A meta-analysis of trials using the intention to treat principle for glutamine supplementation in critically ill patients with burn
A meta-analysis of trials using the intention to treat principle for glutamine supplementation in critically ill patients with burn
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DOI：
10.1016/j.burns.2012.11.008
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发表时间：
2013-06-01
期刊：
影响因子：
2.7
通讯作者：
Lau, Hui-Ling
中科院分区：
文献类型：
--
作者：
Lin, Jiun-Jie;Chung, Xiu-Juan;Lau, Hui-Ling
背景：在危重疾病期间，对谷氨酰胺的需求可能超过从肌肉储备中动员的需求。感染增加了死亡率、发病率、住院时间、抗生素的使用和护理费用。方法：从电子数据库：Cochrane图书馆、MEDLINE、PubMed知识网络和手工搜索期刊中确定随机对照试验。这些试验比较了补充谷氨酰胺和不补充谷氨酰胺对烧伤的影响。使用Cochrane Collaboration的RevMan5.1软件进行统计分析。结果：在关键词搜索中有216篇文章匹配。在筛选标题、阅读摘要和全文后，只有四项随机对照试验纳入，涉及155名患者。谷氨酰胺组和对照组的总烧伤面积(TBSA)相似(MD=2.02，95%CI-2.17，6.21，p=0.34)。补充谷氨酰胺可显著降低革兰氏阴性菌血症患者(OR0.27，95%CI0.08~0.92，p=0.04)和住院死亡率(OR=0.13，95%CI0.03，0.51，p=0.004)，但对其他结果无统计学差异。结论：补充谷氨酰胺营养可降低烧伤患者的住院死亡率和革兰氏阴性菌血症并发症。为了确定任何差异在统计学上和临床上是否重要，还需要进行更大规模和更高质量的试验。(C)2012年爱思唯尔有限公司和ISBI。版权所有。
Background: During critical illness, the demand for glutamine may exceed that which can be mobilized from muscle stores. Infections increase mortality, morbidity, length-of-stay, antibiotic usage and the cost of care. This is a major health care issue.Methods: RCTs were identified from the electronic databases: the Cochrane Library, MEDLINE, PubMed web of knowledge and hand searching journals. The trials compared the supplementation with glutamine and non-supplementation in burn. Statistical analysis was performed using RevMan5.1 software, from Cochrane Collaboration.Results: 216 papers showed a match, in the keyword search. Upon screening the title, reading the abstract and the entire article, only four RCTs, involving 155 patients, were included. For both the glutamine group and control group, total burn surface area (TBSA) (MD = 2.02, 95% CI -2.17, 6.21, p = 0.34) was similar. Glutamine supplementation was associated with a statistically significant decrease in the number of patients with gram-negative bacteremia (OR 0.27, 95% CI 0.08-0.92, p = 0.04) and hospital mortality (OR = 0.13, 95% CI 0.03, 0.51, p = 0.004), however, no statistical difference was noted between groups, for the other results.Conclusion: Glutamine supplemented nutrition can be associated with a reduction in mortality in hospital, complications due to gram-negative bacteremia in burn patients. Further larger and better quality trials are required, in order to determine whether any differences are statistically and clinically important. (c) 2012 Elsevier Ltd and ISBI. All rights reserved.