长期亚低温对比短期亚低温治疗重型颅脑损伤的系统评价

Comparison of long-term and short-term mild hypothermia on severe traumatic brain injury: a systematic review

目的：亚低温技术对重型颅脑损伤的脑保护作用与预后改善有着广泛的认可。文中分析长期亚低温与短期亚低温治疗对重型颅脑损伤患者预后的影响及并发症的情况。方法按Cochrane系统评价方法，全面检索Cochrane协作网、Pubmed、Embase、CBM、CNKI、万方、维普各数据库对纳入文献的质量进行评估，提取数据后运用RevMan 5．2软件进行Meta分析。结果亚低温治疗长期组相对于短期组改善了预后（格拉斯哥预后评分4～5分）[RR＝1．37，95％CI（1．14，1．64）]，差异有统计学意义（ P＝0．0006）；而在肺炎发生率、心律失常发生率以及应激性溃疡发生率等方向，差异均无统计学意义（ P＞0．05）。结论长期亚低温治疗较短期亚低温治疗对重型颅脑损伤患者的预后有改善作用，没有明显增加肺炎、心律失常、应激性溃疡的发生率。

Objective Mild hypothermia provides protection for the brain and improves prognosis in the treatment of severe traumatic brain injury, which is widely acknowledged.The article aimed to analysis the prognosis and complications of long-term and short-term mild hypothermia on patients with severe traumatic brain injury. Methods According to the cochrane systematic review methods, thorough search was carried out in databases including Cochrane, Pubmed, Embase, CBM, CNKI, Wanfang and VIP.Eval-uation was made on the quality of selected documents, and Revman5.2 software was applied for meta analysis after data extraction. Results Long-term mild hypothermia achieved improved prognosis compared to short-term mild hypothermia （ GOS score 4～5 ） [RR=1.37, 95%CI （1.14, 1.64）, P=0.0006].No significant difference was found between these two therapies in pneumonia in-cidence （P=0.94）, arrhythmia incidence （ P=0.54） and stress ulcer incidence （P=0.99）. Conclusion In comparison to short-term hypothermia therapy, long-term mild hypothermia therapy improved the prognosis of patients with severe traumatic brain inju-ry without obvious increase in the incidence of pneumonia, arrhythmia and stress ulcer.