强化胰岛素治疗对重症监护患者病死率影响的Meta分析

目的 系统评价强化胰岛素治疗(IIT)对重症监护病房(ICU)患者病死率的影响.方法 计算机全面检索收集1966-2009年发表的关于IIT对ICU患者病死率影响的随机对照临床试验文献,并严格评价符合纳入文献的质量,用RevMan 5.0软件进行数据分析.结果 最终纳入23个研究,共11 216例患者.Meta分析结果 显示:IIT方案可有效降低重症监护患者的病死率(包括内科ICU、外科ICU及综合ICU中的病死率),降低患者在ICU期间的感染率和并发症发生率,也可以使目标血糖达到最佳范围,但IIT组低血糖发生率略高于传统胰岛素治疗(CIT)组.结论 IIT治疗方案比CIT治疗方案能明显降低ICU患者的病死率、感染率及并发症发生率,使目标血糖阈值达到期望的范围内,从而提高了患者生存质量;然而在低血糖的控制方面IIT方案不及CIT方案.

The influence of intensive insulin therapy on the mortality of critically ill patients in intensive care unit:a Meta-analysis

Objective To assess the influence of intensive insulin therapy (IIT), as compared with conventional insulin therapy (CIT), on mortality of critically ill patients in the intensive care unit (ICU) by Meta-analysis. Methods Computer retrieval was conducted to search for randomly controlled trials (1966 -2009) to compare the result of IIT and CIT. The quality of included studies was critically evaluated and data were analyzed by using the Coehrane Collaboration's RevMan 5.0 software. Results A total of 23 studies were included in the Meta-analyses, consisting 11 216 patients. This Meta-analysis showed that there were significant difference between IIT and CIT in the mortality (unselected in the medical, surgical and mixed ICU), with significant lowering in IIT group. There was remarkable lowering of infection rate and the complication rate in IIT group compared with CIT group. However, the incidence of hypoglycemia was slightly lower in CIT group. Conclusion IIT tends to lower the mortality rate, infection rate, and complications in critically ill patients in the ICU as compared with CIT. Also with liT the target blood glucose can be easier reached than CIT. The therapy can improve the quality of life. However, IIT is not as good as CIT in the control of hypoglycemia.