谷氨酰胺对颅脑损伤患者预后影响的Meta分析  

Glutamine for traumatic brain injury: Meta analysis

作　　者：段磊[1,2] 曾嵘[3,2] 田洪亮[2] 杨克虎[2] 

机构地区：[1]兰州大学第二医院神经外科,甘肃兰州730030 [2]兰州大学循证医学中心,甘肃兰州在读博士730000 [3]兰州大学第二医院肾内科,甘肃兰州730030

出　　处：《甘肃医药》2013年第7期481-486,共6页Gansu Medical Journal

摘　　要：目的:系统评价谷氨酰胺对颅脑损伤患者预后的影响。方法:计算机检索Pubmed,Embase,Cochrane Library,CBM,CNKI,维普及万方数据库,全面收集从建库至2012年2月,有关谷氨酰胺用于颅脑损伤患者营养支持的随机对照试验;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RevMan5.1软件进行分析。结果:共纳入10个随机对照试验,合计492例患者。Meta分析结果显示:与空白对照相比,谷氨酰胺强化治疗能降低肺部感染率[RR=0.40,95%C(I0.26,0.62),P<0.0001],缩短住院时间[SMD=-1.08,95%C(I-1.69,-0.48),P=0.0005],提高GCS评分[SMD=0.73,95%C(I0.40,1.06),P<0.0001]及临床疗效[RR=1.36,95%CI(1.07,1.72),P=0.01];但两组死亡率[RR=0.56,95%C(I0.28,1.12),P=0.10]及腹泻发生率[RR=0.62,95%C(I0.36,1.08),P=0.09]均无统计学差异。结论:谷氨酰胺强化的营养支持能减低颅脑损伤患者肺部感染率,缩短住院时间,提高GCS评分及临床疗效;但不能降低患者的死亡风险及腹泻发生率。纳入研究的方法学质量较低,建议今后的研究采用科学的随机分组方法及分配方案隐藏。Objective：To evaluate the effectiveness of glutamine for severe traumatic brain injury（TBI）. Methods：The databases such as Pubmed（1966 to February 2012）,Embase（1984 to February 2012）,Cochrane Library（February 2012）,CBM（1978 to February 2012）,CNKI,VIP and Wanfang were electronically searched. Two reviewers independently screened the trials according to inclusion and exclusion criteria,extracted the data,and assessed the risk of bias. Meta-analyses were performed using the Cochrane Collaboration’s RevMan 5.1 software. Results：Ten randomized controlled trials（RCTs） involving 492 participants with severe TBI were included. The results of meta-analyses showed that compared with control group,glutamine group could reduce the risk of pulmonary infection [RR= 0.40,95%CI（0.26,0.62）,P0.0001],hospital lengths of stay[SMD=-1.08,95%CI（-1.69,-0.48）,P=0.0005],improve GCS scores SMD =0.73,95% CI（0.40,1.06）,P 0.0001]and clinical effectiveness [RR =1.36,95% CI（1.07,1.72）,P =0.01]. However,they have no differences in mortality rate [RR=0.56,95%CI（0.28,1.12）,P=0.10]and diarrhea rate [RR=0.62,95%CI（0.36,1.08）,P=0.09]. Conclusion：Supplement of glutamine could reduce pulmonary infection,hospital lengths of stay and improve GCS scores and clinical effectiveness. With RCTs of low methodology quality,trials in future should rigor generate random sequence and conceal allocation.

关 键 词：谷氨酰胺 颅脑损伤 随机对照试验 META分析 

分 类 号：R651.15[医药卫生—外科学]