亚低温治疗重型创伤性脑损伤患者疗效及安全性的Meta分析  

Meta-analysis of efficacy and safety of mild hypothermia for patients with severe traumatic brain injury

作　　者：刘艳辉 陈鑫[1] 刘劲芳[1] 周良 唐西杨 刘子源 Liu Yanhui;Chen Xin;Liu Jinfang;Zhou Liang;Tang Xiyang;Liu Ziyuan(Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha 410008,China;Teaching and Research Section of Clinical Nursing,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院神经外科,长沙410008 [2]中南大学湘雅医院临床护理学教研室,长沙410008

出　　处：《中华创伤杂志》2024年第6期506-515,共10页Chinese Journal of Trauma

摘　　要：目的评价亚低温治疗重型创伤性脑损伤(sTBI)患者的疗效及安全性。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网数据库,选择sTBI患者亚低温治疗与常温治疗的前瞻性随机对照试验。检索时限为建库至2023年2月。使用RevMan5.3软件进行Meta分析。评价指标包括文献检索结果、纳入文献的基本特征及质量;治疗后6、12个月预后不良发生率、病死率;治疗期间的肺部感染、心律失常、血小板减少、颅内感染、肾功能不全、消化道溃疡/出血、电解质紊乱的发生率;发表偏倚。结果共纳入16篇文献、2640例患者,其中亚低温组1381例,常温组1259例。亚低温组治疗后6、12个月预后不良发生率显著低于常温组(RR=0.81,95%CI 0.69,0.95,P<0.01;RR=0.65,95%CI 0.51,0.84,P<0.01)。亚低温组治疗后6、12个月病死率与常温组差异均无统计学意义(RR=0.81,95%CI 0.61,1.08,P>0.05;RR=0.69,95%CI 0.47,1.03,P>0.05)。与常温组比较,亚低温组肺部感染发生率差异有统计学意义(RR=1.18,95%CI 1.04,1.34,P<0.01);心律失常发生率差异无统计学意义(RR=1.35,95%CI 0.73,2.49,P>0.05);血小板减少发生率差异有统计学意义(RR=1.78,95%CI 1.34,2.37,P<0.01);颅内感染发生率差异无统计学意义(RR=1.32,95%CI 0.54,3.23,P>0.05);肾功能不全发生率差异无统计学意义(RR=1.22,95%CI 0.71,2.09,P>0.05);消化道溃疡/出血发生率差异无统计学意义(RR=0.98,95%CI 0.73,1.31,P>0.05);电解质紊乱发生率差异无统计学意义(RR=1.39,95%CI 1.00,1.94,P>0.05)。漏斗图图形近似对称,散点集中在漏斗图上部的狭窄区域,提示无发表偏倚。结论与常温治疗sTBI比较,亚低温治疗不能降低治疗后6、12个月的病死率,但可降低治疗后6、12个月的预后不良发生率;亚低温治疗对心律失常、颅内感染、肾功能不全、消化道溃疡/出血、电解质紊乱的发生�Objective To evaluate the efficacy and safety of mild hypothermia for patients with severe traumatic brain injury(sTBI).Methods PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine Disc,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,and VIP Database were searched for prospective randomized controlled researches on mild hypothermia and normothermia for patients with sTBI.The search time was from the establishment of the databases to February 2023.RevMan 5.3 software was used for Meta-analysis.The evaluation indicators included literature search results,basic characteristics and quality of the literature,poor prognosis rate and mortality at 6 and 12 months after treatment,incidence of pulmonary infection,arrhythmia,thrombocytopenia,intracranial infection,renal insufficiency,gastrointestinal ulcer/bleeding and electrolyte disorder during the treatment,and publication bias.Results A total of 16 papers involving 2640 patients were included,comprising 1381 patients in the mild hypothermia group and 1259 patients in the normothermia group.The poor prognosis rate in the mild hypothermia group was significantly lower than that in the normothermia group at 6 and 12 months after treatment(RR=0.81,95%CI 0.69,0.95,P<0.01;RR=0.65,95%CI 0.51,0.84,P<0.01).There was no significant difference in the mortality between the two groups at 6 and 12 months after treatment(RR=0.81,95%CI 0.61,1.08,P>0.05;RR=0.69,95%CI 0.47,1.03,P>0.05).In contrast with the the normothermia group,in the mild hypothermia group the incidence of pulmonary infection was significantly different(RR=1.18,95%CI 1.04,1.34,P<0.01);the incidence of arrhythmia was not significantly different(RR=1.35,95%CI 0.73,2.49,P>0.05);the incidence of thrombocytopenia was significantly different(RR=1.78,95%CI 1.34,2.37,P<0.01);the incidence of intracranial infection was not significantly different(RR=1.32,95%CI 0.54,3.23,P>0.05);the incidence of renal insufficiency was not significantly different(RR=1.22,95%CI 0.71,2.09,P>0.05);the

关 键 词：脑损伤 创伤性 低温 META分析 

分 类 号：R651.15[医药卫生—外科学]