亚低温联合高压氧治疗重型颅脑损伤疗效的Meta分析

Mild Hypothermia and Meta Analysis of Therapeutic Effect of Hyperbaric Oxygen in Treatment of Severe Craniocerebral Injury

目的:采用Meta分析方法评价亚低温(mild hypothermia)联合高压氧(Hyperbaric oxygen, HBO)治疗重型颅脑损伤(severe traumatic brain injury, sTBI)的临床疗效。方法:计算机检索PubMed、Embase、the Cochrane Library、CNKI、WanFang Data、SinoMed和VIP,检索时限均从各数据库建库至2020年9月。收集所有相关的随机对照试验(RCT),由2位研究人员独立对纳入文献进行筛选、数据提取及偏倚风险评价,使用RevMan5.3软件行效应量合并及Meta分析。结果以均数差(MD)、相对危险度(RR)、95%置信区间(CI)等指标进行分析。结果:共纳入15个RCT,共计1271例患者。Meta分析结果显示,联合治疗组的预后良好率高于对照组[RR = 1.60 (95%CI: 1.43, 1.79), P < 0.00001];联合治疗组的病死率低于对照组[RR = 0.36 (95%CI: 0.27, 0.49), P < 0.00001];联合治疗组治疗后的GCS评分优于对照组[MD = 4.80 (95%CI: 4.05, 5.55), P < 0.00001];联合治疗组治疗后的ADL评分优于对照组[MD = 32.50 (95%CI: 19.81, 45.19), P < 0.00001];联合治疗组治疗1周后的颅内压(ICP)明显低于对照组[MD = −0.79 (95%CI: −0.85, −0.73), P < 0.00001];联合治疗组治疗1周后的脑组织氧分压(PbtO)明显高于对照组[MD = 11.93 (95%CI: 7.56, 16.29), P < 0.00001]。结论:sTBI患者在常规治疗的基础上联合亚低温、高压氧治疗,可以显著降低其颅内压,提高脑氧分压,进而有助于神经功能的恢复,降低死亡率及致残率,明显改善了临床预后。

Objective: To evaluate the clinical efficacy of mild hypothermia combined with hyperbaric oxygen in the treatment of severe craniocerebral injury. Methods: Computer retrieval was performed in PubMed, Embase, the Cochrane Library, CNKI, WanFang Data, SinoMed and VIP. The retrieval time was from the establishment of each database to September 2020. In the clinical randomized con-trolled trial (RCTS), 2 researchers independently screened the included literature, performed data extraction and bias risk assessment, and performed effect size combination and Meta analysis using RevMan5.3 software. Results Mean difference (MD), relative risk (RR), 95% confidence interval (CI) and other indicators were used for analysis. Results: A total of 15 RCTS with a total of 1271 patients were included. Meta analysis results showed that the favorable prognosis rate of the combined treatment group was higher than that of the control group [RR = 1.60 (95%CI: 1.43, 1.79), P < 0.00001]. The mortality of the combined treatment group was lower than that of the control group [RR = 0.36 (95%CI: 0.27, 0.49), P < 0.00001]. The GCS score of the combined treatment group was better than that of the control group [MD = 4.80 (95%CI: 4.05, 5.55), P < 0.00001]. ADL score of the combined treatment group was better than that of the control group [MD = 32.50 (95%CI: 19.81, 45.19), P < 0.00001]. The intracranial pressure in the combined treatment group was significantly lower than that in the control group [MD = −0.79 (95%CI: −0.85, −0.73), P < 0.00001]. The oxygen partial pressure in brain tissues of the combined treatment group was significantly higher than that of the control group [MD = 11.93 (95%CI: 7.56, 16.29), P < 0.00001]. Conclusion: Combined with mild hypothermia and hyperbaric oxygen therapy on the basis of conventional treatment, sTBI pa-tients can significantly reduce intracranial pressure, improve partial cerebral oxygen pressure, thereby promoting the recovery of nerve function, reduce mortality and disability rate, and signifi-cantly improve the clinical prognosis.