| Objective :On account of severe acute pancreatitis,development is urgent,the strategy of treatment is comprehensive,the enteral nutrition is widely accepted in recent years,there are more and more doctors found that combine enteral nutrition with probiotics is better,but there was no unified benefit for it.Our aim in this study was to systematically review and quantitatively analyze all randomized controlled trials with regard to important outcomes such as evaluation on mortality,infection,length of hospital stay,blood amylase recovery time and the rate of surgery,in patients with predicted SAP who received probiotics.Method:According to the theme,a systematic literature search of the Pub Med?Cochrane Library databases?CBM?VIP?CNKI and wanfangdata was conducted using specific search terms(from establish to July 2017).Eligible studies were randomized controlled trials that compared the effects of probiotic with placebo treatment in patients with predicted SAP.According to The Cochrane system evaluation method extracting the literature data and quality evaluation.Meta-analysed by Rev Man 5.3 software.Results :Adopt(probiotics OR prebiotics)?enteral nutrition and(acute pancreatitis)for the key words retrieval strategies,a total of 129 article was available,including 56 references repeated,17 animal experiments,review AND other meta analysis of article 17,1 indian article,determine the inclusion criteria:(1)the participants were diagnosed with severe acute pancreatitis;(2)the study type was RCT;(3)the trials were treated with probiotics;(4)the endpoint of research reports including mortality,the rate of incidence of infectious complications,surgery ratio,and length of hospital stay and blood amylase returned to normal time.Exclusion criteria:neiter the English nor Chinese,review and meta-analysis,not RCT,animal experiment and research of short reports and incomplete report.Eventually 9 articles,including 3 articles in English and 6 Chinese articles were selected involving 742 patients,the literature reports all documents are RCT,1 paper reports may have randomized methods errors,all patients were followed-up,the Jadad score is between 3 ~7 points,measurement data using the Weighted Mean differences(WMD)as the evaluation indexes and their confidence interval were 95%;Count data with odds ratio(OR)as evaluation index and calculate the 95% confidence interval.Using I2 test for heterogeneity test,if I2 < 50% and P > 0.10,adopt the fixed effects model,on the contrary,the random effects model is available.Meta-analysis shows that the experimental group with probiotics mortality heterogeneity test results of I2 = 67%,P=0.56,with a larger heterogeneity,adopting random effects model,the experimental group and the control group no significant statistical difference;Heterogeneity in the infection rate analysis of the test results of I2=28%,P=0.02,heterogeneity is less,using fixed effects model,the experimental group and the control group significantly statistical difference;Heterogeneity in the analysis of the length of hospital stay results I2 = 92%,P = 0.008,with large heterogeneity,choosing random effects model,the experimental group and control group has obvious difference;Blood amylase recovery time heterogeneity in the analysis of test results I2=79%,P=0.0005,with a large heterogeneity,using random effects model,the experimental group and control group has significant difference;Surgical rate heterogeneity in the analysis of test results I2=86%,P=0.99,with a large heterogeneity,adopting random effects model,the treatment group and control group have no significant statistical difference.1.The enteral nutrition opportunity of acute pancreatitis is in the early of the 48~72 hours;2.Implementation of enteral nutrition the jejunum nasal tube superior than nasogastric tube;3.Systematic analysis showed that probiotics have significantly affect the pancreatic infection rate(OR=0.65,95% CI=0.46,0.93);4.Systematic analysis showed that probiotics have significantly statistical difference in blood amylase,s time(WMD=-2.60,95% CI=-4.07,-1.13);5.Meta-analysis showed that probiotics have significantly statistical difference in short hospital stay(WMD=-7.32,95% CI=-12.70,-1.94);6.Systematic analysis showed that probiotics have significantly statistical difference in mortality(OR=0.70,95% CI=0.21,2.32);7.Meta-analysis showed that probiotics have no significantly statistical difference in operation rate(OR=1.01,95% CI=0.12,8.84);8.The obvervational indexs were unrelated in age?sex and?BMI?... |
PDF Full Text Request