| Research purposes: The purpose of this study is to determine whether intensive insulin therapy(<110mg/dL)has obvious advantages in blood glucose management in critically ill patients through network meta-analysis,to explore the optimal goal of blood glucose management in critically ill patients,and to obtain maximum clinical benefit,ie mortality,Infection rate,and incidence of hypoglycemia,a balance between the benefits of insulin therapy(lower mortality and infection rates)and risk(low blood sugar rates).Content: This study included an innovative study published by van den Berghe et al.in 2001.It also searched the Internet for PubMed and Cochrane databases related to blood glucose management in critically ill patients from November 8,2001 to March31,2018.test.Included in this study must meet the following criteria: Full text publication in Chinese and English;with different glycemic control goals;adult patients with intravenous insulin lowering after ICU admission;and any fate,prevalence,and incidence of hypoglycemia.The RCTs that meet the conditions for inclusion are analyzed by network meta-analysis after quality assessment and data extraction.The primary outcome measures were hospital mortality,secondary outcomes were infection rates(combination of sepsis or bloodstream infections prior to ICU admission,followed by incidence of wound infections and other infections),and incidence of hypoglycemia.Four groups of different glycemic control ranges(<110,110-144,144-180 and >180 mg/dL)were compared with each other by network meta-analysis to study the corresponding mortality,infection rate,and hypoglycemia rate.The results are presented in the form of forest maps.A subgroup analysis of internal surgery is also needed to assess whether or not there is a difference in internal surgery.Methodology: This study uses Stata 14.0 software to complete data analysis and graphic rendering.Meta-analysis and web-based meta-analysis were used for statistical analysis.By direct comparison and indirect comparison,the effect of the outcome events,namely death,concurrent infection and hypoglycemic events,and its95% CI were used as the effect range,and the differences between the groups were compared.According to the size of the possibility of each component being the best treatment goal,the person with the minimum effect of an outcome is taken as the optimal group under the range standard,the probability is calculated and an ordination chart is drawn to observe which blood glucose range may become the optimal Control plan.it is necessary to perform inconsistency detection during network meta-analysis.Tests were conducted on each of the comparison groups that may have published biases,and a funnel plot was drawn.When studying the even distribution of the two sides of the funnel,it may indicate that there is no publication bias;otherwise there may be bias.Results:This study included a total of 40 RCT trials with 21,522 critically ill patients.There were no significant differences in mortality and infection rates among the four groups of different glycemic control ranges in the overall or subgroup analysis.Compared with 144-180 and>180 mg/dL,the incidence of hypoglycemia in the blood glucose range<110 and 110-144 mg/dL was statistically significant.There was no significant difference in the incidence of hypoglycemia between the blood glucose range<110 and 110-144 mg/dL.110-144 mg/dL treatment is the most likely to have the lowest mortality and infection rate in critically ill patients.CONCLUSIONS:There was no significant difference in the outcome of critical illness patients with different glycemic control range of death and infection,and had nothing to do with internal medicine.Intensive insulin therapy(<110 mg/dL)has no apparent advantage in reducing mortality and infection rates.110-144 mg/dL treatment is the most likely to have the lowest mortality and infection rate in critically ill patients. |
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