ABSTRACT
Background: Enteral nutrition is an essential component for treatment of severe acute pancreatitis (SAP), yet there is no consensus on whether glutamine should be added in the enteral nutrition. Aims: To systematically evaluate the effect of glutamine-supplemented enteral nutrition on the condition and prognosis of SAP. Methods: Randomized controlled trials (RCT) on the effect of glutamine-supplemented enteral nutrition in the treatment of SAP were retrieved from CNKI, Wanfang, VIP, SinoMed, The Cochrane Library, PubMed, Embase and Web of Science from the date of database foundation to June 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the quality was evaluated and data were extracted. RevMan 5.2 software was used to conduct meta-analysis. Results: A total of 18 RCT involving 1 119 patients were included. Meta-analysis showed that glutamine-supplemented enteral nutrition could decrease APACHEⅡ score (MD=-2.20, 95% CI: -2.70-1.71, P<0.000 01), CRP (SMD=-1.20, 95% CI: -1.37-1.02, P<0.000 1), IL-6 (SMD=-2.09, 95% CI: -2.31-1.87, P<0.000 01), TNF-α (SMD=-2.61, 95% CI: -2.82-2.39, P<0.000 01) when compared with conventional enteral nutrition, and could shorten the hospital stay (MD=-4.84, 95% CI: -8.08-1.60, P=0.003). However, no significant differences in the incidence of complications (RR=0.84, 95% CI: 0.66-1.06, P=0.15) and mortality (RR=0.88, 95% CI: 0.51-1.51, P=0.64) were found between the two groups. Conclusions: Glutamine-supplemented enteral nutrition can reduce the inflammation level and improve the severity of SAP, but it has no effect on the incidence of complications and mortality.
ABSTRACT
Objective:To explore the characteristics of Traditional Chinese Medicine (TCM) syndromes in sepsis patients with different blood urea nitrogen (BUN) levels.Methods:From January 2017 to December 2018, 252 sepsis patients, who were admitted in the Department of Intensive Care Unit of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) and met the inclusion criteria, were divided into lower level group (BUN<9.25 mmol/L) and higher level group (BUN≥9.25 mmol/L) according to BUN levels. The baseline data, complications, infection sites and other data were collected. TCM syndromes were judged according to the four diagnostic information of TCM and BUN levels. Variables with P<0.2 in univariate analysis were introduced as candidate variables, and the correlation between TCM syndrome elements and BUN was analyzed by multivariate logistic regression. Results:The comparison of TCM syndromes showed that the proportion of blood stasis syndrome in higher level group was significantly higher than that of the lower level group [74.60% (94/126) vs. 53.17% (67/126), P<0.01)], and the proportion of toxic heat syndrome in the higher level group was significantly lower than that of the lower level group [52.38% (66/126) vs. 65.87% (83/126), P=0.029]. The comparison of TCM deficiency syndromes showed that the proportion of qi deficiency syndrome and yang deficiency syndrome in the higher level group was significantly higher than that of the lower level group [67.46% (85/126) vs. 45.24% (57/126), P<0.01; 11.90% (15/126) vs. 3.97% (5/126), P=0.032, respectively]. Logistic regression analysis showed that the higher blood urea nitrogen level was correlated with the increased incidence of qi deficiency syndrome ( OR=3.425, 95% CI: 1.934-6.068, P<0.01), yang deficiency syndrome ( OR=3.460, 95% CI: 1.160-10.325, P=0.026) and kidney deficiency syndrome ( OR=2.212, 95% CI: 1.173-4.173, P=0.014) in sepsis patients. Conclusion:Sepsis patients with higher blood urea nitrogen level have a higher proportion of blood stasis syndrome, qi deficiency syndrome and yang deficiency syndrome and may be related to the increased incidence of qi deficiency syndrome, yang deficiency syndrome and kidney deficiency syndrome.