不同肠内营养途径对ICU机械通气患者呼吸机相关性肺炎影响的网状Meta分析

Effect of different enteral nutrition pathways on ventilator-associated pneumonia in ICU patients undergoing mechanical ventilation: a network Meta-analysis

摘要:

目的 采用网状Meta分析方法评价不同肠内营养途径对重症监护病房（ICU）机械通气患者呼吸机相关肺炎（VAP）的影响。 方法 检索Cochrane Library、PubMed、EMbase、Web of Science、中国知网、万方数据库、维普和中国生物医学文献数据库中关于肠内营养途径对ICU机械通气患者VAP影响的随机对照试验，经过筛选文献、提取数据并对纳入文献进行质量评价后，采用R4.1.3 Gemtc程序包进行贝叶斯网状Meta分析。 结果 共纳入46篇文献，包括3 510例患者，涉及5种肠内营养途径（鼻肠管、鼻胃管、胃肠双腔管、胃造瘘管、胃空肠造瘘管）。网状Meta分析结果显示：在降低VAP发生率方面，鼻肠管、胃肠双腔管、胃空肠造瘘管、胃造瘘管均优于鼻胃管（均P < 0.05），胃造瘘管排序最优，其次为胃空肠造瘘管和胃肠双腔管。在缩短机械通气时间方面，鼻肠管、胃肠双腔管、胃造瘘管均优于鼻胃管（均P < 0.05）；在缩短ICU住院时间方面，鼻肠管、胃造瘘管均优于鼻胃管（均P < 0.05）；在缩短机械通气和住院时间方面胃造瘘管排序均为最优，其次均为鼻肠管和胃空肠造瘘管。 结论 胃造瘘管、胃空肠造瘘管和胃肠双腔管在降低ICU机械通气患者VAP发生率方面具有优势，胃造瘘管、鼻肠管和胃空肠造瘘管在缩短ICU机械通气患者机械通气时间和ICU住院时间方面具有优势，但受纳入研究数量和质量的限制，结果应谨慎解释。

Abstract:

Objective To evaluate the effect of different enteral nutrition pathways on ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation in intensive care unit (ICU) through network Meta-analysis. Methods Randomized controlled trials on the effect of enteral nutrition on VAP in mechanically ventilated ICU patients were retrieved from the Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases. After literature screening, data extraction and quality evaluation of the included literatures, Bayesian network Meta-analysis was performed using the R4.1.3 Gemtc program package. Results A total of 46 literatures were included in the analysis, involving 3 510 patients and 5 enteral nutrition pathways (nasointestinal tube, nasogastric tube, gastrointestinal double-lumen tube, gastrostomy tube, gastrojejunostomy tube). Network Meta-analysis results showed that in terms of reducing the incidence of VAP, nasointestinal tube, gastrointestinal double-lumen tube, gastrojejunostomy tube and gastrostomy tube were all superior to nasogastric tube (all P < 0.05). Gastrostomy tube was the best, followed by gastrojejunostomy tube and gastrointestinal double-lumen tube. In terms of shortening mechanical ventilation time, nasointestinal tube, gastrointestinal double-lumen tube and gastrostomy tube were all superior to nasogastric tube (all P < 0.05). In terms of shortening the length of stay in ICU, nasointestinal tube and gastrostomy tube were both superior to nasogastric tube (both P < 0.05), In terms of shor-tening duration of mechanical ventilation and length of hospital stay, gastrostomy tube was the best, followed by nasointestinal tube and gastrojejunostomy tube. Conclusion Gastrostomy, gastrojejunostomy and gastrointestinal double-lumen tube have advantages in reducing the incidence of VAP in ICU patients with mechanical ventilation. Gastrostomy tube, nasointestinal tube and gastrojejunostomy tube have advantages in reducing the duration of mechanical ventilation and the length of ICU stay of patients undergoing mechanical ventilation. However, the results should be carefully explained due to the limited number and quality of the included studies.