强化胰岛素治疗在重型颅脑创伤救治中作用的荟萃分析  

Intensive versus conventional insulin therapy in severe traumatic brain injury： a Meta -analysis

作　　者：祁磊[1] 王茂德[1] 刘欣[1] 李奇[1] 王拓[1] 

机构地区：[1]陕西省西安交通大学医学院第一附属医院神经外科,710061

出　　处：《中华神经外科杂志》2012年第9期935-939,共5页Chinese Journal of Neurosurgery

摘　　要：目的评价强化胰岛素治疗（IIT）与常规胰岛素治疗（CIT）在重型创伤性脑损伤（sTBI）救治中的作用。方法系统性检索中、外文文献数据库中的临床随机对照试验（RCT），使用ReviewManager软件进行荟萃分析。评价指标包括：早期（住院期间）病死率、远期（3个月后）病死率、感染率、远期神经功能损伤量表（NSS）评分、低血糖事件发生率等。结果共有12篇文献、共计1277名患者纳入本项分析。早期病死率的合并OR=0．78（95％CI：0．53—1．15，P=0．21）；晚期病死率的合并OR=0．85（95％CI：0．63—1．15，P10．30）；感染率的合并OR：0．49（95％CI：0．37～0．64，P〈0．00001）；远期良好NSS比例的合并OR=1．62（95％CI：1．18～2．21，P=0．003）；低血糖事件发生率的合并OR=4．33（95％CI：1．39～13．49，P=0．01）和2．61（95％CI：2．27～2．99，P〈0．00001）。结论在sTBI救治中，与CIT相比，IIT对降低病死率无明显作用，但可降低患者感染率、改善远期神经功能，同时低血糖事件却明显增多。故IIT不太适合继续应用于救治重型颅脑创伤，进一步的证据还有待深入研究。Objective To evaluate the effects of intensive insulin therapy （IIT） versus conventional insulin therapy （CIT） in treating of severe traumatic brain injury （sTBI）. Methods Systematic searching of randomized controlled trials （RCTs） in literature databases were performed for meta - analysis by Review Manager. Outcome parameters were the early （in hospital） and the late （3 months later） mortalities, infection rates, good late neurological severity scale （NSS） score frequency, and hypoglycemic episodes. Results Twelve studies and 1 277 patients were included in this meta - analysis. The pooled OR of early mortality was 0.78 （95% CI： 0.53 -1.15,P =0.21）. The pooled OR of late mortality was 0.85 （95% CI：0. 63 - 1.15, P = 0. 30）. The pooled OR of infection rate was O. 49 （95% CI： 0. 37 - 0. 64, P 〈 0. 00001 ）. Meanwhile, The pooled OR of late good NSS frequency was 1.62 （95% CI： 1.18 - 2. 21 ,P = 0. 003）. Furthermore, The pooled ORs of hypoglycemic episode frequency were 4. 33 （95% CI： 1.39 - 13.49,P=0.01） and2.61 （95% CI：2.27-2.99,P〈0.00001）. Conclusions In treating ofsTBI, IIT had no obvious beneficial effect on early and late mortality compared with CIT. However IIT could decrease infection rate, improve late NSS score. Meanwhile, hypoglycemic episode frequency was significant higher in IIT group other than CIT group. It is still need further study to clarify whether IIT should be continued in treatment of sTBI.

关 键 词：脑损伤 胰岛素 META分析 

分 类 号：R651.1[医药卫生—外科学]