临床营养治疗全身炎症反应综合征的疗效和安全性的系统评价

Effect of Clinical Nutritional Supplementation for Systematic Inflammatory Response Syndrome: A Systematic Review

目的 系统评价各种临床营养支持方案对全身炎症反应综合征 (systematicinflammatoryresponscsyn drome ,SIRS)的疗效和安全性。方法 计算机检索MEDLINE(1996～ 2 0 0 4 11)、EMBASE(1984～ 2 0 0 2 11)、Cochrane临床对照试验资料库 (2 0 0 4年第 4期 )、中国Cochrane中心临床对照实验资料数据库、中国生物医学文献数据库(1978～ 2 0 0 4 11) ,手工检索纳入试验的所有中文及外文文献及相关文献 ,收集所有对SIRS进行临床营养支持的随机对照试验 ,对其逐个进行方法学质量评价 ,并用RevMan 4 . 2 . 7进行Meta分析。结果 共纳入 6个随机对照试验 ,35 3例使用临床营养治疗的SIRS患者。①在改善SIRS的病死率方面 ,谷氨酰胺、硒等临床营养干预各有 1个研究报道。结果显示 :与对照组比较 ,差异无统计学意义 [RR 1. 19,95 %CI (0. 5 9,2 . 4 1)和RR 0 .6 7,95 %CI(0 . 31,1 .32 ) ];②仅有 1个研究报告了谷氨酰胺干预可以降低SIRS院内感染发生率 ,与对照组比较其差异有统计学意义 [RR 0 . 5 ,95 %CI (0 . 2 7,0 .91) ],但不能降低多器官功能障碍综合征 (multipleorgandysfunctionsyndrome ,MODS)的发生率 [RR 1 .5 3,95 %CI(0 . 6 4 ,3 .6 6 ) ];③分别有 1个和 2个研究报告了谷氨酰胺及低热卡摄入对危?

Objective To assess the effect and safety of clinical nutritional supplementation with different patterns for treating systematic inflammatory response syndrome (SIRS) Methods Randomized controlled trials (RCTs) were identified from MEDLINE(1996Nov 2004), EMBASE(1984Nov 2002),Cochrane Controlled Trials Register (Issue 4, 2004), Chinese Cochrane Centre Database (Issue 4, 2004), CBMdisc (1978Nov 2004) We handsearched related published and unpublished data and their references All RCTs of nutritional interventions for SIRS were included Data were extracted and evaluated by two reviewers independently with designed extraction form RevMan 4 2 7 software was used for data analysis Results Six RCTs involving 353 patients were included All the results of meta analysis were listed as the following: ① Mortality: compared with routine nutrition, one study showed that glutamine had a statistical difference with RR 0 67 and 95%CI 0 31 to 1 32 Compared with no treatment, one study showed selenium had a statistical difference with RR 1 19, 95%CI 0 59 to 2 41 ② Compared with routine nutrition, one study showed that glutamine had a statistical difference on reducing the ratio of nasocomial infection of SIRS with RR 0 5, 95%CI 0 27 to 0 91, but had no statistical difference on reducing the ratio of multiple organ dysfunction syndrome with RR 1 53, 95%CI 0 64 to 3 66 ③ Improvement of the critical condition of SIRS: compared with routine nutrition, one study showed that glutamine had a statistical differences with WMD 4 0, 95%CI 2 36 to 5 64; compared with high calorie intake, two studies showed low calorie intake had a statistical difference with WMD 4 9, 95%CI 1 76 to 8 04 ④ Reduction of the complication of hyperglycemia and hypertriglyceridemia: compared with high calorie intake, one study showed low calorie intake had statistical difference with WMD -0 70, 95%CI -1 20 to -0 20 and WMD -1 80, 95% CI -2 42 to -1 16 respectively and all P≤0 01 ⑤ Increasing of the plasma IgG concentration: compared with routine nutrition, two studies showed that glutamine had a statistical difference with WMD 4 20, 95% CI 2 23 to 6 16 ⑥ Increasing of the nitrogen balance, intestinal permeability, the level of plasma concentration of anlbumin, prealbumin and TRF: compared with control interventions, glutamine, low calorie intake, selenium supplementation and fructose glucose xylitol mixture showed no statistical difference Conclusions Glutamine, low calorie intake, selenium supplementation, FGX mixture may decrease the complication of infection or metabolism and be better than the controlled interventions; but there is no benefit on reducing the rate of death result from SIRS compared with controlled interventions The evidence of most RCTs with poor quality is too weak to draw a conclusion More high quality trials are required