宽松血糖控制对重症患者的影响：一项系统评价和荟萃分析。

Effect of liberal glucose control on critically ill patients: a systematic review and meta-analysis.

作者信息

Ma Jiahui, Wang Xu, Zhang Yan, Ge Chunyan

机构信息

Second District of Critical Care Medicine, Hai 'an People's Hospital, Nantong City, Jiangsu Province, 226600, China.

Department of Nursing, Hai 'an People's Hospital, Nantong, Jiangsu, 226600, China.

出版信息

BMC Endocr Disord. 2025 Feb 12;25(1):36. doi: 10.1186/s12902-025-01864-w.

DOI:10.1186/s12902-025-01864-w

PMID:39934786

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11817051/

Abstract

BACKGROUND

Most current guideline statements support some level of unrestricted glycemic management in critically ill adult patients. Nevertheless, the effectiveness of liberal glucose control is currently not well-supported by evidence. Therefore, our objective is to investigate the influence of liberal glucose control (> 180 mg/dl) on critically ill patients in the intensive care unit (ICU).

METHODS

Until November 23, 2023, English language literature was thoroughly and systematically searched through multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Our primary endpoints of interest were the occurrence of hypoglycemia, mortality in the ICU, and mortality during hospitalization. In addition, our secondary outcomes comprised of 90-day mortality, bloodstream infections, the proportion of patients necessitating renal replacement therapy (RRT), the length of time under mechanical ventilation, duration of stay in the ICU, and length of the overall hospitalization. Weighted mean difference (WMD) and relative risk (RR) were respectively computed as overall effect size for continuous and dichotomous data and reported with their 95% confidence intervals (95% CI).

RESULTS

A total of 9 studies were incorporated, which included 14,878 patients in the ICU. Compared with other blood glucose target control groups, liberal glucose control significantly reduced the incidence of hypoglycemia (RR = 0.41; 95% CI:0.25 to 0.69; P = 0.001), but increased ICU mortality (RR = 1.23; 95% CI:1.03 to 1.48; P = 0.023), in-hospital mortality risk (RR = 1.18; 95% CI:1.03 to 1.35; P = 0.020), and the risk of requiring RRT (RR = 1.26; 95% CI:1.11 to1.42; P < 0.001).

CONCLUSION

Liberal glucose control can reduce the risk of hypoglycemia but increases the risks of ICU mortality, in-hospital mortality, and the requirement for RRT. To confirm the outcomes further, large-scale, high-quality clinical trials are necessary.

摘要

背景

目前大多数指南声明支持对成年危重症患者进行一定程度的无限制血糖管理。然而，目前宽松血糖控制的有效性缺乏充分证据支持。因此，我们的目的是研究宽松血糖控制（>180mg/dl）对重症监护病房（ICU）危重症患者的影响。

方法

截至2023年11月23日，通过多个数据库全面系统地检索英文文献，包括PubMed、Embase、Cochrane图书馆和Web of Science。我们感兴趣的主要终点是低血糖的发生、ICU死亡率和住院期间死亡率。此外，我们的次要结局包括90天死亡率、血流感染、需要肾脏替代治疗（RRT）的患者比例、机械通气时间、ICU住院时间和总住院时间。加权平均差（WMD）和相对风险（RR）分别作为连续和二分数据的总体效应量进行计算，并报告其95%置信区间（95%CI）。

结果

共纳入9项研究，其中包括14878例ICU患者。与其他血糖目标控制组相比，宽松血糖控制显著降低了低血糖的发生率（RR = 0.41；95%CI：0.25至0.69；P = 0.001），但增加了ICU死亡率（RR = 1.23；95%CI：1.03至1.48；P = 0.023）、住院死亡率风险（RR = 1.18；95%CI：1.03至1.35；P = 0.020）以及需要RRT的风险（RR = 1.26；95%CI：1.11至1.42；P < 0.001）。