强化胰岛素治疗对重度烧伤患者临床结局的影响:6个随机对照试验的meta分析

摘要

目的 系统评价强化胰岛素治疗对重度烧伤患者临床结局的影响.方法 电子检索MEDLINE(1966～2011)、EMBASE(1977～2011)、Cochrane 图书馆(1948～2011)、万方数据库(1994～2011.8)、维普中文科技期刊全文数据库(1994～2011),收集强化胰岛素治疗重度烧伤患者的临床随机对照试验(RCTs),主要临床结局指标为:病死率、脓毒血症、多器官功能障碍、烧伤后炎症反应的影响、低血糖发生率.研究方法学质量按照Cochrane系统评价员手册及Jadad评分量表进行评定,用RevMan 5.0软件进行统计分析.结果 563篇相关文献中,共纳入6个RCTs,合计376例患者.病死率(RR=0.36,95%CI为0.16～0.84,P=0.02),脓毒血症(RR=0.26,95%CI 0.12～0.57,P=0.0009),多器官功能障碍(RR=0.35,95%CI为0.15～0.82,P=0.02).烧伤后炎症反应的影响:研究间有异质性(P＜0.0001),采用随机效应模型(RR=-57.17,95%CI为-132.59～18.24,P=0.14).低血糖发生率(RR=2.75,95%CI 2.11～3.60,P=0.00001).结论 在良好监测血糖下,强化胰岛素治疗血糖控制在4.4～8.3 mmol/L能改善重度烧伤患者的临床结局,但尚需进行更多大样本研究进一步验证.%Objective To evaluate the impact of intensive insulin therapyt(IIT) on clinical outcome of patients with severe bum. Methods We conducted searches of electronic databases abstracts from MEDLINE( 1966 -2011 ),EMBASE ( 1977 -2011 ),Cochrane Iibrary( 1948 -2011 ),Wanfang Data( 1994-2011 ) and CNKI( 1994 -2011 ). Published randomized controlled trials( RCTs ) that directly compared ITT with conventional glucose management were included. Clinical outcome indices included mortality, sepsis, organ dysfunction, inflammation response after severe burn, hypoglycemic events. Methodological quality of the study was assessed based on Cochrane Reviewer's Handbook and Jadad's Score Scale, and the meta-analysis was conducted with RevMan5. 0 software. Results Among 563 related articles, six studies including a total of 376 patients were included, all of which were RCT. Mortality :RR =0.36,95% CI =0.16 -0.84,P=0.02;Sepsis:RR=0.26,95%CI=0.12-0.57,P =0. 0009;Organ dysfunction:RR =0.35, 95% CI = 0. 15 - 0. 82, P = 0. 02; Inflammation response after severe burn: heterogeneity was found( P < 0. 0001 ), random-effect model was appliedf RR = -57.17,95%CI = -132.59 -18.24,P =0.14). Hypoglycemic events( RR=2.75, 95%CI=2. 11 -3. 60,P =0.00001). Conclusion IIT for maintaining blood glucose between 4.4 -8. 3 mmol/L may improve the clinical outcome of patients with severe burn,but studies with a large sample are needed to verify the efficiency.