亚低温治疗对重型颅脑损伤患者疗效及安全性的系统评价

Mild hypothermia therapy on the efficacy and safety in patients with severe traumatic brain injury:a systematic review

目的:评价亚低温治疗重型颅脑损伤患者的疗效及安全性。方法:按Cochrane系统评价方法,检索Cochrane协作网、Pubmed、Embase、CBM、CNKI、万方、维普各数据库,对纳入文献进行质量评估,提取数据后进行Meta分析。结果:相对于对照组,亚低温治疗持续≤3 d在病死率上差异无统计学意义,汇总显示差异有统计学意义[RR=0.74,95%CI 0.64～0.85,P<0.000 1];亚低温持续<3 d在改善神经功能预后方面差异无统计学意义,汇总显示差异有统计学意义[RR=1.40,95%CI 1.24～1.59,P<0.000 01];亚低温治疗者肺炎发生率升高(P=0.007),心律失常发生率差异无统计学意义(P=0.06),但敏感性分析后差异有统计学意义。结论:亚低温治疗持续<3 d时无效,持续达到3 d时虽然不能降低病死率但可改善预后(GOS评分4～5分);持续3 d以上或持续至颅内压恢复正常,可降低病死率,改善神经功能预后;亚低温治疗期间肺炎发生率增高,是否增加心律失常发生率尚待确定。

Objective To evaluate the curative effect and safety of mild hypothermia on patients with traumatic brain injury. Methods According to the eoehrane systematic review methods, the data bases such as Cochrane, Pubmed, Embase, CBM, CNKI, Wanfang and VIP database were searched. The quality of included documents were assessed to extract meta analysis data. Results Compared to the control group, there was no statistically significant difference in patients treated by hypothermia for 3 days or less in mortality, but the difference was statistically significant after the summary [RR = 0.74, 95% CI 0.64 - 0.85 ,P 〈 0.000 1 ] ; And there was no statistically significant difference in improving neural function of patients treated by hypothermia for 〈 3 days, but hypothermia improves the prognosis after the summary[RR = 1.40,95%CI 1.24 ~ 1.59,P 〈 0.000 01 ]. The difference was statistically significant in the incidence of pneumonia（P = 0.007）, there was no statistically significant difference in the incidence of arrhythmia （P = 0.06）, but the difference was statistically significant after sensitivity analysis. Conclusions Patients treated by hypothermia for 〈 3 days is not valid for clinical outcomes, the duration of the treament up to 3 days may not reduce mortality rates, but can improve the prognosis, lasts longer than 3 days or until the pressure back to normal, reducing the mortality rate, improve the neurological prognosis; but increased incidence of pneumonia, whether to increase the rate of cardiac arrhythmias have yet to be determined.