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目的:系统评价以谷氨酰胺(Gln)为主的免疫营养支持对颅脑损伤病人的影响。方法:计算机检索Pubmed,Embase,Cochrane Library,中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(维普)、中国期刊全文数据库(CNKI)和中华医学会数字化期刊(万方)等,全面收集有关Gln用于颅脑损伤病人营养支持效果的随机对照试验(RCT)。检索时间截止为2013年7月。经两名研究者独立纳入、排除文献,资料提取及质量评价后,采用RevMan5.2软件进行分析。结果:共纳入14个RCT,合计689例病人。系统评价结果显示,肠内Gln给药亚组与对照组比,能降低腹泻发生率[RR=0.57,95%CI(0.36,0.89),P=0.01],缩短住院时间[SMD=-8.00,95%CI(-15.36,-0.64),P=0.03],差异均有统计学意义。肠外Gln给药亚组与对照组比,能降低肺部感染率[RR=0.45,95%CI(0.25.0.84),P=0.01]和血糖水平[RR=-2.31,95%CI(-3.44,-1.18),P<0.01],差异均有统计学意义。而在治疗有效率、病死率、泌尿系感染、总蛋白含量、清蛋白含量、IgA水平和GCS评分方面,差异均无统计学意义。结论:1肠内给予Gln营养治疗能有效地降低腹泻发生率,提高总蛋白水平,缩短住院时间;2肠外给予Gln营养治疗能有效地降低肺部感染发生率,降低血糖水平;3前两者均不能降低病人的治疗有效率、病死率、泌尿系感染和GCS评分,不能升高病人的总蛋白含量、清蛋白含量和IgA水平。
OBJECTIVE: To systematically evaluate the effect of glutamine-based immunodominant nutritional support on patients with brain injury. METHODS: We searched Pubmed, Embase, Cochrane Library, CBM, CNKI and CNKI (Wanfang) comprehensively A randomized controlled trial (RCT) on Gln for nutritional support in patients with head injury. The search time is up to July 2013. After two researchers independently included, excluding documents, data extraction and quality evaluation, using RevMan5.2 software for analysis. Results: A total of 14 RCTs were enrolled, totaling 689 patients. The results of systematic reviews showed that the intestinal Gln administration subgroup reduced the incidence of diarrhea compared with the control group [RR = 0.57, 95% CI (0.36, 0.89), P = 0.01] and shorter hospital stay [SMD = -8.00, 95% CI (-15.36, -0.64), P = 0.03], the differences were statistically significant. Parenteral administration of Gln decreased the rate of lung infection (RR 0.45, 95% CI 0.25 0.254, P 0.01) and blood glucose levels (RR 2.33, 95% CI 3.44, -1.18), P <0.01], the differences were statistically significant. There was no significant difference in treatment efficiency, case fatality, urinary tract infection, total protein, albumin, IgA and GCS scores. Conclusion: 1 Gln nutrition therapy can effectively reduce the incidence of diarrhea, increase the total protein level and shorten the length of hospital stay; 2 Gln nutrition therapy can effectively reduce the incidence of pulmonary infection and lower blood glucose levels; Did not reduce the patient’s efficacy, mortality, urinary tract infection, and GCS scores, and did not increase the patient’s total protein, albumin, and IgA levels.