| Summary: | 碩士 === 輔英科技大學 === 保健營養系碩士班 === 101 === Objective: The objective of this study is to understand the effects of glutamine-supplemented parenteral nutrition on critical ill patients, and reduce individual limitations of the study. Researcher use meta-analysis to integrate the effectiveness of glutamine of randomized-controls trials and clinical trials for critically ill patients to explore glutamine adjuvant therapeutic effectiveness of clinical outcomes, and further analysis of supplementary doses as well. Hopefully the results of this study can be the reference of clinical treatment of critical patients.
Background: Critically ill patients often induced human inflammation, the body will produce a wide range of injuries, excessive inflammation can cause immune suppression, resulting in the case of sepsis, which can lead to elevate morbidity and mortality. Most clinical trials showed that glutamine have certain efficacy of adjuvant therapy for critically ill patients, yet, there are still some studies did not showed its positive benefits. Therefore, this study will explore the actual benefits glutamine supplementation for critically ill patients.
Methods: A meta-analysis of relevant studies were retrieved by searching Medline, Pubmed, Cochrane library, the collecting period was from 1 January 1990 to 31 March 2013, published in English and Chinese literature. The searching policy was using the keywords, and then read the titles and abstracts through the initial screening, then, according to the research purpose and according to setting of inclusion and exclusion criteria selected literature. The selected literatures were read thoroughly reading literature.
Result: The results of this study showed that supplemental parenteral glutamine dipeptide in the overall complications did not find a significant differences (RR 0.87,95% CI 0.60, 1.25, P = 0.44), and in infectious complications were found a significant reduce (RR = 0.77,95% CI 0.66, 0.90, p = 0.0007). Length of ICU stay did not find significant differences (WMD -2.17,95% CI -4.81, 0.47, P = 0.11), but there is significant reduced total length of hospital stay, (WMD -3.46,95% CI -5.80, -1.12 , P = 0.004); the overall mortality was associated with a non-significantly reduced in glutamine arms(RR 0.80,95% CI 0.64, 1.00 , P = 0.05), but in the high-dose supplement found to have significantly reduced populations the incidence of death (RR 0.67,95% CI 0.46, 0.99, P = 0.04); supplemented glutamine can make plasma glutamine concentration significant increase (WMD 123.17,95% CI 109.61, 136.73, P <0.00001).
Conclusions: Parenteral glutamine dipeptide supplemental in critically ill patients may reduce infectious complications and hospital length of stay,the efficiency of no significant effect on overall mortality but supplemental high doses can reduce mortality. The results showed the high doses of glutamine of supplement have better clinical outcomes. In addition, although supplemental glutamine found a significant increase in plasma glutamine concentration, but still need more studies in further to different doses of the impact on patients.
Keywords: Glutamine, Clinical outcome, Parenteral nutrition, Meta-analysis
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