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严重烧伤患者补充谷氨酰胺不能缩短出院时间
作者:小柯机器人 发布时间:2022/9/16 14:48:58

美国皇后大学Daren K. Heyland团队研究了肠内注射谷氨酰胺治疗烧伤患者对预后的影响。2022年9月9日出版的《新英格兰医学杂志》发表了这项最新研究成果。

谷氨酰胺被认为对严重损伤的代谢和应激反应有有益影响。涉及烧伤患者和其他危重患者的临床试验显示,补充谷氨酰胺的益处和风险存在矛盾。

在一项双盲、随机、安慰剂对照试验中,研究组将深度二度或三度烧伤(影响总体表面积≥10%至≥20%,取决于年龄),每天接受0.5g/kg体重的肠内递送谷氨酰胺或安慰剂治疗。试验药物每4小时通过喂食管给药一次,或每天口服三到四次,直到最后一次植皮手术后7天,从急性护理病房出院,或入院后3个月,以先到者为准。主要结局是存活出院的时间,第90天时进行数据审查。研究组计算了存活出院的亚分布危险比,将死亡作为竞争风险考虑在内。

共有1209名严重烧伤患者(平均烧伤面积占总体表面积的33%)接受随机分组,1200名患者纳入分析(谷氨酰胺组596名,安慰剂组604名)。谷氨酰胺组的中位存活出院时间为40天,安慰剂组为38天,存活出院的亚分布危险比为0.91,组间差异不显著。谷氨酰胺组和安慰剂组6个月死亡率分别为17.2%和16.2%,死亡危险比为1.06。未观察到两组间严重不良事件存在差异。

研究结果表明,对于严重烧伤患者,补充谷氨酰胺并不能缩短患者的出院时间。

附:英文原文

Title: A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries | NEJM

Author: Daren K. Heyland, M.D.,, Lucy Wibbenmeyer, M.D.,, Jonathan A. Pollack, M.D.,, Bruce Friedman, M.D.,, Alexis F. Turgeon, M.D.,, Niknam Eshraghi, M.D.,, Marc G. Jeschke, M.D.,, Sylvain Bélisle, M.D.,, Daisy Grau, M.D.,, Samuel Mandell, M.D., M.P.H.,, Sai R. Velamuri, M.D.,, Gabriel Hundeshagen, M.D., M.M.S.,, Naiem Moiemen, M.D.,, Kayvan Shokrollahi, F.R.C.S.(Plast.),, Kevin Foster, M.D.,, Fredrik Huss, M.D.,, Declan Collins, M.D.,, Alisa Savetamal, M.D.,, Jennifer M. Gurney, M.D.,, Nadia Depetris, M.D.,, Christian Stoppe, M.D.,, Luis Ortiz-Reyes, M.Sc.,, Dominique Garrel, M.D.,, and Andrew G. Day, M.Sc.

Issue&Volume: 2022-09-09

Abstract:

Background

Glutamine is thought to have beneficial effects on the metabolic and stress response to severe injury. Clinical trials involving patients with burns and other critically ill patients have shown conflicting results regarding the benefits and risks of glutamine supplementation.

Methods

In a double-blind, randomized, placebo-controlled trial, we assigned patients with deep second- or third-degree burns (affecting ≥10% to ≥20% of total body-surface area, depending on age) within 72 hours after hospital admission to receive 0.5 g per kilogram of body weight per day of enterally delivered glutamine or placebo. Trial agents were given every 4 hours through a feeding tube or three or four times a day by mouth until 7 days after the last skin grafting procedure, discharge from the acute care unit, or 3 months after admission, whichever came first. The primary outcome was the time to discharge alive from the hospital, with data censored at 90 days. We calculated subdistribution hazard ratios for discharge alive, which took into account death as a competing risk.

Results

A total of 1209 patients with severe burns (mean burn size, 33% of total body-surface area) underwent randomization, and 1200 were included in the analysis (596 patients in the glutamine group and 604 in the placebo group). The median time to discharge alive from the hospital was 40 days (interquartile range, 24 to 87) in the glutamine group and 38 days (interquartile range, 22 to 75) in the placebo group (subdistribution hazard ratio for discharge alive, 0.91; 95% confidence interval [CI], 0.80 to 1.04; P=0.17). Mortality at 6 months was 17.2% in the glutamine group and 16.2% in the placebo group (hazard ratio for death, 1.06; 95% CI, 0.80 to 1.41). No substantial between-group differences in serious adverse events were observed.

Conclusions

In patients with severe burns, supplemental glutamine did not reduce the time to discharge alive from the hospital.

DOI: 10.1056/NEJMoa2203364

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2203364

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home