Effectiveness And Safety Of Enteral Nutrition On Patients With Severe Stroke: A Systematic Review

Objective:To systematically evaluate the effectiveness and safety of enteral nutrition on Patients with Severe Stroke.Methods:We search CBM (1996-2012.2), CNKI (1996.1-2012.2), the Cochrane Library(1996.1-2012.2), PubMed(1996.1-2012.2), EMBAE (1996.1-2012.2) for randomized controlled trails(RCT) relating to the use of enteral nutrition on Patients with Severe Stroke, and languages are English and Chinese. The search were conducted and extracted by the criteria,by two independent evaluators. Under the quality evaluation criteria of CochraneReviewer'S Handbook5.1.0RCT,the quality of included studies was assessed. The software RevMan5.1.6was used for Meta-analysis if there was low heterogeneity.Results:The primary reviewing included80articles, and38RCT articles were admitted after selection, and3516participants were included in the review.All included studies were inadquate in reporting randomization,Concealment of allocation and blinding.Meta-analysis based on included studies Showed that EN(Enteral Nutrition) vs PN (Parenteral enteral Nutrition) or who received normal liquid diet, EN can obviously decreased the mortality of patients with severe stroke [OR=0.40,95%C1(0.26,0.63)], P<0.001Improving of neural function injure(NIHSS score [MD=2.79,95%C1(2.32,2.36)]; Decreasing the rate of the pulmonary infection [RR=0.51,95%Cl(0.44,0.59)]; Compared the7days,14days,21days and28days before and after treatment serum albumin (ALB) drop degree respectively [MD=-1.39,95%Cl(-2.05,-0.72)],[MD=-2.86,95%C1(-3.44,-2.27)],[MD=-2.56,95%Cl(-3.05,-2.07)][MD=-3.11,95%Cl(-3.99,-2.24)], These are better than the control group. After the sensitivity analysis, Compared the7days,14days,21days before and after treatment serum albumin (ALB) drop degree respectively[MD=-5.10,95%C1(-9.02,-1.18)],[MD=-5.00,95%C1(-5.67,-4.33)],[MD=-1.86,95%Cl(-2.79,-0.92)]With the analysis of the overall conclusion consistent. Parenteral and Enteral Nutrition sequential therapy vs PN (Parenteral Nutrition) or who received normal liquid diet, Parenteral and Enteral Nutrition sequential therapy can obviously decreased the mortality of patients with severe stroke [OR=0.42,95%Cl(0.18,0.96)],P=0.04; Decreasing the rate of the pulmonary infection[RR=0.55,95%Cl(0.40,0.75)]; Compared the7days,14days,21days before and after treatment serum albumin (ALB) drop degree respectively[MD=-1.17,95%C1(-1.87,-0.47)].[MD=-2.10,95%Cl (-2.88,-1.33],[MD=-2.18,95%Cl(-8.43,4.08)], But the results of treatment21days is invalid,the rest is better than the control group.All the study reported the enteral nutrition on Patients with Severe Stroke of the main adverse effects for Diarrhea, vomiting, high blood glucose regurgitation, etc.Conclusions:The use of enteral nutrition on Patients with Severe Stroke significantly reduces the mortality, impoved nutrition condition and grade of nerval action, decrease the rate of the pulmonary infection, reduce the risk of Hypoalbuminemia. However,these is poor quality study,and more center, large sample and the rigorous test are need.