围手术期严格控制血糖对心脏手术患者预后的影响（Meta分析）  

Effect of intensive glucose control during peri-operative period on prognosis of patients undergoing cardiac surgery： a Meta-analysis

作　　者：马龙[1] 吴昆[1] 安园园[1] 宋婷[1] 于湘友[1] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054

出　　处：《中国危重病急救医学》2012年第4期201-206,共6页Chinese Critical Care Medicine

基　　金：新疆维吾尔自治区自然科学基金（2011211A065）;新疆乌鲁木齐市科技计划项目（Y111310024）

摘　　要：目的对文献进行系统评价，比较围手术期严格血糖控制和正常血糖控制对心脏手术患者预后的影响。方法根据Cochrane协作网制定的策略，并使用PubMed数据库进行英文检索，对符合检索条件的文献进行系统评价，文献质量评价和数据提取由2名评价员独立完成，使用RevMan5．0软件进行分析。结果共有7篇随机对照临床试验（RCT）的文献、共2329例患者纳入荟萃分析（Meta分析）。分析结果显示：严格血糖控制能降低患者感染率[比值比（OR）=0．42，95％可信区间（95％CI）为（0．25，0．73），P=0．002]和病死率[OR=0．54，95％CI（0．34，0．87），P=0．01]，缩短机械通气时间[加权均数差（WMD）=-2．68，95％CI（-4．99，-0．37），P=0．02]和重症监护病房（ICU）监护治疗时间[WMD=-15．49，95％CI（-16．14，-14．83），P〈0．00001]，使术后心房颤动的发生率有所降低[OR=O．77，95％CI（0．60，1．00），P=0．05]，但并不能减少心外膜起搏使用频率[OR=0．32，95％CI（0．09，1．05），P=0．06]。结论围手术期严格控制血糖能有助于改善心脏手术患者的预后。Objective To systematically review the literature to determine the effects of intensive versus normal glycaemie control during peri-operative period on prognosis of patients undergoing cardiac surgery. Methods The literature was systematically reviewed based on searching criteria established by Cochrane Collaboration. PubMed database searching was conducted for literature and the language was limited to English. Each paper was reviewed by 2 independent reviewers and data extracted for statistical analysis. Data from identified studies were collected for Meta-analysis （RevMan 5.0）. Results Seven randomized controUed trials （RCTs）, involving a total of 2329 patients, were identified in the literature. The results showed that intensive glycaemic control could reduce the incidence of infection （odds ratio （OR）=0.42, 95% confidence interval （95%C/） 0.25 to 0.73, P=0.002~, mortality （OR=0.54, 95%CI 0.34 to 0.87, P=0.01 ）, the duration of mechanical ventilation [weighted mean difference （VdMD）=-2.68, 95%CI-4.99 to -0.37, P=0.02], and length of stay in the intensive care unit （ICU, WMD=-15.49, 95%CI-16.14 to -14.83, P〈 0.000 01 ）, and also could slightly reduce the incidence of post-surgical atrial fibrillation （OR = 0.77, 95% CI 0.60 to 1.00, P=0.05）. However, intensive glycaemic control could not reduce the use of epieardial pacing （OR =0.32, 95% CI 0.09 to 1.05, P=0.06）. Conclusion Intensive blood glucose control during peri-operative period could improve the prognosis of patients undergoing cardiac surgery.

关 键 词：心脏手术 围手术期 血糖控制 META分析 

分 类 号：R654.2[医药卫生—外科学]