免疫营养支持对颅脑损伤病人影响的系统评价  

Immuonutrition support for traumatic brain injury:A systematic review

作　　者：王文涛[1] 马弟娃 牛小东[1] 王振伟[2] 董华腾[3] 张祎年[4] 

机构地区：[1]兰州大学第二临床医学院 [2]兰州大学第一临床医学院 [3]甘肃省妇幼保健院 [4]兰州大学第二医院神经外科,甘肃兰州730000

出　　处：《肠外与肠内营养》2014年第5期273-277,281,共6页Parenteral & Enteral Nutrition

基　　金：中央高校基本科研业务专项基金(861163);教育部高等学校博士学科专项基金(20130211120026)

摘　　要：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 evaluate the effectiveness of immuonutrition support （glutamine） for severe traumatic brain injury （TBI）.Methods：The databases such as Pubmed（1966 to July 2013）,Embase（1984 to July 2013）,Cochrane Library（July 2013）,CBM（1978 to July 2013）,CNKI （July 2013）,VIP（July 2013） and Wanfang （July 2013） were electronically searched.Two reviewers independently screened the trials according to inclusions and exclusion criteria,data extraction and systematic reviews.Systematic reviews were performed using the Cochrane Collaboration＇s RevMan 5.2 software.Results：Fourteen randomized controlled trials （RCTs） involving 689 participants with severe TBI were included.The results of Systematic Reviews showed that compared with control group,glutamine supplemented enteral nutrition group could reduce,the diarrhea [RR =0.57,95％ CI （0.36,0.89）,P =0.01] and hospital lengths of stay [SMD =-8.00,95％ CI （-15.36,-0.64）,P =0.03].The glutamine supplemented parenteral nutrition group might reduce the risk of pulmonary infection[RR =0.45,95％ CI （0.25,0.84）,P =0.01] and the blood glucose level [RR =-2.31,95 ％ CI （-3.44,-1.18）,P ＜ 0.01].Conclusion：Glutamine supplemented enteral nutrition can reduce the diarrhea and hospital lengths of stay,and increase total protein.Glutamine supplemented parenteral nutrition may reduce risk of pulmonary infection and the blood glucose level.

关 键 词：免疫营养 颅脑损伤 系统评价 

分 类 号：R651.15[医药卫生—外科学]