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目的：Accordingly, we performed a systematic review and meta-analysis to determine whether intensive insulin therapy is associated with improved neurological outcomes and reduced mortality in TBI.

方法

注冊：

The protocol was written according to the preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA)-P statement and was registered in the PROSPERO database (registration number CRD42016044071) [16, 17, 18]. The PRISMA-P and PRISMA checklists were used.

納入排除標準：

Eligible studies were randomised controlled trials comparing intensive with conventional glycaemic control in adult patients (age >?16 years) with TBI requiring admission to a critical care unit. The cut-off for intensive glycaemic control was defined as those studies aiming for“normal values” (Paediatric studies, animal studies and observational, quasi-randomised or cross-over studies were excluded.

文獻檢索：

We performed an unrestricted electronic database search in Medline (via Ovid?), Embase (via Ovid?) and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception date until 15 November 2016. Search details are provided in Additional file 1.

數(shù)據(jù)收集：

Extracted data included。。。。。。

文獻質(zhì)量評估：

Two reviewers (JH and MPP) independently and in duplicate assessed risk of bias among included studies using the Cochrane risk-of-bias tool。

統(tǒng)計：

with effect estimates presented as relative risk (RR) and 95% confidence interval (95% CI). Heterogeneity was estimated by the I2-statistic. A secondary network meta-analysis was performed, based upon the target ranges intensive (

結(jié)果

研究選擇

研究特點

部分截圖

死亡率

ICU死亡率

Secondary network meta-analysis showed a non-significant lower risk for both liberal and conventional control compared with tight control, with RR (95% CI) 0.90 (0.55–1.46) and 0.91 (0.55–1.48), respectively, for ICU mortality and with 0.99 (0.74–1.33) and 1.24 (0.83???1.86) for hospital mortality. The indirect estimates for liberal versus moderate control  were 0.99 (0.49–1.98) and 0.80 (0.49–1.32) for ICU and hospital  mortality, respectively.

神經(jīng)功能

Network meta-analysis showed a non-significant increase in risk of an unfavourable outcome for both liberal and moderate control compared with tight control, with RR (95% CI)?=?1.10 (0.96–1.26) and 1.14 (0.96–1.34), respectively and with the indirect estimate for liberal versus moderate control?=?0.97 (0.78–1.20), which was also non-significant.

低血糖發(fā)生率

感染發(fā)生率

異質(zhì)性過大，無法進行meta分析。故僅進行系統(tǒng)評價。

討論：略。