亚低温治疗对重型创伤性颅脑损伤患者预后影响的系统评价

摘要
图/表
参考文献(30)
相关文章 (15)

全文: PDF (1604 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨亚低温治疗技术对重型创伤性脑损伤（sTBI）患者预后的影响，为临床实践提供循证依据。方法通过系统检索PubMed、Cochrane library、clnicaltrials.gov及中国知网数据库从建库至2017年6月间发表的与研究主题相关的所有随机对照临床试验。由两名研究人员独立地阅读、提取入选研究中的数据。研究结局变量为患者死亡率及神经功能恢复状况。运用Review Manager 5.3及CMA3.0对收集的数据进行分析，同时运用TSA 0.9对研究结果的可靠性进行评估。结果共计14篇文献纳入本研究，涉及2024例sTBI患者，分为亚低温治疗组与常温治疗组；合并后的结果表明，两组患者死亡率比较，差异无统计学意义（RR = 0.92，95%CI=0.74~1.14，P = 0.43），TSA分析提示该结论较为肯定；同时发现亚低温治疗有利于患者的远期神经功能恢复（RR = 1.23，95%CI=1.02~1.49，P = 0.03），但TSA分析显示该结论还需要更多研究证实。结论亚低温治疗有助于改善患者的远期神经功能恢复，但无助于降低患者的死亡率。基于纳入文献的整体质量偏低，需要更多高质量的临床研究对结果进行验证。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	何海燕1
	2 黄华平2 康秀华2 傅静1▲

关键词 ：亚低温, 创伤性脑损伤, 预后, 系统评价

Abstract：Objective To explore the effects of hypothermia on prognosis in severe traumatic brain injury (sTBI) patients, and provide the best evidence to clinical practice. Methods The databases PubMed, the Cochrane library, clnicaltrials.gov and CNKI were systematically searched from their inception to June 2017 to identify relevant randomized controlled trials (RCTs). Two authors independently reviewed and extracted data from included studies. The outcome variables of the study were mortality and neurologic recovery. All data was analyzed by Review Manager version 5.3 and CMA version 3.0, TSA version 0.9 beta was applied to estimate whether the pooled outcome was conclusive. Results A total of 14 trials involving 2024 sTBI patients divided into subhypothermia treatment group and normal temperature treatment group were included in this study. The pooled results showed that there was no significant statistical difference in mortality between two groups (RR = 0.92, 95%CI=0.74-1.14, P = 0.43), and TSA indicated that the current available evidence was conclusive. However, patients receiving hypothermia therapy had better neurological outcome than those receiving normothermia therapy (RR=1.23, 95%CI=1.02-1.49, P = 0.03), and TSA indicated that more studies should be included to clarify this issue. Conclusion Hypothermia can improve long-term neurological recovery for sTBI patients, but which is not helpful to decrease the mortality. Based on the low overall quality of included articles, more high-quality studies are needed to verify these results.

Key words： Hypothermia Traumatic brain injury Prognosis Systematic review

通讯作者: ▲通讯作者

引用本文:

何海燕1，2 黄华平2 康秀华2 傅静1▲. 亚低温治疗对重型创伤性颅脑损伤患者预后影响的系统评价[J]. 中国医药导报, 2018, 15(23): 56-61,75.
HE Haiyan1,2 HUANG Huaping2 KANG Xiuhua2 FU Jing1▲. The effects of hypothermia on prognosis in severe traumatic brain injury patients: a systematic review. 中国医药导报, 2018, 15(23): 56-61,75.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I23/56

