Garrel Dominique, Patenaude Julie, Nedelec Bernadette, Samson Louise, Dorais Judy, Champoux Julie, D'Elia Michele, Bernier Jacques
Burn Centre, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu, Quebec, Canada.
Crit Care Med. 2003 Oct;31(10):2444-9. doi: 10.1097/01.CCM.0000084848.63691.1E.
Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on burn patients is not known. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity, length of care, and the immune system in burn patients.
Double-blinded, randomized clinical trial.
Burn center.
Forty-five adults with severe burns.
Patients were randomized to receive either glutamine or an isonitrogenous control mixture until complete healing occurred. Length of care, incidence of positive blood culture, and mortality were recorded. Phagocytosis by circulating polymorphonuclear cells was measured every 3 days.
Patient characteristics were similar in both groups. Four patients were excluded from the analysis, because three of them died within 72 hrs and the fourth could not receive enteral nutrition and amino acid supplements for the first 10 days. Of the remaining 41 patients, length of care in the survivors was not different between groups (0.9 vs. 1.0 days/percent total body surface area for glutamine vs. control, respectively), positive blood culture was three times more frequent in control than in glutamine treatment (4.3 vs. 1.2 days/patient, p <.05), and Pseudomonas aeruginosa was detected in six patients on control and zero on glutamine (p <.05). Phagocytosis by polymorphonuclear cells was not different between groups. Mortality rate was significantly lower in glutamine than in control: intention to treat, two vs. 12 (p <.05); per protocol analysis, zero vs. eight (p <.01).
Enteral glutamine supplementation in adult burn patients reduces blood infection by a factor of three, prevents bacteremia with P. aeruginosa, and may decrease mortality rate. It has no effect on level of consciousness and does not appear to influence phagocytosis by circulating polymorphonuclear cells.
肠内补充谷氨酰胺已被证明可降低创伤患者的感染发病率，但其对烧伤患者的影响尚不清楚。本研究的目的是测量肠内补充谷氨酰胺对烧伤患者感染发病率、护理时长和免疫系统的影响。
双盲随机临床试验。
烧伤中心。
45名重度烧伤的成年人。
患者被随机分为两组，分别接受谷氨酰胺或等氮对照混合物，直至完全愈合。记录护理时长、血培养阳性发生率和死亡率。每3天测量循环多形核细胞的吞噬作用。
两组患者的特征相似。4名患者被排除在分析之外，因为其中3人在72小时内死亡，第4人在最初10天内无法接受肠内营养和氨基酸补充剂。在其余41名患者中，两组幸存者的护理时长无差异（谷氨酰胺组和对照组分别为0.9天/全身表面积百分比和1.0天/全身表面积百分比），对照组血培养阳性的频率是谷氨酰胺治疗组的3倍（4.3天/患者 vs. 1.2天/患者，p <.05），对照组有6名患者检测到铜绿假单胞菌，谷氨酰胺组为0例（p <.05）。两组多形核细胞的吞噬作用无差异。谷氨酰胺组的死亡率显著低于对照组：意向性分析，2例 vs. 12例（p <.05）；符合方案分析，0例 vs. 8例（p <.01）。
成年烧伤患者肠内补充谷氨酰胺可使血液感染减少三分之一，预防铜绿假单胞菌菌血症，并可能降低死亡率。它对意识水平没有影响，似乎也不会影响循环多形核细胞的吞噬作用。
