重症患者肠内营养中断：患病率、原因及临床结局的系统评价与荟萃分析。
完整摘要 · 中文译文
引言：肠内营养中断（ENI）在危重症患者中常见，并可能影响营养供给，但其发生率、原因和临床后果仍不确定。本系统评价和荟萃分析综合了关于ENI发生率、促成因素、临床结局和潜在干预措施的证据。 方法：检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、CNKI和万方数据，检索时间自建库至2025年12月。接受肠内营养的危重症成人研究符合纳入条件。本综述遵循PRISMA指导，并在PROSPERO注册（CRD420251266654）。进行了随机效应模型、亚组分析、敏感性分析和GRADE评估。 结果：纳入41项研究，涉及8,260例危重症患者。粗ENI发生率范围为11.2%至100%，中位数为68.5%（IQR，57.1%-96.6%）。估计的合并发生率为79.2%，尽管异质性极端（I 2 = 99%），且发表偏倚明显（Egger检验，p < 0.001）。常见原因包括气道管理、放射学或影像学操作、胃肠道不耐受以及外科手术或准备。ENI与能量充足性降低相关（均数差，-4.21个百分点；95% CI，-7.71至-0.71；p = 0.02）。未观察到与ICU住院时间有统计学显著关联（均数差，-0.41天；95% CI，-2.05至1.23；p = 0.62）。短期死亡率与ENI无统计学显著关联（风险比，1.86；95% CI， 0.67-5.11），但估计值不精确且存在异质性（I² = 88%）。 讨论：ENI 似乎常见且主要与操作相关。它与能量充足率降低相关，而其对 ICU 住院时间和短期死亡率的影响仍不确定，原因是 ENI 定义不一致、异质性显著、发表偏倚以及结局数据有限。标准化定义、缩短围操作期禁食时间、改进胃肠道管理以及多学科营养方案可能减少可避免的中断。需要开展高质量的前瞻性研究和随机试验。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251266654.
完整摘要 · 英文原文
INTRODUCTION: Enteral nutrition interruption (ENI) is common in critically ill patients and may compromise nutritional delivery, but its prevalence, causes, and clinical consequences remain uncertain. This systematic review and meta-analysis synthesized evidence on ENI prevalence, contributing factors, clinical outcomes, and potential interventions. METHODS: PubMed, Embase, CINAHL, Web of Science, Cochrane Library, CNKI, and WanFang Data were searched from inception through December 2025. Studies of critically ill adults receiving enteral nutrition were eligible. The review followed PRISMA guidance and was registered in PROSPERO (CRD420251266654). Random-effects models, subgroup analyses, sensitivity analyses, and GRADE assessments were performed. RESULTS: Forty-one studies involving 8,260 critically ill patients were included. Crude ENI prevalence ranged from 11.2% to 100%, with a median of 68.5% (IQR, 57.1%-96.6%). The estimated pooled prevalence was 79.2%, although heterogeneity was extreme (I 2 = 99%) and publication bias was evident (Egger's test, p < 0.001). Common causes included airway management, radiological or imaging procedures, gastrointestinal intolerance, and surgical procedures or preparation. ENI was associated with reduced energy adequacy (mean difference, -4.21 percentage points; 95% CI, -7.71 to -0.71; p = 0.02). No statistically significant association was observed with ICU length of stay (mean difference, -0.41 days; 95% CI, -2.05 to 1.23; p = 0.62). Short-term mortality was not statistically significantly associated with ENI (risk ratio, 1.86; 95% CI, 0.67-5.11), but the estimate was imprecise and heterogeneous (I 2 = 88%). DISCUSSION: ENI appears common and is predominantly procedure-related. It is associated with reduced energy adequacy, whereas its effects on ICU length of stay and short-term mortality remain uncertain because of inconsistent ENI definitions, substantial heterogeneity, publication bias, and limited outcome data. Standardized definitions, shorter peri-procedural fasting, improved gastrointestinal management, and multidisciplinary nutrition protocols may reduce avoidable interruptions. High-quality prospective studies and randomized trials are needed. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251266654.