亚低温治疗重型颅脑损伤的Meta分析

A Meta analysis of hypothermia for severe traumatic brain injury

目的综合评价亚低温辅助治疗重型颅脑损伤的临床疗效、对颅内压(ICP)的影响及并发症发生情况。方法制定原始文献的纳入标准,全面检索Ovid、PubMed、Cochrane Database of Systematic Reviews、EMBASE、CBM、CJFD、万方全文数据库、维普中文科技期刊数据库。对筛选出的8个随机对照研究进行文献质量评价,再用Review Manager4.2.8进行Meta分析,对比亚低温治疗组与对照组在病死率、GOS评分、ICP及常见并发症发生率等方面的差异。结果漏斗图检验未发现明显的发表偏倚。亚低温治疗后24h,亚低温组ICP显著性低于对照组(WMD=-2.92,95%CI:-3.49～-2.34,P<0.0001);随访期间,亚低温治疗组病死率显著性低于对照组(P=0.001,OR=0.66,95%CI:0.51～0.84),GOS评分显著性优于对照组(P<0.00001,OR=0.56,95%CI:0.44～0.70),但肺炎发生率(OR=1.55,95%CI:1.13～2.12)、心律失常发生率显著性高于对照组(OR=2.14,95%CI:1.30～3.52)。结论亚低温治疗可降低重型颅脑损伤病人的病死率,有效降低ICP,改善其功能预后;但有增加肺炎及心律失常发生率的趋势。

Objective To comprehensively evaluate the clinical efficacy and complications of hypothermia for severe traumatic brain injury and its effects on intracranial pressure （ICP）. Methods The data bases such as Ovid, PubMed, Cochrane Database of Systematic Reviews, EMBASE, CBM, CJFD, Wanfang Data, and Vip Fulltext Databse were searched extensively according to the criteria established for original articles. Following the methodological quality of 8 screened randomized controlled trails （RCT） was assessed, Meta analysis was performed with software Review Manager 4.2.8 for the difference in mortality, Glasgow Outcome Scale （GOS）, changing of ICP and complications between hypothermia group and normal temperature group. Results Publication bias was not found through funnel plot analysis. ICP was significantly lower in the hypothermia group in the control group 24 h after treatment （WMD = -2.92, 95%CI： -3.49 to -2.34 ,P 〈 0.000 1）. In comparison with the routine therapy, hypothermia could significantly decrease mortality （P = 0.001, OR = 0.66, 95 %CI： 0.51 to 0.84） and improve GOS （P〈0.000 01, OR = 0.56, 95%CI： 0.44 to 0.70）, but increase the incidence of pneumonia （OR = 1.55, 95%CI： 1.13 to 2.12） and cardiac arrhythmia （OR = 2.14, 95%CI： 1.30 to 3.52）. Conclusion Therapeutic hypothermia can reduce the mortality, improve neurological outcome and efficaciously decrease ICP in patients with severe traumatic brain injury, but can also increase the risk of pneumonia and cardiac arrhythmia compared with control group.