近红外光谱测量脑血氧饱和度与成人心脏骤停后接受目标体温管理患者神经系统预后的关系:系统评价和荟萃分析

The relationship between cerebral oxygen saturation monitoring by near-infrared spectroscopy and neurological outcomes in adult patients receiving targeted temperature management after cardiac arrest:a systematic review and meta-analysis

目的研究脑血氧饱和度(rSO_(2))在心脏骤停后综合征(PCAS)昏迷患者的目标体温管理(TTM)期间预测神经系统预后的作用。方法本研究根据PRISMA指南进行报告,检索了Pubmed、Embase、Cochane Library、Web of science、Google Scholar、Clinical gov、万方、维普、CNKI共9个数据库。除外研究类型为病例报告、综述和研究样本量小于5例的研究,收集所有在成人心脏骤停(CA)期间进行近红外光谱(NIRS)测量的研究。两名审稿人评估纳入文章的质量并提取数据。结果效应使用标准化平均差(SMD)进行标准化。结果本荟萃分析纳入11项研究,其中2项为随机对照研究,9项为观察性研究。共计681例患者。患者TTM期间NIRS测量的rSO_(2)值在TTM 24 h(低温结束)、TTM 24~36 h(复温阶段)和TTM 36~48 h(初始常温阶段)与神经系统预后相关(TTM 24 h:SMD=0.45,95%CI 0.29~0.61;TTM 24~36 h:SMD=1.17,95%CI 0.85~1.50;TTM 36~48 h:SMD=0.26,95%CI 0.10~0.43),良好的神经系统预后(CPC 1~2)组具有较高的rSO_(2)值。在TTM开始时、TTM期间和TTM 72 h的常温阶段,均未发现NIRS测量的rSO_(2)值与神经系统预后的相关性。结论对于行TTM的CA患者,在TTM 24~48 h期间良好神经系统预后患者NIRS测量的rSO_(2)值高于神经系统预后不良的患者,其中TTM 24~36 h(复温阶段)与良好神经系统预后有较强的关联。

Objective To investigate the role of cerebral oxygen saturation(rSO_(2))in predicting neurological outcomes during targeted temperature management(TTM)in coma patients with post-cardiac arrest syndrome(PCAS).Methods This study was reported according to PRISMA criteria,and 9 databases including Pubmed,Embase,Cochane Library,Web of science,Google Scholar,Clinical gov,Wanfang,Weipu,and CNKI were searched.All observational studies with near-infrared spectroscopy(NIRS)surveillance during adult cardiac arrest(CA)were collected,with the exception of case reports,reviews,and studies with sample size less than 5 patients.Two reviewers assessed the quality of included articles and extracted data.Outcome effects were standardized by using the standardized mean difference(SMD).Results This review included 11 studies,of which 2 were randomized controlled trials and 9 were observational researchs.There were a total of 681 patients.The study found that rSO_(2) measured by NIRS at 24 h of TTM(end of hypothermia),24-36 h of TTM(rewarming phase),and 36-48 h of TTM(initial normothermic phase)in the patients during TTM was associated with neurological outcomes(24 h of TTM:SMD=0.45,95%CI 0.29-0.61;24-36 h of TTM:SMD=1.17,95%CI 0.85-1.50;36-48 h of TTM:SMD=0.26,95%CI 0.10-0.43),the group with good neurological prognosis(CPC 1-2)had higher rSO_(2) measurements.No correlation between rSO_(2) and neurological outcome was found at the onset of TTM,during TTM,and during the normothermic phase of TTM for 72 h.Conclusions Among CA patients undergoing TTM,rSO_(2) during 24-48 h of TTM was higher in the patients with good neurological outcome than in the patients with poor neurological outcome,24-36 h of TTM(rewarming stage)was strongly associated with good neurological outcome.