目的： 研究證實以胰島素 (insulin) 積極控制血糖於正常值，可降低外科加護病房患者罹病率、住院天數、死亡率，也降低內科加護病房患者罹病率，在急性腦損傷患者是否也有降低罹病率、死亡率、改善神經復原等效益則未有定論。本研究在探討以insulin 積極控制急性腦損傷患者血糖之療效及安全性。
方法： 於PubMed、Medline、Cochrane Library 資料庫搜尋急性腦損傷以insulin 積極控制血糖比較傳統治療之隨機對照試驗 (randomized controlled trial, RCT) ，並篩選全國已發表論文及參考書目所列。計得1,180 篇文獻，2 位審核者個別評讀選擇收納及排除試驗，依Jadad scale 評核試驗品質。研究運用review manager 統計，目標在死亡率、感染率、神經復原評估，及發生低血糖事件，計算odds ratio (OR)及95% confidence interval (CI) 以為量測結果。
結果： 共納入10 個RCTs，實驗組設定血糖控制在≤ 120 mg/dL，死亡率分析相較於對照組未達統計學上顯著差異 (OR, 0.95; 95% CI, 0.74 ~ 1.23) 。進一步分析控制於≤ 110 mg/dL，在死亡率也得到同樣結論。感染率分析結果OR, 0.64; 95% CI , 0.5 ~ 0.83，顯示積極控制血糖降低患者住院期間的感染率。神經復原療效評估則分別比較glasgow outcome scale (GOS) 、modified rankin scale (mRS) 分數變化，發現兩組皆無差別。積極控制血糖發生低血糖風險 ( ≤ 60 mg/dL) 是傳統治療的6.9 倍 (95% CI, 4.43 ~ 10.75) 。
結論： 積極以insulin 來控制急性腦損傷患者血糖，其臨床效益目前仍無法證實，反而提高低血糖發生風險。
Objective: Previous studies have confirmed that attaining normoglycaemia by insulin in surgical ICU has benefits in reducing morbidity, length of hospitalization, mortality and in medical ICU reducing mortality rate. However, similar benefits in patients with acute brain injury are controversial.This study was to evaluate the safety and efficacy of intensive insulin therapy for controlling blood glucose level in patients with acute brain injury.
Methods: The PubMed, Medline, Cochrane Library related to randomised controlled trials (RCTs) were searched to compare intensive insulin therapy versus conventional therapy in patients with acute brain injury. Relevant information from all published papers in Taiwan and related articles from references were also screened. A total of 1,180 papers were reviewed. Two reviewers independently selected the included and extracted studies by using Jadad scale for reporting the quality of included studies. Review manager software was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mortality rate, infection rate, neurorecovery outcome and the incidence of hypoglycemia.
Results: A total of 10 randomized controlled trials were included. We found that keeping blood glucose level ≤ 120 mg/dl was insignificant in terms of mortality (OR, 0.95; 95% CI, 0.74 to 1.22). Furthermore,when the blood glucose was lowered ≤ 110 mg/dl, the result was still insignificant. Intensive insulin therapy was significant in reducing infection rate (OR, 0.64;95% C I, 0 .5 t o 0 .83).Comparing the GOS and mRS scores to assess the neurorecovery outcomes, no significant difference was found. Hypoglycemia ( ≤ 60 mg/dl) was more often in intensive insulin therapy group, approximately 6.9 times (95% CI, 4.43 to 10.75) higher than the control group.
Conclusions: For acute brain injury patients,the benefits of intensive insulin therapy are still uncertain;however,the risks of hypoglycemia increase.
