免疫营养应该成为重症患者的常规吗? 对证据的系统审查
D K Heyland1, F Novak, J W Drover
1Angada 3, Kingston General Hospital, 76 Stuart St, Kingston, Ontario K7L 2V7, Canada. dkh2@post.queensu.ca
JAMA
|August 31, 2001
概括
用增强免疫力的营养素进行肠道营养可能会减少重症患者的传染性并发症,但不会显著影响整体死亡率. 治疗效果因干预措施,患者组和研究质量而异.
科学领域:
- 临床营养学 临床营养学
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
背景情况:
- 营养素会影响免疫和炎症反应.
- 免疫增强营养在重症患者的临床影响是不确定的.
研究的目的:
- 检查免疫增强肠道营养与重症患者的结果之间的关系.
- 评估对传染性并发症和死亡率的影响.
主要方法:
- 从多个数据库中对随机试验 (1990-2000) 的系统审查.
- 包括的研究评估了用氨酸,谷氨酸,核酸和omega-3脂肪酸的肠道营养.
- 评估感染并发症和死亡率.
主要成果:
- 免疫营养与较低的感染并发症相关 (RR 0.66;95% CI,0.54-0.80).
- 没有显著的整体死亡率优势 (RR 1.10;95% CI,0.93-1.31).
- 商业配方中含有高氨酸的配方显示,并发症减少,死亡率降低.
结论:
- 免疫营养可以降低感染并发症,但不能降低整体死亡率.
- 治疗效果根据干预措施,患者群体和研究质量而变化.
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