亚低温干预对弥漫性轴索损伤患者预后的影响  

Effect of hypothermia treatment on the prognosis of patients with diffuse axonal injury

作　　者：张斌飞[1] 宋锦宁[1] 赵永林[1] 马旭东[1] 李丹东[1] 刘尊伟[1] 赵君杰[1] 黄廷钦[1] 

机构地区：[1]西安交通大学医学院第一附属医院神经外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2015年第1期54-59,88,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.30471774);教育部新世纪优秀人才支持计划资助项目(No.NCET-05-0831);陕西省自然科学基金资助项目(No.2003C1-16)~~

摘　　要：目的本研究旨在评价亚低温治疗（HT）对弥漫性轴索损伤（DAI）的疗效及安全性。方法计算机检索Pubmed、Embase、Cochrane Library、中国知网、万方、维普、中国生物医学文献数据库,时间截止到2014年6月,纳入HT与常温（NT）对比治疗DAI的随机对照研究（RCT）。由2位研究者独立评价纳入研究的质量、提取数据,采用RevMan 5.2.7进行统计分析。结果共纳入18个方法学质量较低的研究,包括1 332例DAI患者,其中HT组713例,NT组619例。Meta分析结果显示：HT组患者的病死率低于NT组（RR=0.62,95%CI：0.53～0.73,P〈0.000 01）;格拉斯哥预后评分（GOS）显示HT组3月GOS 4～5（RR=1.65,95%CI：1.45～1.88,P〈0.000 01）与6月GOS 4～5（RR=1.54,95%CI：1.08～2.19,P=0.02）均高于NT组;HT治疗24h后患者颅内压低于NT组（MD=-0.70,95%CI：―0.94～―0.47,P〈0.000 01）。在感染、出血事件、心律失常等并发症方面HT与NT之间差异无统计学意义。结论目前没有确切证据表明HT治疗具有明显优势,DAI患者可能从HT治疗中受益,但在临床上推广应十分谨慎。期待设计严格、统一标准的大样本、多中心RCT继续研究。Objective To evaluate the efficacy and safety of hypothermia treatment （HT） on patients with diffuse axonal injury （DAI）. Methods Systematic literature retrieval was carried out to obtain randomized controlled trials （RCTs） before June 2014 which focused on HT and normothermia treatment （NT） for patients with DAI from Pubmed, Embase, Cochrane Library, CNKI, WanFang, VIP and CBM databases. Data extraction and quality evaluation of studies were performed by two investigators independently. A meta-analysis was performed with RevMan 5.2.7. Results Totally lg low-quality studies were included. They involved 1 332 patients with 713 in HT group and 619 in NT group. Meta-analysis showed that compared with NT, HT had a lower fatality （RR = 0.62, 95% CI：0.53-0.73, P〈C0.00001）, ahigher Glasgow Outcome Scale （GOS） at 3 month GOS 4--5 （RR 1.65, 95% CI：1.45--1.88, P〈0.00001） and 6 month GOS4--5 （RR=1.54, 95% CI：1.08--2.19, P 0,02） , and lower intracranial pressure at 24h after treatment （MD=-0.70, 95% CI：--0.94-0.47, P〈0.000 01）. There was no significant difference between HT and NT in infection, bleeding events, arrhythmia and other complications. Conclusion There is no exact evidence indicating that HT has obvious advantages. Patients with DA1 might benefit from HT, but the clinical application should be taken with caution. Further rigorously designed multi-center RCTs with uniform standards and large sample sizes on this topic are still needed.

关 键 词：亚低温 弥漫性轴索损伤 META分析 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学] R454.5[医药卫生—临床医学]