系统评价早期低热量肠内营养对危重症患者预后的影响。

计算机检索Cochrane Library、Embase、PubMed、中国知网、万方数据库及维普数据库中关于危重症患者早期低热量肠内营养支持的随机对照试验，检索时限为建库至2022年5月31日。试验组给予低热量肠内营养，对照组给予常规热量肠内营养。由2名研究者筛选文献、提取资料及质量评价，应用RevMan 5.3软件对纳入文献数据进行Meta分析。

共纳入11项随机对照试验，Meta分析结果显示，与对照组比较，试验组患者喂养不耐受的发生率显著降低[比值比（OR）= 0.72，95%置信区间（CI）（0.56，0.93），Z = 2.54，P = 0.01]。而两组患者间的住院病死率[OR = 1.00，95%CI（0.81，1.24），Z < 0.01，P = 1.00]、感染率[OR = 1.03，95%CI（0.86，1.23），Z = 0.32，P = 0.75]、ICU住院时间[均数差（MD）= 0.43，95%CI（-1.07，1.93），Z = 0.56，P = 0.58]、总住院时长[MD = -0.15，95%CI（-4.69，4.38），Z = 0.07，P = 0.95]、机械通气时长[MD = 1.11，95%CI（-7.72，9.94），Z = 0.25，P = 0.81]、低血糖发生率[OR = 1.15，95%CI（0.68，1.96），Z = 0.53，P = 0.59]及低血钾发生率[OR = 0.90，95%CI（0.42，1.96），Z = 0.26，P = 0.80]的比较，差异均无统计学意义。

与常规热量肠内营养支持相比，早期低热量肠内营养支持能够降低重症患者喂养不耐受的发生率，同时并不影响患者住院病死率、感染率、ICU住院时间、总住院时长、机械通气时长、低血糖发生率及低血钾发生率。

To systematically evaluate the effect of early hypocaloric enteral nutrition support on the prognosis of critically ill patients.

Randomized controlled trials on early hypocaloric enteral nutrition support for critically ill patients were searched from the Cochrane Library, Embase, PubMed, CNKI, Wanfang and VIP databases published up to May 31, 2022. The experimental group was given hypocaloric enteral nutrition support, and the control group was given conventional heat enteral nutrition support. Two researchers screened literature, extracted data and evaluated quality, and then meta-analysis was performed using RevMan 5.3.

A total of 11 randomized controlled trials were included. Meta-analysis showed that the incidence of feeding intolerance in the experimental group was much lower than that in the control group [odds ratio (OR) = 0.72, 95% confidence interval (CI) (0.56, 0.93), Z = 2.54, P = 0.01]. However, the in-hospital mortality [OR = 1.00, 95%CI (0.81, 1.24), Z < 0.01, P = 1.00], infection rate [OR = 1.03, 95%CI (0.86, 1.23), Z = 0.32, P = 0.75], length of stay in ICU [mean difference (MD) = 0.43, 95%CI (-1.07, 1.93), Z = 0.56, P = 0.58], total length of hospital stay [MD = -0.15, 95%CI (-4.69, 4.38), Z = 0.07, P = 0.95], length of mechanical ventilation [MD = 1.11, 95%CI (-7.72, 9.94), Z = 0.25, P = 0.81], incidence of hypoglycemia [OR = 1.15, 95%CI (0.68, 1.96), Z = 0.53, P = 0.59] and incidence of hypokalemia [OR = 0.90, 95%CI (0.42, 1.96), Z = 0.26, P = 0.80] between the two groups all showed no significant differences.

Compared with the conventional heat enteral nutrition support, early hypocaloric enteral nutrition support can reduce the incidence of feeding intolerance in critically ill patients, and does not affect their in-hospital mortality, infection rate, length of ICU stay, total hospitalization duration, mechanical ventilation time, incidence of hypoglycemia and incidence of hypokalemia.