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目的采用Meta分析法比较添加结构脂肪乳和不添加结构脂肪乳的肠外营养支持治疗方案的疗效和安全性。方法检索Pub Med、EMBase、Cochrane Library、中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库和维普数据库等文献资料,收集1990—2015年期间发表的使用添加结构脂肪乳的肠外营养液进行营养支持治疗的随机对照试验,按纳入、排除标准进行筛选并进行质量评价,应用Rev Man 5.3软件进行Meta分析。结果共纳入19篇(n=889)符合标准的随机对照试验相关文献。分析结果显示,与添加其他脂肪乳剂相比,使用添加结构脂肪乳的肠外营养支持治疗方案在提高血浆白蛋白水平[WMD=0.09,95%CI(0.03～0.15),P<0.05];减少对脂肪代谢的影响[WMD=-0.15,95%CI(-0.26～-0.03),P<0.05]等方面具有显著优势;在改善患者肝功能的指标方面,其对于降低丙氨酸转氨酶的水平具有显著优势[SMD=-0.64,95%CI(-1.21～-0.08),P<0.05]。其他指标如降低总胆红素[WMD=-1.95,95%CI(-4.10～0.20),P>0.05]及γ-谷氨酰转移酶水平[SMD=-0.10,95%CI(-1.05～0.84),P>0.05]等方面则不具有显著差异。结论添加结构脂肪乳的肠外营养支持治疗方案疗效优于添加其他脂肪乳剂,并可在一定程度上减少肠外营养使用对患者肝功能造成的损伤,是一种较为安全有效的治疗方法。
Objective To compare the efficacy and safety of parenteral nutrition supportive therapy with and without structured fatty emulsion by Meta-analysis. Methods PubMed, EMBase, Cochrane Library, Chinese Biomedical Literature Database, Chinese Academic Journal Full-text Database, Wanfang Database and VIP Database were searched to collect the data of parenteral nutrition solution Randomized controlled trials of nutritional support were screened and quality assessed by inclusion and exclusion criteria, and Meta-analysis was performed using RevMan 5.3 software. Results A total of 19 randomized controlled trials (n = 889) were included. The results of the analysis showed that parenteral nutrition support regimens with structured fatty emulsion increased plasma albumin levels compared with the addition of other fat emulsions [WMD = 0.09, 95% CI (0.03-0.15), P <0.05]; decreased (WMD = -0.15, 95% CI (-0.26 ~ -0.03), P <0.05] and other aspects of the significant advantages; in improving the indicators of patients with liver function, which reduce the level of alanine aminotransferase There was a significant advantage [SMD = -0.64, 95% CI (-1.21 ~ -0.08), P <0.05]. Other indicators such as total bilirubin [WMD = -1.95,95% CI (-4.10-0.20), P> 0.05] and γ-glutamyltransferase levels [SMD = -0.10,95% CI -1.05 ~ 0.84), P> 0.05] and so there is no significant difference. Conclusion The parenteral nutrition supportive regimen with structured fatty emulsion is superior to other fat emulsions and can reduce the damage of liver function caused by parenteral nutrition to a certain extent. It is a safe and effective treatment.