颅内压监测对重型创伤性颅脑损伤患者临床疗效的Meta分析

Meta-analysis of clinical efficacy of intracranial pressure monitoring in patients with severe traumatic brain injury

目的系统评价持续颅内压(ICP)监测对重型颅脑损伤(TBI)患者疗效与安全性的影响。方法计算机检索Cochrane Library、MEDLINE、EMbase、CNKI、万方等数据库,收集符合纳入标准的研究,检索时限均为从建库至2015年3月,并追溯纳入研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Rev Man5.2软件进行Meta分析。结果共纳入1个随机对照研究,11个病例对照研究。Meta分析结果显示,与传统的临床和影像学监测对照组相比,ICP监测组的病死率并未显著降低,OR=0.87,95%CI(0.62,1.22),P=0.42。亚组分析结果显示,在经济发达及欠发达地区,ICP监测组与对照组的病死率相比,差异无统计学意义。2012年以后发表的文献合并OR值显示,ICP监测可显著降低病死率,OR=0.61,95%CI(0.39,0.95),P=0.03;ICP监测组与对照组ICU病死率及6个月的病死率相比,差异均无统计学意义;仅2周的病死率显著减少,OR=0.52,95%CI(0.40,0.68),P<0.01。结论对于重型TBI患者,持续ICP监测的临床疗效受多方面因素的影响,统一研究对象的纳入标准及ICP的规范化应用将会得出更为可靠的临床结论。

Objective To explore the clinical efficacy of intracranial ressure （ICP） monitoring for patients with severe traumatic brain injury（TBI）. Methods The literature concerning studies that compared CP monitoring with no CP monitoring for the treatment of TBI from PubMed, Cochrane Library, Embase, CNKI,Wanfang database with the time range of searching set from establishment of the databases to March 2015. Meta -analysis was conducted using the Cochrane Collaboration＇s RevMan 5.2 software. Results A total of 12 studies including 21,345 patients were analyzed. The rectaanalysis provided no evidence that ICP monitoring decreased the risk of death （OR = 0.87, [95% CI 0.62-1.22] ,P = 0. 42）. Six studies conducted in developed country showed no evidence that ICP monitoring decreased the risk of death, similar to the other studies conducted in poor countries. Six of the studies were published after 2012, and they revealed that ICP monitoring was significantly associated with a greater decreased in mortality than no ICP monitoring（ OR = 0.61 [95% CI 0.39, 0.95 ] ,P =0.03）. Two of the studies revealed that ICP monitoring significantly decrease the risk of 2- week mortality （ OR = 0.52, [ 95% CI 0.40,0.68 ], P 〈 0.01 ）. Conclusion For severe TBI patients, the clinical efficacy of ICP monitoring is influenced by many factors. To unify standard of research object and the standardization of the ICP application will get more reliable clinical conclusions.