Parenteral glutamine supplementation in critical illness: a systematic review.
Parenteral glutamine supplementation in critical illness: a systematic review.
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DOI：
10.1186/cc13836
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发表时间：
2014-04-18
期刊：
影响因子：
--
通讯作者：
Heyland DK
中科院分区：
文献类型：
--
作者：
Wischmeyer PE;Dhaliwal R;McCall M;Ziegler TR;Heyland DK
肠外补充谷氨酰胺(Gln)的潜在益处一直是重症监护环境中最常被研究的营养干预措施之一。这项系统性综述的目的是将危重疾病中传统肠外补充谷氨酰胺的最新试验与先前存在的数据结合起来。确定了1997至2013年间进行的所有危重患者静脉注射谷氨酰胺的随机对照试验。排除单纯肠内谷氨酸氨基转移酶或肠/肠外联合谷氨酸氨基转移酶的研究。对研究的方法学质量进行评分，并由独立评价者提取数据。在ICU患者中，共有26项研究，涉及2484名患者，只检查肠外补充谷氨酰胺的营养支持。肠外补充谷氨酰胺与降低总死亡率(相对危险度(RR)0.88，95%可信区间(CI)0.75，1.03，P = 0.10)和显著降低住院死亡率(RR0.68，95%CI 0.51，0.90，P = 0.008)相关。此外，静脉注射谷氨酰胺可显著减少感染并发症(RR 0.86，95%CI 0.73，1.02，P = 0.09)和ICU住院天数(WMD-1.91，95%CI-4.10，0.28，P = 0.09)和住院天数(WMD-2.56，95%CI-4.71，-0.42，P = 0.02)。在检查接受肠外营养(PN)的患者的研究子集中，肠外补充谷氨酰胺与总体死亡率下降的趋势相关(RR0.84，95%CI0.71，1.01，P = 0.07)。在营养支持的同时给予胃肠外补充谷氨酰胺仍然与显著降低住院死亡率和住院死亡率有关。肠外补充谷氨酰胺作为营养支持的一个组成部分，应继续考虑以改善危重患者的预后。
The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data. All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers. A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD –1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07). Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients.
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