强化胰岛素治疗对急性脑卒中医院感染率影响的Meta分析
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杨秀云

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R181.3+2

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上海市卫生和计划生育委员会科研基金(201440472);浦东新区科技发展创新基金(PKJ2014-Y27)


Effect of intensive insulin treatment  on healthcareassociated infection rate in acute stroke: A Metaanalysis
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    摘要:

    目的评价强化胰岛素治疗对急性脑卒中伴应激性高血糖患者医院感染率的影响。方法计算机检索PubMed、Embase、Cochrane Library、WanFang及CNKI Data数据库,同时手工检索相关专业杂志并追溯纳入文献的参考文献,按照统一的纳入和排除标准选择文献,系统评价强化胰岛素治疗急性脑卒中患者医院感染发生率与平均血糖。结果纳入 13 个随机对照试验(RCT),共1 032例患者。Meta分析结果显示,医院感染率比较最终纳入 10 个研究 832 例患者,强化组和常规组医院感染率分别为28.3%和56.1%,Z=4.50,两组差异有统计学意义[RR=0.53(95 %CI:0.40~0.70),P<0.001];血糖水平比较最终纳入5个研究 328 例患者,两组患者平均血糖差异有统计学意义[MD=-2.52(95%CI:-4.30~-0.74),P=0.006]。医院感染率漏斗图分析显示存在发表性偏倚。结论强化胰岛素治疗用于急性脑卒中伴应激性高血糖的调控,可降低医院感染率和患者血糖。

    Abstract:

    ObjectiveTo evaluate effect of intensive insulin treatment(IIT) on healthcareassociated infection (HAI) rate in patients with acute stroke and stress hyperglycemia.MethodsDatabases, including PubMed, Embase, Cochrane Library, WanFang, and China National Knowledge Infrastructure(CNKI) Data, were electronically searched, relevant journals and references of the included literatures were also searched manually, literatures were selected according to the uniform inclusion and exclusion criteria, incidence of HAI and mean blood glucose in patients who received IIT for acute stroke were assessed systematically.ResultsA total of 13 randomized controlled trials (RCT) involving 1 032 patients were included in this systematic review. Metaanalysis results showed that 10 studies involving 832 patients were finally enrolled for comparing HAI rate, HAI rates in IIT group and conventional insulin treatment group were 28.3% and 56.1%, respectively(Z=4.50), difference between two groups was statistically significant  (RR=0.53 [95 %CI: 0.40 to 0.70], P<0.001); A total of 328 patients in 5 studies were finally included in the comparison of blood glucose, difference in mean blood glucose between two groups was statistically significant( MD=-2.52 [95% CI: -4.30 to -0.74], P=0.006). Funnel plot of HAI rate revealed that there was publication bias.ConclusionIIT is used for the regulation of stress hyperglycemia in acute stroke, it can reduce the incidence of HAI and blood glucose in patients.

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杨中良, 杨秀云,等.强化胰岛素治疗对急性脑卒中医院感染率影响的Meta分析[J]. 中国感染控制杂志,2016,15(8):556-560. DOI:10.3969/j. issn.1671-9638.2016.08.005.
YANG Zhongliang, YANG Xiuyun, et al. Effect of intensive insulin treatment  on healthcareassociated infection rate in acute stroke: A Metaanalysis[J]. Chin J Infect Control, 2016,15(8):556-560. DOI:10.3969/j. issn.1671-9638.2016.08.005.

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  • 收稿日期:2015-10-24
  • 最后修改日期:2015-12-29
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  • 在线发布日期: 2016-08-18
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