长短期亚低温治疗重型颅脑损伤的疗效评价

Effects of Long-term and Short-term Mild Therapeutic Hypothermia on Sever Traumatic Brain Injury

目的评价长、短期亚低温(mild therapeutic hypothermia,MTH)干预在治疗重型颅脑损伤(sever traumatic brain injury,sTBI)疗效中的差异。方法系统性检索PubMed、EMBASE、知网(CNKI)等数据库收集相关随机对照研究(RCT)文献,提取数据资料;采用Jadad量表评价RCT文献质量;通过STATA12.0软件进行统计分析,合并效应指标;采用漏斗图评估发表偏移。结果共纳入13项RCT研究,含接受长期MTH治疗sTBI患者1632例。Meta分析结果显示,长期亚低温治疗组(降温时间≥3天)较短期治疗组患者(降温时间<3天)病死率未见显著降低[相对风险(RR)=0.90,95%置信区间(CI):0.77~1.06,P=0.204];同时,亚低温治疗可明显改善sTBI患者预后(RR=1.12,95%CI:1.01~1.24,P=0.031)。漏斗图显示研究间不存在发表偏移。结论长期MTH干预并不能降低sTBI患者的病死率,但可明显改善患者预后,值得临床推广应用。

Objective To investigate the different effects between long-term and short-term mild therapeutic hypothermia (MTH) that used in the treatment of sever traumatic brain injury (sTBI).Methods Multiple online databases as PubMed,EMBASE,and CNKI were reviewed for eligible randomized controlled trail (RCT) studies,and data were finally extracted.Study quality of RCT was judged by the Jadad list.Statistical analyses were conducted using STATA 12.0 software.Publication bias was examined using the funnel plot.Results A total of 13 eligible RCT studies were included,comprising 1632 sTBI cases in the long-term treatment group.Results of the meta-analysis displayed that patients received long-term MTH could not obtain declined motility rate than that with short-term MTH [risk ratio,RR=0.90;95% confidence interval (CI):0.77-1.06,P =0.204].Similarly,the combined effect for outcome manifested that the long-term also revealed favorable neurological outcome than the short-term group (RR=1.12,95% CI:1.01-1.24,P =0.031).The funnel plot showed no clear publication bias among studies.Conclusion long-term MTH can not decline the motility rate of patients with sTBI,but results in favorable neurological outcome,which therefore is worthy of promotion and application in clinic.