摘要
研究目的:比较胰岛素强化治疗(IIT)和常规胰岛素治疗(CIT)对创伤性脑损伤(TBI)患者临床转归的影响。研究方法:从MEDLINE、EMBASE、Google Scholar、ISI Web of Science和Cochrane Library系统搜索TBI患者的IIT与CIT的随机对照试验(RCT),并进行对比分析,从中提取研究特征、重症监护(ICU)事件和长期预后结果,使用随机形式进行荟萃分析。研究结果:获得包括1070个患者在内的7个RCT,尽管经过IIT治疗的患者有着更好的神经系统预后(GOS>3,RR=0.87,95%CI=0.78~0.97,P=0.01,I^2=0%),但敏感性分析显示其中的一项研究似乎影响了这一治疗方案的总体评估(RR=0.90,95%CI=0.80~1.01,P=0.07,I^2=0%),IIT与低血糖风险的增加密切相关(RR=5.79,95%CI=3.27~10.26,P<0.01,I^2=38%);在早期或晚期死亡率方面,IIT和CIT似乎没有差异(RR=0.96,95%CI=0.79~1.17,P=0.7,I^2=0%);感染率(RR=0.82,95%CI=0.59~1.14,P=0.23,I^2=68%)或ICU内停留时间(SMD=-0.14,95%CI=-0.35~0.07,P=0.18,I^2=45%)。研究结论:IIT不能改善长期神经系统预后、死亡率和感染率,并且与低血糖风险增加有关,应该设计更为严谨的TBI亚组RCT实验,以产生更有力的结论。
Research purposes:IIT and CIT on TBI Impact of clinical outcomes.METHODS:A randomized controlled trial(RCT)of IIT and CIT in patients with TBI was searched from MEDLINE、EMBASE、Google Scholar、ISI Web of Science,and Cochrane Library,and comparative analysis was performed to extract study features and intensive care(ICU)events.And long-term prognostic outcomes,meta-analysis using randomized forms.RESULTS:Seven RCTs including 1070 patients were obtained,although patients treated with IIT had a better neurological outcome(GOS>3,RR=0.87,95%CI=0.78 to 0.97,P=0.01,I^2=0%),but sensitivity analysis showed that one of the studies seemed to affect the overall assessment of this treatment(RR=0.90,95%CI=0.80 to 1.01,P=0.07,I^2=0%),IIT It was closely associated with an increased risk of hypoglycemia(RR=5.79,95%CI=3.27 to 10.26,P<0.01,I^2=38%);there was no difference in IIT and CIT in terms of early or late mortality(RR=0.96,95%CI=0.79 to 1.17,P=0.7,I^2=0%);infection rate(RR=0.82,95%CI=0.59 to 1.14,P=0.23,I^2=68%)or residence time in ICU(SMD=-0.14,95%CI=-0.35 to 0.07,P=0.18,I^2=45%).Conclusion:IIT does not improve long-term neurological prognosis,mortality,and infection rates,and is associated with an increased risk of hypoglycemia.We should design RCT experimental analysis of the more rigorous TBI subgroup to produce more powerful conclusions.
作者
杨猛
YANG Meng(The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《冰雪运动》
2019年第4期86-96,共11页
China Winter Sports
基金
黑龙江省卫生厅课题基金(2011-041)
黑龙江省教育厅课题(2012).
关键词
创伤性脑损伤
胰岛素强化治疗
常规胰岛素治疗
血糖控制
随机对照试验
Traumatic brain injury(TBI)
Intensive insulin therapy(IIT)
conventional insulin therapy(CIT)
Blood glucose control(BGC)
Randomized controlled trial(RCT)
作者简介
杨猛(1974-),女,黑龙江哈尔滨人,副主任护师,研究方向为神经护理。
