强化胰岛素治疗对重型颅脑疾病患者院内感染率影响的Meta分析  

Influence of intensive insulin therapy on nosocomial infection rate in patients with severe craniocerebral diseases complicated with stress hyperglycemia: a 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ICU,上海200125 [2]海盐县中医院呼吸内科,浙江海盐314300 [3]浙江省立同德医院呼吸内科,浙江杭州310009

出　　处：《中国临床研究》2016年第3期312-317,320,共7页Chinese Journal of Clinical Research

基　　金：上海市卫生和计划生育委员会科研课题计划(201440472);上海市浦东新区科技发展基金创新资金(医疗卫生)项目(PKJ2015-Y27)

摘　　要：目的评价强化胰岛素治疗对重型颅脑疾病伴应激性高血糖患者院内感染发生率的影响。方法计算机检索Pub Med、Embase、Cochrane Library、Wan Fang及CNKI Data,同时手工检索相关专业杂志并追溯纳入文献的参考文献。检索时限均为建库至2015年8月。按照纳入与排除标准选择试验、提取资料和评价质量,采用Rev Man 5.2软件进行Meta分析。结果纳入27个随机对照试验(RCT),共2 909例患者。所有研究的方法质量学评价均为C级。Meta分析结果显示,与常规组相比,强化组院内感染发生率显著降低(RR=0.61,95%CI:0.51~0.72,P<0.01),平均血糖显著降低(MD=-2.22,95%CI:-3.25^-1.19,P<0.01),ICU住院时间显著缩短(MD=-2.66,95%CI:-3.91^-1.40,P<0.01),抗菌药物使用时间显著缩短(MD=-5.75,95%CI:-7.41^-4.08,P<0.01)。结论强化胰岛素治疗用于重型颅脑疾病伴应激性高血糖的调控,可明显降低院内感染发生率,降低血糖,并可缩短ICU住院时间。由于纳入研究的质量有限,本研究结论尚需高质量的RCT证实。Objective To evaluate the influence of intensive insulin therapy on nosocomial infection rate in severe craniocerebral diseases complicated with stress hyperglycemia. Methods Such databases as Pub Med,Embase,Cochrane Library,Wan Fang and CNKI were searched electronically from the date of their establishment to August 2015,and other relevant journals and references of the included literatures were also searched manually in the same time. In accordance with the inclusion and exclusion criteria,the clinical trials were screened,and the data were extracted,and then the quality of methodology was assessed. A meta-analysis was performed using Rev Man 5. 2 software. Results A total of 27 randomized control trials（ RCT） involving 2 909 patients were included in this paper. All the RCTs had the methodology quality of grade C.The results of meta-analysis showed that compared with conventional insulin therapy,intensive insulin therapy significantly decreased nosocomial infection rate（ RR = 0. 61,95% CI： 0. 51- 0. 72,P 〈0. 01）,blood glucose levels（ MD =- 2. 22,95% CI：- 3. 25-- 1. 19,P 〈0. 01）,shortened ICU stays（ MD =- 2. 66,95% CI：- 3. 91-- 1. 40,P 〈0. 01） and antibiotics administration time（ MD =- 5. 75,95% CI：- 7. 41-- 4. 08,P 〈0. 01） ]. Conclusion Intensive insulin therapy has significant effect on decreasing nosocomial infection rate and blood glucose level and can shorten ICU stays as well as antibiotics administration time in patients with severe craniocerebral diseases complicated with stress hyperglycemia. Because of the quality limitation of included literatures,the conclusion still needs to be proved by performing higher quality RCTs.

关 键 词：重型颅脑疾病 应激性高血糖 强化胰岛素治疗 院内感染 META分析 

分 类 号：R742[医药卫生—神经病学与精神病学]