Effect of early enteral nutrition combined with microecological preparation on severe acute pancreatitis: meta-analysis / 中华肝胆外科杂志

ABSTRACT

Objective:To systematically evaluate the efficacy and clinical value of early enteral nutrition (EEN) combined with microecological agents in the treatment of severe acute pancreatitis (SAP).Methods:China National Knowledge Infrastructure, Chinese biomedical literature database, Wanfang Database, VIP, Cochrane Library, PubMed, Embase, and Web of Science were analyzed, and the retrieval time range is from the establishment of the datebase to November 1, 2019. To compare the clinical efficacy of EEN combined with microecological agents (experiment group) and single EEN treatment (control group) in SAP patients, and to compare the main outcome indicators serum C-reactive protein level, incidence of multiple organ dysfunction syndrome, incidence of pancreatic infection necrosis, incidence of other complications, mortality, and length of hospital stay. And secondary outcome measures: plasma interleukin-8 (IL-8), tumor necrosis factor-α level, gastrointestinal score, and incidence of surgical intervention. The quality of the included literature was evaluated by using the Cochrane systematic evaluator's manual 5.1.0 risk of bias assessment tool, and meta-analysis was performed by using Stata16.0 software.Results:A total of 762 patients were enrolled in 9 RCTs. The results of meta-analysis showed that among the main outcome indicators, C-reactive protein level [Mean Difference ( MD)=-7.58, 95% CI -23.71-8.55, P>0.05], incidence of multiple organ dysfunction syndrome [Logarithm Risk Ratio (Log RR)=-0.30, 95% CI -0.71-0.10, P>0.05], incidence of pancreatic infection and necrosis (Log RR=-0.21, 95% CI -0.57-0.16, P>0.05) and mortality rate (Log RR=0.13, 95% CI -0.36-0.62, P>0.05) the differences were not statistically significant. The incidence of complications in the experimental group was significantly lower than that in the control group (Log RR=-0.29, 95% CI -0.51-0.07, P<0.05), and the length of hospital stay in the experimental group ( MD=-4.45, 95% CI -7.47--1.43, P<0.05) was significantly shorter than that in the control group. Plasma IL-8 levels ( MD=-7.43, 95% CI -14.28--0.57, P<0.05), TNF-α level ( MD=-38.96, 95% CI -72.96--4.95, P<0.05)and gastrointestinal score ( MD=-0.15, 95% CI -0.17--0.13, P<0.05)were significantly lower in the experimental group than in the control group, and the incidence of surgical intervention was significantly lower than that of the control group (Log RR=-1.63, 95% CI -8.96-0.57, P>0.05) no statistical significance. Conclusion:EEN combined with microecological preparations can reduce the length of hospital stay in SAP patients and the incidence of complications. Therefore, EEN combined with microecological agents may be beneficial for SAP patients.