胰岛素泵对糖尿病患者围术期血糖控制效果的Meta分析

目的 分析国内糖尿病患者围术期应用持续皮下注射胰岛素（CSII）与多次皮下注射胰岛素（MSII）控制血糖的效果。方法 计算机检索2000年1月～2014年3月万方数据库、中国知网、中国生物医学文献数据库发表的围术期糖尿病患者应用CSII与MSII控制血糖疗效比较的随机对照试验和临床对照试验。采用Cochrane协作网专用软件RevMan 5.1对数据进行统计分析。结果 检索共纳入12篇文献,随机对照试验9篇,临床同期对照试验3篇,合计1286例患者。Meta分析结果显示：CSII组血糖达标时间与MSII组比较,差异有高度统计学意义WMD=-2.29,95%CI（-3.22,-1.37）,P〈0.000 01],达标时间CSII组少于MSII组。两组间住院时间比较差异有高度统计学意义SMD=-0.85,95%CI（-1.00,-0.70）,P〈0.000 01],住院时间CSII组少于MSII组。两组患者胰岛素用量差异有高度统计学意义WMD=-12.31,95%CI（-17.06,-7.66）,P〈0.0001],CSII组患者胰岛素用量少于MSII组患者。两组间低血糖发生情况差异有高度统计学意义OR=-0.28,95%CI（0.19,0.41）,P〈0.0001],CSII组患者低血糖发生情况少于MSII组患者。两组伤口延迟愈合情况差异有高度统计学意义OR=0.04,95%CI（0.01,0.21）,P=0.0001],CSII组伤口延迟愈合患者数少于MSII组。结论 CSII与MSII相比有达标时间短、住院时间短、胰岛素用量少、低血糖及伤口延迟愈合发生率低等优点,使患者能尽早手术、尽早离院,有助于患者的身体恢复。

Comparison between subcutaneous insulin infusion and multiple subcuta-neous insulin injection therapy for perioperative diabetics of Chinese lit-erature Meta-analysis

Objective To evaluate the efficiency and safety of two blood glucose control treatments, continuous subcuta- neous insulin infusion （CSII） and multiple subcutaneous insulin injection（MSII）, to find a better way to control the blood glucose of diabetes mellitus patients during perioperation period. Methods The China Info, CNKI, CBM published be- tween January 2000 and March 2014 were searched using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing CSII with MSII for diabetes patients during preoperative period were concluded. The Cochrane collaboration＇s RevMan5.1 was used for Meta analysis. Results 12 controlled clinical trials （9 randomized controlled experiment, 3 same period clinical controlled trials） were included, totally 1286 patients. The Meta-analysis showed that： there were significant differences in the average time for targeting blood glucose between the two groups WMD = -2.29, 95%CI （-3.22, -1.37）, P 〈 0.000 01], the CSII group was shorter than MSII group. There were signifi- cant differences in hospitalization time between the two groups SMD = -0.85, 95%CI （-1.00, -0.70）, P 〈 0.000 01], the CSII group was shorter than MSII group. There were significant differences in the dosage of insulin between the two groups WMD = -12.31, 95%CI （-17.06, -7.66）, P 〈 0.0001], the CSII group was less than MSII group. There were significant differences between two groups in the rate of hypoglycemia OR = -0.28, 95%CI （0.19, 0.41）, P 〈 0.0001] and the rate of the delayed wound healing OR = 0.04, 95%CI （0.01, 0.21）, P = 0.0001], the CSII group were less than MSII group in both of them. Conclusion Compared with the MSII, CSII has some advantages, the average time for tar- geting blood glucose, duration of hospital stay and dosage of insulin are less, which makes the patients able to have their operation earlier, leave the hospital earlier, and help the body recover. Besides, the hypoglycemia incidence andthe delayed wound h