重症监护病房中对脓毒症患者进行强化或宽松血糖控制？一项随机对照试验的荟萃分析。

Intensive or liberal glucose control in intensive care units for septic patients? A meta-analysis of randomized controlled trials.

作者信息

Meng Jiahao, Li Xi, Xiao Yifan, Tang Hang, Liu Pan, Wu Yumei, Xiong Yilin, Gao Shuguang

机构信息

Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China.

Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.

出版信息

Diabetes Metab Syndr. 2024 May;18(5):103045. doi: 10.1016/j.dsx.2024.103045. Epub 2024 May 23.

DOI:10.1016/j.dsx.2024.103045

PMID:38796958

Abstract

OBJECTIVE

To compare the clinical outcomes of intensive glucose control and liberal glucose control for septic patients in intensive care unit.

METHODS

The databases of PubMed, Cochrane Library, Embase and Web of Science were searched systematically from inception to November 27, 2023 to identify trials involving a randomized comparison between intensive and liberal glucose control for septic patients in intensive care unit.

RESULTS

A total of 14 randomized controlled trials involving 6226 patients were finally included. There was no statistically significant difference observed between intensive glucose control and liberal glucose control in terms of all-cause mortality, the need for renal replacement, vasopressor-free and mechanical ventilation-free days, and length of hospital stay. However, it is noteworthy that intensive glucose control exhibited a statistically higher risk of severe hypoglycemia (RR 2.66; 95%CI 1.85 to 3.83), need for blood transfusion (RR 1.12; 95%CI 1.01 to 1.23), and statistically prolonged length of stay in the ICU (MD 1.67; 95%CI 0.22 to 3.12) compared to liberal glucose control. Nevertheless, sensitivity analysis revealed that the need for blood transfusion and length of stay in the intensive care unit were not robust.

CONCLUSIONS

Both intensive and liberal glucose control had comparable effects on improving patient outcomes, but intensive glucose control carried a higher risk of severe hypoglycemia.

摘要

目的

比较重症监护病房中脓毒症患者强化血糖控制与宽松血糖控制的临床结局。

方法

系统检索PubMed、Cochrane图书馆、Embase和科学网数据库，检索时间从建库至2023年11月27日，以识别涉及重症监护病房中脓毒症患者强化血糖控制与宽松血糖控制随机对照比较的试验。

结果

最终纳入14项随机对照试验，共6226例患者。强化血糖控制与宽松血糖控制在全因死亡率、肾脏替代需求、无血管活性药物及无机械通气天数和住院时间方面无统计学显著差异。然而，值得注意的是，与宽松血糖控制相比，强化血糖控制出现严重低血糖的风险在统计学上更高（RR 2.66；95%CI 1.85至3.83），输血需求（RR 1.12；95%CI 1.01至1.23），且在重症监护病房的住院时间在统计学上更长（MD 1.67；95%CI 0.22至3.12）。尽管如此，敏感性分析显示输血需求和在重症监护病房的住院时间并不稳健。