急性呼吸窘迫综合征期间饮食脂质成分调整：系统回顾与荟萃分析

　　背景：包括ω-3和竞争性类似物ω-6脂肪酸的药理营养被用于调节急性呼吸窘迫综合征（ARDS）期间的炎性反应。在前瞻性随机临床试验中评估这些治疗临床收益的结果存在矛盾。我们尝试解释出现矛盾结果的原因，包括对照液体成分的可能影响。

　　方法：我们收集了来自于PubMed、Ovid、Cochrane数据库、Embase、美国国家卫生研究院数据库以及ARDSnet数据库中一直到2013年3月的所有资料。我们纳入了所有评价肠内药理营养与对照配方相比，对死亡率、撤去呼吸机的时间、重症监护病房（ICU）住院时间（LOS）以及非ICU住院时间影响的试验。利用敏感性分析来研究对照配方中脂质成分的影响。

　　结果：我们发现了7篇合格的研究（802例患者中405例被随机分到了药理营养组）。总体结果显示肠内药理营养对死亡率无影响（风险比 [RR]=0.83 [0.55～1.25]，P=0.37），但是在与脂质丰富对照配方相比的试验中，肠内药理营养可以改善死亡率（RR=0.57 [0.41～0.78]，P＜0.001）。随机分到肠内药理营养组患者的ICU LOS明显缩短（RR=0.5 [0.85～0.16]）。

　　结论：与含有丰富脂质（高于目前推荐量）的对照配方相比，在ARDS患者中应用肠内药理营养的方法与死亡率的降低相关。因此，并没有充分的证据来支持在ARDS中应用肠内药理营养。

JPEN J Parenter Enteral Nutr. 2015;39(7):837-46.

Modulation of Dietary Lipid Composition During Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis.

Santacruz CA, Orbegozo D, Vincent JL, Preiser JC.

Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.

BACKGROUND: Pharmaconutrition including omega-3 and competitive analogs of omega-6 fatty acids has been used to modulate the inflammatory response during acute respiratory distress syndrome (ARDS). The clinical benefit of this approach when assessed in prospective randomized clinical trials has been inconsistent. We tried to assess the reasons for the conflicting results, including the possible influence of the composition of the control solution.

METHODS: We collected data from studies listed in PubMed, Ovid, the Cochrane Database of Systematic Reviews, Embase, the U.S. National Institute of Health database, and the ARDSnet database up to March 2013. We included all trials that evaluated effects of enteral pharmaconutrition vs a control solution on mortality, ventilator-free days, length of stay (LOS) in the intensive care unit (ICU), and ICU-free days. A sensitivity analysis was carried out to study the influence of the lipid content of the control solution.

RESULTS: We found 7 eligible studies (802 patients; 405 randomized to pharmaconutrition). The aggregated results showed no overall effect on mortality (risk ratio [RR] = 0.83 [0.55-1.25], P = .37), but there was a mortality benefit when only studies in which pharmaconutrition was compared to a lipid-rich control solution were considered (RR = 0.57 [0.41-0.78], P < .001). ICU LOS was shorter in patients randomized to pharmaconutrition (RR = 0.5 [0.85-0.16]).

CONCLUSION: Use of enteral pharmaconutrition in patients with ARDS was associated with decreased mortality only when the comparator solution contained a greater amount of lipid than is currently recommended. Hence, there is insufficient evidence to support the use of enteral pharmaconutrition in ARDS.

KEYWORDS: critically ill; mechanical ventilation; meta-analysis; mortality; ω-3 fatty acids

PMID: 25560681

DOI: 10.1177/0148607114562913