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严格控制严重病情的成年人血糖的好处和风险:一个元分析
Renda Soylemez Wiener1, Daniel C Wiener, Robin J Larson
1VA Outcomes Group, 111 B, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA. renda.s.wiener@dartmouth.edu
JAMA
|August 30, 2008
概括
严格控制危急病患者的葡萄糖并不能降低医院死亡率,但增加了低血糖的风险. 这项元分析评估了34项涉及8432名患者的试验,发现严格和常规血糖控制策略之间的整体死亡率没有显著差异.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 代谢障碍 代谢障碍 代谢障碍
背景情况:
- 目前的指导方针建议严格控制重症患者的葡萄糖,主要是基于单个手术重症监护室试验的有限证据.
- 随后的研究结果相互矛盾,以及与严格的血糖控制相关的低血糖风险,需要对基础数据进行批判性评估.
- 本综述批判性地评估了实施严格血糖控制的好处和风险,而不是在成人重症监护机构的常规护理.
研究的目的:
- 进行全面的元分析,评估严格控制葡萄糖的益处和风险,与严重病情的成年患者的通常护理相比.
- 确定严格的血糖控制是否显著影响医院死亡率,败血症风险,透析的需要和低血糖的发生率.
主要方法:
- 在多个数据库 (MEDLINE,Cochrane图书馆,临床试验注册) 和2001-2008年会议摘要中进行了系统的文献搜索.
- 纳入标准侧重于随机试验,比较成年重症监护患者的严格血糖控制与通常的血糖控制.
- 数据提取和质量评估由两位评论员独立进行,用于元分析的随机和固定效应模型.
主要成果:
- 分析包括29个随机对照试验,其中8432名患者.
- 在严格的血糖控制 (21.6%) 和常规护理 (23.3%) 之间没有观察到医院死亡率的显著差异.
- 严格的血糖控制与败血症风险降低有关 (RR,0.76),但降低血糖的风险显著增加 (RR,5.13).
结论:
- 严格控制严重病情的成年患者的葡萄糖并没有与医院死亡率的显著降低有关.
- 严格控制葡萄糖的做法与严重低血糖的风险大大增加有关.
- 这些发现表明,目前严格控制重症患者血糖的建议需要重新评估.
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