CAJ | 학술논문

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[W MD=-2.29，95%CI(-3.22，-1.37)，P<0.00001]，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<0.00001]，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[W MD =-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。
목적：분석국내당뇨병환자위술기응용지속피하주사이도소(CSII)여다차피하주사이도소(MSII)공제혈당적효과。방법계산궤검색2000년1월~2014년3월만방수거고、중국지망、중국생물의학문헌수거고발표적위술기당뇨병환자응용CSII여MSII공제혈당료효비교적수궤대조시험화림상대조시험。채용Cochrane협작망전용연건RevMan 5.1대수거진행통계분석。결과검색공납입12편문헌，수궤대조시험9편，림상동기대조시험3편，합계1286례환자。 Meta분석결과현시：CSII조혈당체표시간여MSII조비교，차이유고도통계학의의[W MD=-2.29，95%CI(-3.22，-1.37)，P<0.00001]，체표시간CSII조소우MSII조。량조간주원시간비교차이유고도통계학의의[SMD=-0.85，95%CI(-1.00，-0.70)，P<0.00001]，주원시간CSII조소우MSII조。량조환자이도소용량차이유고도통계학의의[W MD =-12.31，95%CI(-17.06，-7.66)，P<0.0001]，CSII조환자이도소용량소우MSII조환자。량조간저혈당발생정황차이유고도통계학의의[OR =-0.28，95%CI(0.19，0.41)，P<0.0001]，CSII조환자저혈당발생정황소우MSII조환자。량조상구연지유합정황차이유고도통계학의의[OR =0.04，95%CI(0.01，0.21)，P=0.0001]，CSII조상구연지유합환자수소우MSII조。결론 CSII여MSII상비유체표시간단、주원시간단、이도소용량소、저혈당급상구연지유합발생솔저등우점，사환자능진조수술、진조리원，유조우환자적신체회복。
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 [W MD=-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 [W MD = -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 and the delayed wound healing incidence are decreased in CSII as compared with MSII.