Glutamine supplementation in serious illness: A systematic review of the evidence
Glutamine supplementation in serious illness: A systematic review of the evidence
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DOI：
10.1097/00003246-200209000-00011
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发表时间：
2002-09-01
影响因子：
8.8
通讯作者：
Su, XY
中科院分区：
文献类型：
--
作者：
Novak, F;Heyland, DK;Su, XY
目标。研究谷氨酰胺补充与外科手术和危重疾病患者住院时间、并发症发生率和死亡率之间的关系。数据源。电子数据库的计算机化检索和个人档案、摘要会议记录、相关期刊的检索，以及参考书目的查阅。研究选择：我们回顾了550篇标题、摘要和文章。如果是危重病人或外科病人的随机试验，评估谷氨酰胺与标准治疗对临床结果的影响，则纳入初级研究。数据提取：我们独立地提取了两份关于主要研究方法和结果的相关数据。合成数据。有14项随机试验比较了外科和危重病人补充谷氨酰胺的使用。当这些试验的结果汇总时，关于死亡率，谷氨酰胺补充与0.78的风险比（RR）相关（95%可信区间[Cl]， 0.58-1.04）。补充谷氨酰胺还与较低的感染并发症发生率（RR, 0.81; 95% Cl, 0.64-1.00）和较短的住院时间（-2.6天；95% Cl, -4.5至-0.7）相关。我们检查了几个优先级指定的子组。虽然没有发现统计学上显著的亚组差异，但有一些重要的趋势。在死亡率方面，与肠内谷氨酰胺（RR, 1.08; 95% Cl, 0.57-2.01）和低剂量谷氨酰胺（RR, 1.02; 95% Cl, 0.52-2.00）的研究相比，肠外谷氨酰胺（RR, 0.71; 95% Cl, 0.51-0.99）和高剂量谷氨酰胺（RR, 0.73; 95% Cl, 0.53-1.00）的研究具有治疗优势。在住院时间方面，手术患者（-3.5天；95% Cl, -5.3至-1.7）与危重患者（0.9天；95% Cl, -4.9至6.8）相比，所有治疗获益均在手术患者中观察到。结论：在外科病人中，谷氨酰胺。补充可能与降低感染并发症发生率和缩短住院时间有关，而对死亡率没有任何不良影响。在危重病人中，补充谷氨酰胺可能与并发症和死亡率的减少有关。在接受高剂量肠外谷氨酰胺治疗的患者中观察到最大的益处。
Objective. To examine the relationship between glutamine supplementation and hospital length of stay, complication rates, and mortality in patients undergoing surgery and experiencing critical illness.Data Sources. Computerized search of electronic databases and search of personal files, abstract proceedings, relevant journals, and review of reference lists.Study Selection: We reviewed 550 titles, abstracts, and articles. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of glutamine vs. standard care on clinical outcomes.Data Extraction: We abstracted relevant data on the methodology and outcomes of primary studies in duplicate, independently.Data Synthesis. There were 14 randomized trials comparing the use of glutamine supplementation in surgical and critically ill patients. When the results of these trials were aggregated, with respect to mortality, glutamine supplementation was associated with a risk ratio (RR) of 0.78 (95% confidence interval [Cl], 0.58-1.04). Glutamine supplementation was also associated with a lower rate of infectious complications (RR, 0.81; 95% Cl, 0.64-1.00) and a shorter hospital stay (-2.6 days; 95% Cl, -4.5 to -0.7). We examined several a priori-specified subgroups. Although there were no statistically significant subgroup differences detected, there were some important trends. With respect to mortality, the treatment benefit was observed in studies of parenteral glutamine (RR, 0.71; 95% Cl, 0.51-0.99) and high-dose glutamine (RR, 0.73; 95% Cl, 0.53-1.00) compared with studies of enteral glutamine (RR, 1.08; 95% Cl, 0.57-2.01) and low-dose glutamine (RR, 1.02; 95% Cl, 0.52-2.00). With respect to hospital length of stay, all of the treatment benefit was observed in surgical patients (-3.5 days; 95% Cl, -5.3 to -1.7) compared with critically ill patients (0.9 days; 95% Cl, -4.9 to 6.8).Conclusion: In surgical patients, glutamine. supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality. In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine.