肠内补充谷氨酰胺治疗严重烧伤患者：系统评价和荟萃分析。

Enteral glutamine supplements for patients with severe burns: A systematic review and meta-analysis.

机构信息

Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.

Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China; Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

出版信息

Chin J Traumatol. 2024 Dec;27(6):359-367. doi: 10.1016/j.cjtee.2023.06.005. Epub 2023 Jun 28.

DOI:10.1016/j.cjtee.2023.06.005

PMID:37460347

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11624305/

Abstract

PURPOSE

Our previous study in 2009 concluded that glutamine may shorten the length of hospital stay (LOS) in patients with severe burns. Recent large-scale studies have suggested a decline in the effectiveness of glutamine in treating patients with severe burns over the last decade. Therefore, we conducted this systematic review and meta-analysis to update the status of glutamine uses in patients with severe burns.

METHODS

We retrieved related literature prior to December 2022 from the PubMed, Web of Science, Cochrane Library, Embase, SinoMed, Wanfang, and CNKI databases. Terms such as glutamine, enteral and burn were linked for searching. Adults patients with severe burns were included and non-randomized controlled trials were excluded. Data from studies that compared enteral glutamine for severe burns with a control group were extracted. The primary outcomes of mortality and infectious morbidities were pooled and analyzed. The modified Jadad scale and Cochrane collaboration's tool were used to assess the risk of bias in RCTs, and the Review Manager 5.4 was used to pool and analyze the data.

RESULTS

Six randomized controlled trials involving 1398 patients were included in the analysis. There were no significant differences in overall mortality (risk ratio (RR) = 0.37; 95% confidence interval (CI): 0.06 - 2.37; p = 0.300) or infectious morbidities (RR = 0.73; 95% CI: 0.41 - 1.31; p = 0.290). The incidence of multiple organ dysfunction syndrome was similar between the 2 groups (RR = 0.27; 95% CI: 0.03 - 2.24; p = 0.220). The LOS (mean difference (MD) = -8.97; 95% CI: -15.22 to -2.71; p = 0.005) and LOS/total burn surface area (MD = -0.27; 95% CI: -0.54 to 0.00; p = 0.050) decreased in the enteral glutamine group. The incidence of wound infection was significantly reduced (RR = 0.42; 95% CI: 0.16 - 1.06; p = 0.070).

CONCLUSION

Compared to the control group, enteral glutamine administration may not improve the mortality, although it may be associated with a shorter LOS, a lower LOS/total burn surface area ratio, and may reduce the risk of wound infection in patients with severe burns.

摘要

目的

我们之前在 2009 年的研究得出结论，谷氨酰胺可能会缩短严重烧伤患者的住院时间（LOS）。最近的大规模研究表明，在过去十年中，谷氨酰胺治疗严重烧伤患者的效果有所下降。因此，我们进行了这项系统评价和荟萃分析，以更新严重烧伤患者使用谷氨酰胺的现状。

方法

我们检索了 2022 年 12 月前来自 PubMed、Web of Science、Cochrane 图书馆、Embase、SinoMed、万方和中国知网数据库的相关文献。使用谷氨酰胺、肠内和烧伤等术语进行搜索。纳入成人严重烧伤患者，排除非随机对照试验。提取比较肠内谷氨酰胺治疗严重烧伤与对照组的研究数据。使用改良 Jadad 量表和 Cochrane 协作工具评估 RCT 的偏倚风险，并使用 Review Manager 5.4 进行数据合并和分析。

结果

纳入的 6 项随机对照试验共涉及 1398 名患者。两组患者的总死亡率（风险比（RR）=0.37；95%置信区间（CI）：0.06-2.37；p=0.300）或感染性并发症发生率（RR=0.73；95%CI：0.41-1.31；p=0.290）无显著差异。两组患者多器官功能障碍综合征的发生率相似（RR=0.27；95%CI：0.03-2.24；p=0.220）。肠内谷氨酰胺组的 LOS（均数差（MD）=-8.97；95%CI：-15.22 至-2.71；p=0.005）和 LOS/总烧伤面积（MD=-0.27；95%CI：-0.54 至 0.00；p=0.050）降低。肠内谷氨酰胺组的伤口感染发生率显著降低（RR=0.42；95%CI：0.16-1.06；p=0.070）。