特集 conditionally essential amino acid, グルタミンジペプチド (Glutamine dipeptide), 多臓器不全 Ⅰ はじめに sepsis RE- DOXS Ⅱ 重症患

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1 143 特集 conditionally essential amino acid, グルタミンジペプチド (Glutamine dipeptide), 多臓器不全 Ⅰ はじめに sepsis RE Ⅱ 重症患者における生体内でのグルタミンの役割 1950 Eagle /

2 conditionally essential amino acid Ⅲ 実臨床におけるグルタミンの投与方法 L- S 99 L g 1 80 g 300 kcal L g glutamine dipeptide Fresenius Kabi Glamin Dipeptiven L- dipeptide Ⅳ 重症患者に対するグルタミン投与の臨床効果 2013 REDOXS meta analysis 1 meta analysis ICU 40RCT Bollhalder meta analysis 11 RR CI RR CI CI ESPEN 0.2 g/kg BW/day 9 3 critical illness 2014 Wischmeyer systematic review 26 RCT 2,484 RR 0.68, 95 CI , P WMD 2.56, 95 CI , P 0.02 RR 0.86, 95 CI , P Wischmeyer

3 145 RE- 0.5 g/ kg/day 19RCT 1243 Sandini WMD CI p RR CI p RR 0.84, 95 CI p meta analysis 2009 Jiang meta analysis abstract APACHE score RCT 3RCT 489 3RCT 6 van Zanten meta analysis Metaplus study 11RCT 1079 RR 0.94, 95 CI p 0.74 RR 0.93, 95 CI p 0.39 ICU WMD 1.36 days, 95 CI p 0.52 WMD 4.73 days, 95 CI p 0.02 subgroup RR 0.19, 95 CI p WMD 9.16, 95 CI p RCT randomized controlled trial, RR risk ratio, CI confidence interval, WMD weighted mean difference Ⅴ 重症患者に対するグルタミン投与は有害? 2009 SIGNET n g odds ratio 1.18, 95 CI REDOXS n g+0.35 g/kg vs CI P g Na 2014 MetaPlus 72 ICU n 301 ω-3 IMHP

4 146 HP IMHP 1500ml 23 g 30 g 6 IMHP RR CI P IMHP 54 vs 35 p ICU 11,12 Ⅵ 最近のガイドライン変化 ESPEN ICU mg/kg/day L- e.g g/kg/day alanyl glutamine dipeptide REDOXS Heyland 15 REDOXS REDOXS meta analysis MetaPlus SCCM/ASPEN Ⅶ おわりに REDOXS RE-

5 147 文献 1 Eagle H, Oyama VI, Levy M et al. The growth response of mammalian cells in tissue culture to L glutamine and L glutamic acid. The Journal of biological chemistry , Windmueller HG, Spaeth AE Uptake and metabolism of plasma glutamine by the small intestine. The Journal of biological chemistry , Bollhalder L, Pfeil AM, Tomonaga Y et al. A systematic literature review and meta analysis of randomized clinical trials of parenteral glutamine supplementation. Clinical nutrition , Wischmeyer PE, Dhaliwal R, McCall M et al. Parenteral glutamine supplementation in critical illness a systematic review. Critical care 18 R76, Sandini M, Nespoli L, Oldani M et al. Effect of glutamine dipeptide supplementation on primary outcomes for elective major surgery systematic review and meta analysis. Nutrients , Jiang H, Chen W, Hu W et al. The impact of glutamine enhanced enteral nutrition on clinical outcome of patients with critical illness a systematic review of randomized controlled trials. Zhonghua shao shang za zhi Zhonghua shaoshang zazhi Chinese journal of burns , van Zanten AR, Dhaliwal R, Garrel D et al. Enteral glutamine supplementation in critically ill patients a systematic review and meta analysis. Critical care , Andrews PJ, Avenell A, Noble DW et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ 342 d1542, Heyland D, Muscedere J, Wischmeyer PE et al. A randomized trial of glutamine and antioxidants in critically ill patients. The New England journal of medicine , van Zanten AR, Sztark F, Kaisers UX et al. High protein enteral nutrition enriched with immune modulating nutrients vs standard high protein enteral nutrition and nosocomial infections in the ICU a randomized clinical trial. JAMA , Gottschalk A, Wempe C, Goeters C Glutamine in the ICU who needs supply? Clinical nutrition , Heyland DK, Elke G, Cook D et al. Glutamine and Antioxidants in the Critically Ill Patient A Post Hoc Analysis of a Large Scale Randomized Trial. JPEN Journal of parenteral and enteral nutrition Kreymann KG, Berger MM, Deutz NE et al. ESPEN Guidelines on Enteral Nutrition Intensive care. Clinical nutrition , Singer P, Berger MM, Van den Berghe G et al. ES- PEN Guidelines on Parenteral Nutrition intensive care. Clinical nutrition , McClave SA, Martindale RG, Vanek VW et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine SCCM and American Society for Parenteral and Enteral Nutrition A.S.P.E.N.. JPEN Journal of parenteral and enteral nutrition , McClave SA et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine SCCM and American Society for Parenteral and Enteral Nutrition A.S.P.E.N. JPEN J Parenter Enteral Nutr , in press.

外科と代謝・栄養_51巻2号.indb

外科と代謝・栄養_51巻2号.indb 51 2 2017 4 55 特集 Ⅰ はじめに intravenous fat emulsions IVFEs Ⅱ IVFEs の世代分類図 1 American Society for Parenteral and Enteral Nutrition AS- PEN 1 IVFEs 2 IVFEs soybean oil SO medium chain triglyceride MCT olive

特 集 conditionally essential amino acid, グルタミンジペプチド (Glutamine dipeptide), 多臓器不全 Ⅰ はじめに sepsis RE- DOXS Ⅱ 重症患

特集 conditionally essential amino acid, グルタミンジペプチド (Glutamine dipeptide), 多臓器不全 Ⅰ はじめに sepsis RE- DOXS Ⅱ 重症患