摘要
目的评价谷氨酰胺强化肠内营养治疗重型创伤性脑损伤（sTBI）患者的有效性。方法检索PubMed、Cochrane Library、中国期刊网全文数据库（CNKI）、维普中文科技期刊数据库及万方数据库，检索时间从建库至2017年5月，收集谷氨酰胺强化肠内营养治疗STBI患者的随机对照试验（RCT）。由2名研究者严格按照纳入和排除标准筛选文献，提取资料，评价质量并用RevMan 5．3软件对数据进行Meta分析，评价谷氨酰胺强化肠内营养对患者白蛋白含量、免疫球蛋白G（IgG）水平、腹泻发生率、肺部感染发生率、血糖、格拉斯哥昏迷评分（GCS）、住院时间及病死率的影响。 结果最终纳入17篇研究，共939例sTBI患者，谷氨酰胺组512例，对照组427例。Meta分析结果显示，谷氨酰胺组与对照组比较，住院时间和病死率差异无统计学意义（P〉0．05），在自蛋白含量（95％CI 0．19-2．54，Z=2．27，P〈0．05）、IgG水平（95％C1 0．67-1．80，Z=4．25，P〈0．01）、腹泻发生率（95％CI 0．23-0．57，Z=4．41，P〈0．01）、肺部感染发生率（95％C10．14-0．56，Z=3．62。P〈0．01）、血糖（95％CI-2．53--0．52，Z=2．98，P〈0．01）、GCS（95％C10．50-2．68，Z=1．49，P〈0．01）方面差异有统计学意义。 结论谷氨酰胺强化肠内营养相对于常规肠内营养更能提高患者白蛋白含量和IgG水平，降低腹泻发生率、肺部感染发生率和血糖，促进神经功能恢复，但不能缩短住院时间和降低病死率。
Objective To evaluate the efficacy of Glutamine enriched enteral nutrition in the treatment of severe traumatic brain injury （sTBI）. Methods PubMed, Coehrane Library, Chinese National Knowledge Infrastructure （CNKI）, V1P Database for Chinese Technical Periodicals, and Wanfang databases were searched to identify randomized controlled trials （RCT） on the application of Glutamiue enriched enteral nutrition for severe TBI patients from database establishment time to May 2017. Two investigators screened the literature strictly according to the inclusion and exclusion criteria, extracted the data, evaluated the literature quality, and performed meta-analysis using RevMan 5.3 software. The effects of glutamine enhanced enteral nutrition on albumin content, immunoglobulin G （IgG） level, the incidence of diarrhea, incidence of pulmonary infection, blood glucose, Glasgow Coma Scale （GCS）, length of hospital stay, and mortality were evaluated. Results A total of 17 articles involving 939 sTBI patients were included, with 512 patients in Glutamine group and 427 controls in control group. There were no significant differences in the length of hospital stay and mortality between the two groups （P 〉0.05）. Significant differences were found in albumin content （95% CI0. 19-2.54, Z = 2.27, P〈0.05） , level of IgG （95% CI 0. 67-1. 80, Z =4. 25, P 〈0.01）, incidence of diarrhea （95% CI 0. 23-0.57, Z = 4.41, P 〈 0.01 ）, incidence of lung infections （95% CI 0. 14-0.56, Z = 3.62, P〈0.01）, blood sugar （95%CI -2.53--0.52, Z=2.98, P〈0.01）, and the GCS score （95% CI 0. 50-2. 68, Z = 1.49, P 〈 0.01 ） between the two groups. Conclusion Compared with routine enteral nutrition, Glutamine enriched enteral nutrition can increase albumin content and IgG level, reduce the incidence of diarrhea and lung infections, reduce blood sugar, and improve the GCS score, but it cannot shorten hospital stay or reduce mortality.
作者
卢浩
谭华俊
冯若扬
陈乾
闫华
Lu Hao, Tan Huajun, Feng Ruoyang, Chen Qian, Yan Hua.(Graduate School of Tianjin Medical University, Tianjin 300070, China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第10期898-905,共8页
Chinese Journal of Trauma
