亚低温治疗重型颅脑损伤复温时机的Meta分析

Mild Hypothermia for Severe Craniocerebral Injuries:A Meta-analysis of Rewarming Time

目的分析亚低温治疗时间对重型颅脑损伤患者预后和颅内压的影响,寻找亚低温治疗后的最佳复温时机。方法全面检索Cochrane协作网、PubMed、EMBase、中国生物医学文献数据库（CBM）、CNKI数据库、万方数据库、维普数据库2013-07-12之前发表的文献。依据Cochrane Reviewer Handbook 5.2对纳入文献的质量进行评估,提取数据后采用RevMan 5.2软件进行Meta分析。结果共8篇文献纳入Meta分析,结果显示,亚低温组病死率低于常温组〔RR=0.75,95%CI（0.60,0.93）,P=0.007〕;亚组分析显示,在病死率方面亚低温持续3～5 d亚组与亚低温持续至颅内压正常亚组均低于常温组（RR值分别为0.68和0.65）。在预后〔格拉斯哥预后评分（GOS评分）4～5分〕方面,亚低温组的预后好于常温组〔RR=1.32,95%CI（1.11,1.57）,P=0.002〕;亚组分析：亚低温持续72 h亚组〔RR=1.76,95%CI（1.23,2.52）,P=0.002〕、持续3～5 d亚组〔RR=1.41,95%CI（1.09,1.82）,P=0.009〕、持续至颅内压正常亚组〔RR=1.41,95%CI（1.15,1.73）,P=0.0010〕预后均好于常温组。结论亚低温治疗的最佳复温时机有可能在伤后第5天前后,但其尚需更多高质量的临床研究进一步验证。

Objective To analyze the effects of mild hypothermia therapy（MHT） time on the prognosis and intracranial pressure（IP） in patients with severe craniocerebral injuries,to find the best rewarming time after MHT.Methods The Cochrane,PubMed,EMBase,CBM,CNKI,Wangfang Data,VIP database were searched for relevant information and evaluated the quality of the enrolled literatures according to Cochrane Reviewer Handbook 5.2.RevMan 5.2 software was used to do meta-analysis on the extracted data.Results A total of eight literatures were included in this Meta-anlysis.The mortality rate was lower in MHT group than in normal temperature（NT） group〔RR=0.75,95% CI（0.60,0.93）,P=0.007〕.By subgroup analysis,mortality was lower in subgroups 3 ～ 5 d-MHT and MHT-till-normal-IP than in NT group（RR=0.68,0.65）.The prognosis was better in MHT group than in NT group〔RR=1.32,95% CI（1.11,1.57）,P=0.002〕.By subgroup analysis,prognosis was better in subgroups 72 h-MHT〔RR=1.76,95% CI（1.23,2.52）,P=0.002〕,3 ～ 5 d-MHT〔RR=1.41,95% CI（1.09,1.82）,P=0.009〕,MHT-till-normal-IP〔RR=1.41,95% CI（1.15,1.73）,P= 0.0010〕than in NT group.Conclusion The best MHT rewarming time may be on the 5th day,which needs more high-quality clinical studies for further validation.