Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, No.82, North Section 2, 2nd Ring Road, Jinniu District, Chengdu, Sichuan, 610081, China.
Longquanyi Hospital, Chengdu, Sichuan, China.
Crit Care. 2018 Mar 4;22(1):57. doi: 10.1186/s13054-018-1976-2.
Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children.
A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017. Paired reviewers independently screened citations, assessed risk of bias of included studies, and extracted data. A random-effects model was used to report all outcomes. The Grading of Recommendations Assessment, Development and Evaluation system was used to quantify absolute effects and quality of evidence. The primary outcome was hospital mortality. The secondary outcomes were hypoglycemia (any, severe), sepsis, new need for dialysis, and seizures.
A total of 4030 patients were included from six studies. All six studies were rated as at low risk of bias. Our meta-analysis showed that TGC did not result in a decrease in risk of hospital mortality (odds ratio (OR), 0.95; 95% confidence interval (CI), 0.62-1.45; I = 40%; moderate quality), sepsis (OR, 0.82; 95% CI, 0.63-1.08), or seizures (OR, 0.98; 95% CI, 0.59-1.63). TGC was associated with a decrease in new need for dialysis (OR, 0.63; 95% CI, 0.45-0.86). However, TGC was associated with a significant increase in any hypoglycemia (OR, 4.39; 95% CI, 2.39-8.06) and severe hypoglycemia (OR, 4.11; 95% CI, 2.67-6.32).
Among critically ill children with hyperglycemia, TGC does not result in a decrease in hospital mortality, but appears to reduce a new need for dialysis. However, TGC is associated with higher incidence of hypoglycemia.
PROSPERO registration number CRD42017074039 .
高血糖在儿科重症监护病房的患者中很常见。本研究的目的是描述危重病患儿严格血糖控制（TGC）的益处和风险。
对儿科重症监护病房收治的危重病患儿 TGC 的随机对照试验进行了系统评价和荟萃分析。检索的数据库包括 Medline、Embase 和 CENTRAL 数据库，检索时间截至 2017 年 5 月 1 日。配对审查员独立筛选引文，评估纳入研究的偏倚风险，并提取数据。使用随机效应模型报告所有结局。采用推荐评估、制定与评价系统（Grading of Recommendations Assessment, Development and Evaluation system）对绝对效应和证据质量进行量化。主要结局是医院死亡率。次要结局是低血糖（任何程度、严重程度）、败血症、新的透析需求和癫痫发作。
共有 6 项研究的 4030 例患者纳入本研究。所有 6 项研究均被评为低偏倚风险。我们的荟萃分析显示，TGC 并未降低医院死亡率的风险（比值比（OR），0.95；95%置信区间（CI），0.62-1.45；I²=40%；中等质量）、败血症（OR，0.82；95%CI，0.63-1.08）或癫痫发作（OR，0.98；95%CI，0.59-1.63）。TGC 与新的透析需求减少相关（OR，0.63；95%CI，0.45-0.86）。然而，TGC 与任何程度低血糖（OR，4.39；95%CI，2.39-8.06）和严重低血糖（OR，4.11；95%CI，2.67-6.32）的发生率显著增加相关。
在伴有高血糖的危重病患儿中，TGC 并未降低医院死亡率，但似乎可减少新的透析需求。然而，TGC 与低血糖发生率升高有关。
PROSPERO 注册号 CRD42017074039。
