重型脑外伤患者强化胰岛素治疗对神经功能预后影响的Meta分析  

Influence of intensive insulin therapy on Glasgow outcome scale in severe traumatic brain injury:a systematic review and meta-analysis

作　　者：杨中良[1] 杨秀云[2,3] 黄飞华[2] 郭梅凤[1] 孙宝玲[1] 赵明珠[1] 

机构地区：[1]上海市浦东新区浦南医院重症监护室,上海200125 [2]浙江省海盐县中医院内科,浙江海盐314300 [3]浙江省立同德医院内科,浙江杭州310009

出　　处：《中国医刊》2016年第2期87-91,共5页Chinese Journal of Medicine

基　　金：上海市卫生和计划生育委员会科研基金(201440472);上海市浦东新区科技发展创新基金(PKJ2015-Y27)

摘　　要：目的评价重型脑外伤伴应激性高血糖采用强化胰岛素治疗调控后对6个月神经功能预后的影响。方法计算机检索Pub Med、Cochrane Library、万方中文文献数据库及中国知网文献。检索时限为建库至2015年8月。采用Rev Man 5.2软件进行Meta分析。结果纳入375个文献,共14个随机对照试验共1265例患者。Meta分析显示,强化胰岛素治疗较常规组可显著提高6个月神经功能预后良好(格拉斯哥预后评分4~5分)患者的比率,相对危险度为1.33(95%置信区间:1.15~1.54),P<0.0001;降低平均血糖,其均方差为-2.59(95%置信区间:-2.91^-2.28),P<0.00001。结论重型脑外伤伴应激性高血糖采用强化胰岛素治疗进行调控,可明显改善6个月神经功能预后,稳定血糖。本结论尚需高质量、大样本的随机对照试验证实。Objective To evaluate the influence of intensive insulin therapy on 6-month neurological function prognosis in severe traumatic brain injury complicated with stress hyperglycemia. Method Such databases as Pub Med, Cochrane Library, Wan Fang and CNKI Data were searched electronically from the date of their establishment to Aug 2015, and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies in accordance with the inclusion and exclusion criteria, extracted data and assessed methodology quality. Then the Meta-analysis was performed using Rev Man 5.2 software. Result A total of 14 randomized control trials（RCT） involving 1265 patients were included in this systematic review, which include 375 literatures. The results of Meta-analysis showed that intensive insulin therapy significantly increased proportion of patients with good 6-month neurological function prognosis（Glasgow outcome scale： 4~5 points）; relative risk（RR）： 1.33, 95% confidence interval（CI）： 1.15~1.54,P〈0.0001. Blood glucose levels were decreased, the mean difference（MD） was-2.59, 95% CI：-2.91^-2.28, P〈0.00001. Conclusion Intensive insulin therapy showed better efficacy than conventional insulin therapy in improving 6-month neurological function prognosis in patients with severe traumatic brain injury complicated with stress hyperglycemia. For the quantity and quality limitation of included studies, this conclusion needs to be proved by performing higher quality and larger sample RCTs.

关 键 词：重型脑外伤 应激性高血糖 强化胰岛素治疗 神经功能 META分析 

分 类 号：R651.15[医药卫生—外科学]