[1] Maas AI，Stocchetti N，Bullock R. Moderate and severe traumatic brain injury in adults [J]. Lancet Neurol，2008，7（8）：728-741.
[2] 朱国，卞晓星.颅脑外伤后的免疫变化及调理[J].国际神经病学神经外科学杂志，2011，38（4）：403-406.
[3] Bao L，Chen D，Ding L，et al. Fever Burden is an independent predictor for prognosis of traumatic brain injury [J]. PLoS One，2014，9（3）：e90956.
[4] Arrich J，Holzer M，Havel C，et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation [J]. Cochrane Database Syst Rev，2016，2：CD004128.
[5] Marion DW，Penrod LE，Kelsey SF，et al. Treatment of traumatic brain injury with moderate hypothermia [J]. N Engl J Med，1997，336（8）：540-546.
[6] Maekawa T，Yamashita S，Nagao S，et al. Brain-Hypothermia Study Group： Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury： A randomized controlled trial [J]. J Neurotrauma，2015，32（7）：422-429.
[7] Andrews PJ，Sinclair HL，Rodriguez A，et al. Hypothermia for intracranial hypertension after traumatic brain injury [J]. N Engl J Med，2015， 373（25）：2403-2412.
[8] Higgins JP，Altman DG，G?覬tzsche PC，et al. The Cochrane Collaboration′s tool for assessing risk of bias in randomized trials [J]. BMJ，2011，343：d5928.
[9] Higgins JP，Thompson SG，Deeks JJ，et al. Measuring inconsistency in meta-analyses [J]. BMJ，2003，327（7414）：557-560.
[10] 翁鸿，郭成城，吕军，等.试验序贯分析之信息量的计算[J].中国循证医学杂志，2017，17（1）：113-116.
[11] Tang C，Bao Y，Qi M，et al. Mild induced hypothermia for patients with severe traumatic brain injury after decompressive craniectomy [J]. J Crit Care，2017，39：267-270.
[12] Clifton GL，Allen S，Barrodale P，et al. A phase Ⅱ study of moderate hypothermia in severe brain injury [J]. J Neurotrauma，1993，10（3）：263-271.
[13] Clifton GL，Miller ER，Choi SC，et al. Lack of effect of induction of hypothermia after acute brain injury [J]. N Engl J Med，2001，344（8）：556-563.
[14] Clifton GL，Valadka A，Zygun D，et al. Very early hypothermia induction in patients with severe brain injury （the National Acute Brain Injury Study： Hypothermia Ⅱ）： A randomised trial [J]. Lancet Neurol，2011，10（2）：131-139.
[15] Jiang J，Yu M，Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury： 1-year follow-up review of 87 cases [J]. J Neurosurg，2000，93（4）：546-549.
[16] Lee HC，Chuang HC，Cho DY，et al. Applying cerebral hypothermia and brain oxygen monitoring in treating severe traumatic brain injury [J]. World Neurosurg，2010， 74（6）：654-660.
[17] Liu WG，Qiu WS，Zhang Y，et al. Effects of selective brain cooling in patients with severe traumatic brain injury： A preliminary study [J]. J Int Med Res，2006，34（1）：58-64.
[18] Qiu WS，Liu WG，Shen H，et al. Therapeutic effect of mild hypothermia on severe traumatic head injury [J]. Chin J Traumatol，2005，8（1）：27-32.
[19] Qiu W，Zhang Y，Sheng H，et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy [J]. J Crit Care，2007，22（3）：229-235.
[20] Shiozaki T，Hayakata T，Taneda M，et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure [J]. J Neurosurg，2001，94（1）：50-54.
[21] Zhi D，Zhang S，Lin X. Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury [J]. Surg Neurol，2003，59（5）：381-385.
[22] 张飞鹏.亚低温治疗在重型颅脑损伤中的研究进展[J].安徽医药，2017，21（5）：807-810.
[23] Crossley S，Reid J，McLatchie R，et al. A systematic review of therapeutic hypothermia for adult patients following traumatic brain injury [J]. Crit Care，2014，18（2）：R75.
[24] Bosarge PL，Shoultz TH，Griffin RL，et al. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury [J]. J Trauma Acute Care Surg，2015，79（2）：289-294.
[25] Cap AP，Spinella PC. Severity of head injury is associated with increased risk of coagulopathy in combat casualties [J]. J Trauma，2011，71（1）：S78-S81.
[26] Nielsen N，Wetterslev J，Cronberg T，et al. Targeted temperature management at 33℃ versus 36℃after cardiac arrest [J]. N Engl J Med，2013，369（23）：2197-2206.
[27] Brain Trauma Fundation. Prophylactic hyperthermia [J]. J Neurotaum，2007，24：S21-25.
[28] Jiang JY，Xu W，Li WP，et al. Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury [J]. J Cereb Blood Flow Metab，2006，26（6）：771-776.
[29] Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries [J]. Lancet，2008，371（9628）：1955-1969.
[30] 杨莘，李冬，刘芳，等.适宜复温速率对重型颅脑损伤亚低温治疗患者的效果研究[J].护理管理杂志，2015，15（9）：647-649.