强化胰岛素治疗对急性脑卒中医院感染率影响的Meta分析  

Effect of intensive insulin treatment on healthcare-associated infection rate in acute stroke: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,上海200125 [2]海盐县中医院浙江省立同德医院海盐分院,浙江海盐314300 [3]浙江省立同德医院,浙江杭州310012

出　　处：《中国感染控制杂志》2016年第8期556-560,共5页Chinese Journal of Infection Control

基　　金：上海市卫生和计划生育委员会科研基金(201440472);浦东新区科技发展创新基金(PKJ2014-Y27)

摘　　要：目的评价强化胰岛素治疗对急性脑卒中伴应激性高血糖患者医院感染率的影响。方法计算机检索PubMed、Embase、Cochrane Library、WanFang及CNKI Data数据库,同时手工检索相关专业杂志并追溯纳入文献的参考文献,按照统一的纳入和排除标准选择文献,系统评价强化胰岛素治疗急性脑卒中患者医院感染发生率与平均血糖。结果纳入13个随机对照试验(RCT),共1 032例患者。Meta分析结果显示,医院感染率比较最终纳入10个研究832例患者,强化组和常规组医院感染率分别为28.3%和56.1%,Z=4.50,两组差异有统计学意义[RR=0.53(95%CI:0.40~0.70),P<0.001];血糖水平比较最终纳入5个研究328例患者,两组患者平均血糖差异有统计学意义[MD=-2.52(95%CI:-4.30^-0.74),P=0.006]。医院感染率漏斗图分析显示存在发表性偏倚。结论强化胰岛素治疗用于急性脑卒中伴应激性高血糖的调控,可降低医院感染率和患者血糖。Objective To evaluate effect of intensive insulin treatment（IIT）on healthcare-associated infection （HAI）rate in patients with acute stroke and stress hyperglycemia.Methods Databases,including PubMed,Em-base,Cochrane Library,WanFang,and China National Knowledge Infrastructure（CNKI）Data,were electronically searched,relevant journals and references of the included literatures were also searched manually,literatures were selected according to the uniform inclusion and exclusion criteria,incidence of HAI and mean blood glucose in patients who received IIT for acute stroke were assessed systematically.Results A total of 13 randomized controlled trials （RCT）involving 1 032 patients were included in this systematic review.Meta-analysis results showed that 10 studies involving 832 patients were finally enrolled for comparing HAI rate, HAI rates in IIT group and conventional insulin treatment group were 28.3% and 56.1 %,respectively（Z =4.50 ）,difference between two groups was statistically significant （RR=0.53 [95 %CI ：0.40 to 0.70],P 〈0.001 ）;A total of 328 patients in 5 studies were finally included in the comparison of blood glucose,difference in mean blood glucose between two groups was statistically significant（MD =-2.52 [95% CI ：-4.30 to -0.74],P =0.006）.Funnel plot of HAI rate revealed that there was publication bias.Conclusion IIT is used for the regulation of stress hyperglycemia in acute stroke,it can reduce the incidence of HAI and blood glucose in patients.

关 键 词：急性脑卒中 应激性高血糖 强化胰岛素治疗 院内感染 血糖 医院感染 META分析 

分 类 号：R181.32[医药卫生—流行病学]