Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, People's Republic of China.
Pediatr Res. 2018 Jul;84(1):22-27. doi: 10.1038/s41390-018-0002-3. Epub 2018 May 24.
There still are controversies in the impact of tight glycemic control (TGC) in critically ill children. The aim of this study was to assess the benefits and risks of TGC compared with conventional glycemic control (CGC) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) by using data retrieved from randomized controlled trials (RCTs).
EMBASE, CNKI, PubMed, and the Cochrane Database were searched for RCTs comparing TGC with CGC in critically ill children in PICU.
The meta-analysis included five RCTs representing 3933 patients and compared TGC with CGC. Our result revealed that TGC did not reduce the 30-day mortality rates (OR 0.99, 95% CI 0.74-1.32, P = 0.95) and was not associated with decreasing health care-associated infections (OR 0.80, 95% CI 0.64-1.00, P = 0.05) compared with CGC, but significantly increased the incidence of hypoglycemia (OR 6.37, 95% CI 4.41-9.21, P < 0.001).
Tight glycemic control was not associated with reducing the 30-day mortality rates and acquired infections compared with CGC in critically ill children. Significant increase of the incidence of hypoglycemia was revealed in TGC group. The conclusion should be interpreted with caution for the methodological heterogeneity among trials.
在危重病儿童中，严格血糖控制（TGC）的影响仍存在争议。本研究旨在通过从随机对照试验（RCT）中检索的数据评估 TGC 与常规血糖控制（CGC）相比在儿科重症监护病房（PICU）中危重病患儿的益处和风险。
检索 EMBASE、CNKI、PubMed 和 Cochrane 数据库，比较 TGC 与 PICU 中危重病儿童的 CGC。
荟萃分析包括 5 项 RCT，共 3933 例患者，比较了 TGC 与 CGC。我们的结果表明，TGC 并未降低 30 天死亡率（OR 0.99，95%CI 0.74-1.32，P=0.95），与 CGC 相比，也与降低医疗保健相关感染无关（OR 0.80，95%CI 0.64-1.00，P=0.05），但与 CGC 相比，低血糖发生率显著增加（OR 6.37，95%CI 4.41-9.21，P<0.001）。
与 CGC 相比，TGC 并未降低危重病儿童的 30 天死亡率和获得性感染率。TGC 组低血糖发生率显著增加。由于试验之间存在方法学异质性，因此应谨慎解释该结论。
