1. Искусство защиты
Дипептивен. Европейские рекомендации и стандарты
Дипептивен®
Критические
состояния
Необходимо включать 0,2–0,4 г/кг/сут. глутамина =
0,3–0,6 г/кг/сут. дипептида аланил-глутамина
(1,5–3 мл/кг Дипептивена)
Уровень
доказательств А
Хирургия
…для тяжелых хирургических пациентов, нуждающихся в
искусственном питании, вводить внутривенно глутамин
Уровень
доказательств В
• Снижает смертность
Панкреатит
…рассмотреть вопрос о внутривенном введении
0,3–0,4 г/кг/сут. дипептида глутамина
Уровень
доказательств В
• Снижает длительность
госпитализации
Онкология
Есть доказательства, что введение глутамина улучшает… баланс
азота и иммунную функцию, снижает риск инфекционных
осложнений, время госпитализации и смертность
Уровень
доказательств В
ESPEN Guidelines Parenteral Nutrition: Intensive Care
Официальный сайт Европейской ассоциации
энтерального и парентерального питания ESPEN
http://www.espen.org/espenguidelines
(январь 2009)
Уровень доказательств – А (1)
Представительство «Фрезениус Каби Дойчланд ГмбХ»
тел.: (495) 988-45-78, факс: (495) 988-45-79
E-mail: freka@fresenius-kabi.ru, www.fresenius-kabi.ru

2. Дипептивен. Эффекты
Дипептивен. Доказательства
Мета-анализ 9 клинических исследований, включающих 424 пациента (Wischmeyer, 2008): введение дипептивена
снижает риск летального исхода на 33%
ials
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Glutamine su
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100,00
Всего (95% ДИ)
267
267
Случаев: 39 (Глутамин в/в), 63 (контроль)
Test for heterogeneity: x2 = 3,19, df = 6 (P = 0,79), I2 = 0%
Test for overall effect: Z = 2,44 (P = 0,01)
0,1 0,2
0,5
1
2
5
RR
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0,97 [0,14, 6,62]
0,63 [0,12, 3,28]
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0,72 [0,39, 1,32]
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0,15 [0,01, 2,73]
0,19 [0,02, 1,57]
год
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2006
2004
1997
1999
2001
2004
2009
10
Преимущество «глутамин» Преимущество «контроль»
Эффект парентерального глутамина на смертность
при критических состояниях
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DOI: 10.1097/01
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Crit Care Med
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in
2002 Vol. 30,
trition e [1]. This eding and venous glutthese effect ion, glutam use an incr lead to ad ain. Altern
No. 9
outcom travenous fe with intra ground to ine deplet 7]. may ca in turn mayn in the br
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T
Исследование Глутамин в/в
n/N
Dechelotte 2006
2/58
Fuentes-Orozco
2/17
Griffiths
18/42
Powell-Tuck
14/83
Wischmeyer
2/15
Xian-Li
0/20
Ziegler
1/32
млн пациентов с метаболическим
стрессом получали Дипептивен
Мета-анализ 10 клинических исследований, включающих 355 пациентов после хирургических операций (Jiang, 2004): введение
дипептивена снижает длительность госпитализации на 3 дня и снижение частоты инфекционных осложнений на 58%
Частота инфекционных осложнений
Исследование Глутамин в/в
n/N
Chen SL
1/15
Cheng AQ
3/20
Huang MS
0/11
Jiang ZM
0/30
Li HY
2/20
Liang CH
1/12
Neri
1/16
Yao GX
0/14
Zhu J
5/24
Zhu MW
1/15
Subtotal (95%)
14/177
Контроль
n/N
2/15
3/20
2/11
3/30
4/20
3/12
4/17
2/14
10/24
3/15
36/178
RR
ДИ 95%
Уд. вес, %
5,4
8,0
6,7
9,4
10,7
8,0
10,4
6,7
26,8
8,0
100,0
RR
ДИ 95%
0,50 (0,05, 4,94)
1,00 (0,23, 4,37)
0,20 (0,01, 3,74)
0,14 (0,01, 2,65)
0,50 (0,10, 2,43)
0,33 (0,04, 2,77)
0,27 (0,03, 2,13)
0,20 (0,01, 3,82)
0,50 (0,20, 1,25)
0,33 (0,04, 2,85)
0,42 (0,24, 0,72)
100,00
0,42 (0,24, 0,72)
Test for heterogeneity chl-square=2,65 df=9 p=0,97
Test for overall effect z=-3,15 p=0,002
Всего (95% ДИ)
14/177
36/178
Test for heterogeneity chl-square=2,65 df=9 p=0,97
Test for overall effect z=-3,15 p=0,002
-1 -2
1
5
10
Преимущество «глутамин» Преимущество «контроль»
Мета-анализ 14 клинических исследований. Введение глутамина при тяжелых заболеваниях (Novak F. et al. Crit Care
Med 2002; 30, No. 9). На 2,6 дня меньше длительность госпитализации в ОРИТ у пациентов, получавших Дипептивен