肠内营养新进展解析.ppt

Page 3 – Complications After survival the most relevant question is how many complications occur and how can they be reduced. Enteral nutrition was shown to be significantly better than parenteral nutrition in this important outcome parameter. When looking specifically at hyperglycaemia, the study by Koretz showed that this metabolic complication was significantly reduced by 30% in critically ill patients - an impressive number. The meta-analysis by Peter encompassed 24 studies. These studies reported numbers of patient experiencing infective complications (not further specified). As you can see from the forest plot, most of the blue dots are on the right side, meaning the result favours enteral nutrition. And this is also statistically shown in the overall result where the diamond is clearly on the right side; it is not touching the neutrality line and therefore represents a significant result. The extent of this risk reduction can also be seen in the forest plot: 8% less complications were developed in this group when compared with the parenteral group. In the analysis by Koretz where only critically ill patients were included the reduction of infective complications was 9% when enteral nutrition was used. In addition to the infective complications reported above, Peter also analyzed the non-infective complications. The result was that enteral nutrition again significantly reduced these complications by 5% (most pronounced in the medical group). It might be obvious – but still worthwhile to mention – that parenteral nutrition can pose a risk due to the intravenous access route. And if such infections occur they are often serious. Peter showed that parenteral nutrition was associated with a significant increase in catheter-related bloodstream infections. On the other hand diarrhoea is often perceived as a negative side effect of enteral nutrition. It should be stressed that this is in no way comparable with the severity of a catheter-related complication. Neve