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中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (01) : 41 -48. doi: 10.3877/cma.j.issn.1674-6880.2018.01.007

所属专题: 文献

荟萃分析

谷氨酰胺强化肠外营养支持对重症患者临床结局影响的Meta分析
何晓玮1, 鲁晟1, 钟涛2, 徐巍3, 严冰1, 吴飞连1, 邱丽1, 何昱4, 唐坎凯3,()   
  1. 1. 313000 浙江湖州,湖州师范学院附属第一医院药剂科
    2. 313000 浙江湖州,浙北明州医院药剂科
    3. 313000 浙江湖州,湖州师范学院附属第一医院重症医学科
    4. 310053 杭州,浙江中医药大学药学院
  • 收稿日期:2017-04-13 出版日期:2018-02-01
  • 通信作者: 唐坎凯
  • 基金资助:
    国家自然科学基金项目(81373898); 浙江省医药一般项目(2016KYB279); 湖州市科技计划项目(2017GYB03)

Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis

Xiaowei He1, Sheng Lu1, Tao Zhong2, Wei Xu3, Bing Yan1, Feilian Wu1, Li Qiu1, Yu He4, Kankai Tang3,()   

  1. 1. Department of Pharmacy, First Affiliated Hospital, Huzhou University, Huzhou 313000, China
    2. Department of Pharmacy, Zhebei Mingzhou Hospital, Huzhou 313000, China
    3. Department of Intensive Care Unit, First Affiliated Hospital, Huzhou University, Huzhou 313000, China
    4. College of pharmacy, Zhejiang Chinese Medical University, Hangzhou 310053, China
  • Received:2017-04-13 Published:2018-02-01
  • Corresponding author: Kankai Tang
  • About author:
    Corresponding author: Tang Kankai, Email:
引用本文:

何晓玮, 鲁晟, 钟涛, 徐巍, 严冰, 吴飞连, 邱丽, 何昱, 唐坎凯. 谷氨酰胺强化肠外营养支持对重症患者临床结局影响的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2018, 11(01): 41-48.

Xiaowei He, Sheng Lu, Tao Zhong, Wei Xu, Bing Yan, Feilian Wu, Li Qiu, Yu He, Kankai Tang. Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(01): 41-48.

目的

系统评价谷氨酰胺强化肠外营养支持治疗对重症患者免疫营养功能及临床结局的影响。

方法

检索Embase、Medline、Cochrane Central Register of Controlled Trials、The Cochrane Database of Systematic Reviews、中国期刊全文数据库、维普中文科技期刊全文数据库、万方数据库及中国生物医学文献数据库自建库至2016年12月期间研究常规肠外营养(常规组)与谷氨酰胺强化肠外营养(干预组)支持治疗对ICU重症患者病死率、感染发生率及住院时间等临床结局影响的随机对照试验。由2名研究者按照纳入及排除标准独立进行文献筛选、提取和质量评估后,使用Review Manager 5.2.0分析软件进行Meta分析。

结果

共纳入18项随机对照试验,包括1 708例患者。Meta分析结果显示,应用谷氨酰胺强化的肠外营养,可以显著降低重症患者住院病死率[RR=0.63,95%CI(0.47,0.84),Z=3.16,P=0.002],但两组间ICU病死率[RR=1.00,95%CI(0.83,1.22),Z=0.04,P=0.97]、6个月病死率[RR=0.95,95%CI(0.67,1.34),Z=0.29,P=0.77]比较,差异均无统计学意义;且肺部感染发生率[RR=0.91,95%CI(0.62,1.32),Z=0.52,P=0.61]、尿路感染发生率[RR=0.79,95%CI(0.37,1.67),Z=0.62,P=0.54]、菌血症[RR=0.52,95%CI(0.21,1.33),Z=1.36,P=0.18]、导管相关感染[RR=0.69,95%CI(0.32,1.49),Z=0.95,P=0.34]及其他感染[RR=0.94,95%CI(0.80,1.10),Z=0.81,P=0.42]比较,差异亦均无统计学意义;同时,两组患者间住院时间[WMD=-0.26,95%CI(-3.81,3.28),Z=0.15,P=0.88]及住ICU时间[WMD=-1.04,95%CI(3.95,1.87),Z=0.70,P=0.48]比较,差异均无统计学意义。

结论

使用谷氨酰胺强化的肠外营养支持疗法不能改善重症患者临床结局。

Objective

To evaluate the immunonutrition function and clinical outcomes of glutamine-supplemented parenteral nutrition treatment on critically ill patients.

Methods

Randomized controlled trials which focused on clinical outcomes (like the mortality, the infection rate and the length of stay) of converntional parenteral nutrition treatment (the control group) and glutamine-supplemented parenteral nutrition treatment (the glutamine group) on critically ill patients were systematically retrieved from Embase, Medline, Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, CNKI database, CQVIP database, Wan Fang database and CMB databases from their inception to December 2016. Included articles were independently screened, extracted and evaluated by two reviewers according to the inclusion and exclusion criteria and then conducted the meta-analysis by RevMan 5.2.0.

Results

A total of 1 708 patients in 18 studies were included. Meta-analysis showed that the hospital mortality in the glutamine group was much lower than that in the control group [RR=0.63, 95%CI (0.47, 0.84), Z=3.16, P=0.002]. However, there were no significant differences in the ICU mortality [RR=1.00, 95%CI (0.83, 1.22), Z=0.04, P=0.97], 6-month mortality [RR=0.95, 95%CI (0.67, 1.34), Z=0.29, P=0.77], pulmonary infection [RR=0.91, 95%CI (0.62, 1.32), Z=0.52, P=0.61], urinary tract infection [RR=0.79, 95%CI (0.37, 1.67), Z=0.62, P=0.54], bacteremia [RR=0.52, 95%CI (0.21, 1.33), Z=1.36, P=0.18], catheter-related infection [RR=0.69, 95%CI (0.32, 1.49), Z=0.95, P=0.34], and other infections [RR=0.94, 95%CI (0.80, 1.10), Z=0.81, P=0.42] between the two groups. The hospital length of stay[WMD=-0.26, 95%CI (-3.81, 3.28), Z=0.15, P=0.88] and ICU length of stay [WMD=-1.04, 95%CI (3.95, 1.87), Z=0.70, P=0.48] also showed no significant differences between the two groups.

Conclusion

Parenteral glutamine supplementation can not improve the clinical outcomes of critically ill patients.

表1 纳入18篇随机对照研究的基本特征
图1 谷氨酰胺强化肠外营养对重症患者住院病死率影响的森林图
图2 谷氨酰胺强化肠外营养对重症患者ICU病死率影响的森林图
图3 谷氨酰胺强化肠外营养对重症患者6个月病死率影响的森林图
图4 谷氨酰胺强化的肠外营养对重症患者感染发生率影响的森林图
图5 谷氨酰胺强化的肠外营养对重症患者住院时间影响的森林图
图6 谷氨酰胺强化肠外营养对重症患者住ICU时间影响的森林图
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