治疗性低温对心脏骤停患者神经功能预后和存活率影响的Meta分析

Effectiveness of therapeutic hypothermia on neurological status and survival in patients after cardiac arrest： a Meta-analysis

目的 系统评价治疗性低温对心脏骤停患者神经功能预后和存活率的影响.方法 检索MEDLINE、PubMed、荷兰医学文摘（EMBASE）、Cochrane图书馆、万方数据库、中国期刊网全文数据库（CNKI）和中国生物医学文献数据库（CBM）,纳入治疗性低温对心脏骤停患者的随机对照实验（RCT）,结局指标为神经功能预后和存活率.采用RevMan 5.0软件进行Meta分析,二分类变量效应量用相对危险度（RR）及其95％可信区间（CI）表达,以P＜0.05为差异具有统计学意义.结果 在8个随机对照实验中,共1 512例心脏骤停患者.与常温组比较,治疗性低温能改善患者神经功能预后,且差异具有统计学意义（RR=1.34,95％ CI：1.01～1.78,P＜0.05）;两组存活率比较差异无统计学意义（RR =1.09,95％CI：0.98～1.20,P＞0.05）.与常温组比较,应用传统降温方法的治疗性低温能改善患者神经功能预后,且差异具有统计学意义（RR=1.51,95％ CI：1.22～1.87,P＜0.01）;传统降温方法的治疗性低温能提高存活率,差异具有统计学意义（RR=1.36,95％CI：1.13 ～1.63,P＜0.01）.结论 治疗性低温能改善心脏骤停后患者神经功能预后,不能提高存活率;应用传统降温方法的治疗性低温不但能改善患者神经功能预后,而且能提高存活率.

Objective To evaluate the effects of therapeutic hypothermia on both neurological status and survival rate in patients after cardiac arrest.Methods The data were searched from MEDLINE,PubMed,EMBASE,Cochrane Library,Wanfang database,CNKI and CBM.The randomized and controlled trials were selected for evaluating the main outcomes of neurological status and survival rate in patients after cardiac arrest.Meta-analysis was carried out by using Review Manger 5.0 software.The results were expressed in risk ratio （RR） for dichotomous outcomes data with 95% confidence intervals （CI）,and P 〈 0.05 was considered to be significant.Results Eight randomized controlled clinical trials with a total of 1 512 patients met our inclusion criteria.The overall risk ratio of favorable neurological status was 1.34 （95% CI：1.01-1.78,P 〈0.05） and of survival rate was 1.09 （95% CI：0.98-1.20,P 〉0.05） with therapeutic hypothermia compared with controls,however,when the applications of conventional cooling trials were analyzed,the risk ratio was 1.51 （95% CI：1.22-1.87,P 〈0.01） and 1.36 （95%CI：1.13 -1.63,P 〈 0.01）,respectively.Conclusions Patients treated with therapeutic hypothermia after cardiac arrest had more favorable neurological status compared with the controls.There was no benefit of therapeutic hypothermia to survival rate identified.Compare with conventional cooling methods,the therapeutic hypothermia could improve neurological status and survival rate in patients after cardiac arrest.