.65，P=0.000）；益生菌组患者的死亡风险低于对照组人群（RR=0.56，96%CI=0.38～0.82，P=0.003）；益生菌组患者的胃肠道并发症发生风险低于对照组人群（RR=0.19，96%CI=0.13～0.25，P=0.000）；益生菌组患者的重症监护病房（intensive care unite，ICU）住院天数短于对照组人群（MD=-4.55，96%CI=-5.91～-3.19，P=0.000）。结论：添加益生菌的早期肠内营养有效降低了重型颅脑损伤患者的感染率、死亡率及胃肠道并发症发生率，并明显缩短了患者的ICU住院天数，建议临床推广使用。

Abstract:

Objective：To assess the effects of early enteral nutrition supplemented with probiotics on clinical outcomes in patients with severe head injury. Methods：PubMed，Cochrane Central Register of Controlled Trials，China National Knowledge Infrastructure，Wan－fang database，and Chinese Biomedical Literature were electronically searched for the purpose of identifying the randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with severe head injury，as well as the bibliographies of eligible studies and topic-related reviews were manually checked. Two investigators checked citations，extracted data，appraised risk of bias of included studies，and then STATA 12.0 was used to perform meta-analysis. Results：Totally 18 trials enrolling 1 016 patients were included. Meta-analysis indicated that early enteral nutrition supplemented with probiotics was associated with decreased risk of infection（RR=0.53，96%CI=0.44 to 0.65，P=0.000），decreased risk of mortality（RR=0.56，96%CI=0.38 to 0.82，P=0.003），decreased risk of gastrointestinal complications（RR=0.19，96%CI=0.13 to 0.25，P=0.000），and shortened stays in intensive care unit（MD=-4.55，96%CI=-5.91 to -3.19，P=0.000）. Conclusion：Early enteral nutrition supplemented with probiotics effectively decreases the risk of infection，mortality，and gas－trointestinal complications，as well as shortens the stays in ICU，and thus it should be extensively adopted to manage these given patients.