亚低温治疗重型颅脑损伤复温时机的 Meta 分析

摘要

Objective To analyze the effects of mild hypothermia therapy(MHT)time on the prognosis and intracra-nial pressure(IP)in patients with severe craniocerebral injuries,to find the best rewarming time after MHT. Methods The Cochrane,PubMed,EMBase,CBM,CNKI,Wangfang Data,VIP database were searched for relevant information and evalua-ted the quality of the enrolled literatures according to Cochrane Reviewer Handbook 5. 2. RevMan 5. 2 software was used to do meta - analysis on the extracted data. Results A total of eight literatures were included in this Meta - anlysis. The mortality rate was lower in MHT group than in normal temperature(NT)group〔RR = 0. 75,95% CI(0. 60,0. 93),P = 0. 007〕. By subgroup analysis,mortality was lower in subgroups 3 ~ 5 d - MHT and MHT - till - normal - IP than in NT group(RR = 0. 68, 0. 65). The prognosis was better in MHT group than in NT group〔RR = 1. 32,95% CI(1. 11,1. 57),P = 0. 002〕. By sub-group analysis,prognosis was better in subgroups 72 h - MHT〔RR = 1. 76,95% CI(1. 23,2. 52),P = 0. 002〕,3 ~ 5 d -MHT〔RR = 1. 41,95% CI(1. 09,1. 82),P = 0. 009〕,MHT - till - normal - IP〔RR = 1. 41,95% CI(1. 15,1. 73),P= 0. 0010〕than in NT group. Conclusion The best MHT rewarming time may be on the 5th day,which needs more high -quality clinical studies for further validation.%目的：分析亚低温治疗时间对重型颅脑损伤患者预后和颅内压的影响，寻找亚低温治疗后的最佳复温时机。方法全面检索 Cochrane 协作网、PubMed、EMBase、中国生物医学文献数据库（ CBM）、CNKI 数据库、万方数据库、维普数据库2013-07-12之前发表的文献。依据 Cochrane Reviewer Handbook 5.2对纳入文献的质量进行评估，提取数据后采用 RevMan 5.2软件进行 Meta 分析。结果共8篇文献纳入 Meta 分析，结果显示，亚低温组病死率低于常温组〔RR ＝0.75，95% CI（0.60，0.93），P ＝0.007〕；亚组分析显示，在病死率方面亚低温持续3~5 d 亚组与亚低温持续至颅内压正常亚组均低于常温组（RR 值分别为0.68和0.65）。在预后〔格拉斯哥预后评分（GOS 评分）4~5分〕方面，亚低温组的预后好于常温组〔RR ＝1.32，95% CI（1.11，1.57），P ＝0.002〕；亚组分析：亚低温持续72 h 亚组〔RR ＝1.76，95% CI（1.23，2.52），P ＝0.002〕、持续3~5 d 亚组〔 RR ＝1.41，95% CI（1.09，1.82），P ＝0.009〕、持续至颅内压正常亚组〔RR ＝1.41，95% CI（1.15，1.73），P ＝0.0010〕预后均好于常温组。结论亚低温治疗的最佳复温时机有可能在伤后第5天前后，但其尚需更多高质量的临床研究进一步验证。