谷氨酰胺双肽在腹部外科围手术期临床应用的系统评价

Clinical Application of Glutamine Dipeptide in Abdominal Surgery:A Systematic Review

目的评价谷氨酰胺双肽在腹部外科围手术期的临床应用和卫生经济学价值。方法通过计算机检索Cochrane图书馆、MEDLINE、EMBASE数据库和CNKI、VIP、CBMDISK数据库,评价纳入随机对照研究,应用RevMan 4.2软件进行Meta分析。结果纳入15个临床研究(n=531)。Meta-分析显示,谷氨酰胺双肽增强的肠外营养与对照组比较可使患者临床感染率降低至34％,95％CI[0.19,0.62],P=0.0004；患者平均总住院时间缩短3.20天,95％CI[-4.95,-1.44],P=0.0004；并可提高术后肠外营养效益,与对照组比较,累积氮平衡提高3.96 g,95％CI[3.07,4.96],P＜0.00001。结论谷氨酰胺双肽在治疗剂量,能够有效降低腹部外科手术患者术后感染风险,促进负氮平衡改善,缩短住院时间；但目前的证据还无法充分肯定是否对手术患者死亡率有影响。在卫生经济学方面,有研究发现谷氨酰胺双肽可以减少平均住院花费,但尚需大样本进一步深入研究。

To assess the clinical and economics validity of glutamine dipeptid application in abdominal surgery. Methods The following electronic databases were retrieved via computer system： Cochrane Library, MEDLINE, EMBASE, Chinese CNKI, VIP, and CBMDISK database. The found randomized control trials were then appraised. Meta analysis was conducted with RevMan 4.2. Results Fifteen studies （n=531） were included. Meta analysis showed that there was a significantly lower infectious risk was found in glutamine dipeptide group （RR： 0.34; 95% CI： 0.19-0.62; P=0.0004）. The mean hospital stay time was reduced by 3.20 days （95% CI： -4.95, -1.44, P = 0.0004）. Compared with the control group, the accumulative nitrogen balance increased by 3.96 g （95% CI： 3.07, 4.96, P〈 0.00001）. Conclusion Glutamine dipeptide supplementation can reduce the infection risk and length of hospital stay in surgical and critical patients. However, currently available evidences are still not confirmative enough to determine whether it has a role in the mortality of surgical patients. A beneficial trend of economics may exist but requires further investigation.