亚低温治疗对重型颅脑损伤疗效及安全性的系统评价
发布时间:2018-07-16 14:15
【摘要】:目的分析并评价亚低温治疗对重型颅脑损伤患者死亡率、预后的影响和亚低温治疗的安全性。方法按Cochrane系统评价方法,分别检索Cochrane协作网、Pubmed、Embase、CBM、CNKI、万方、维普数各据库,检索截止日期为2013年7月12日,然后根据纳入和排除标准,筛选以重型颅脑损伤为研究对象的临床随机对照试验,并人工检索相关文献的参考文献、杂志增刊和会议摘要。对纳入文献的质量进行评估,提取数据后运用Rev Man5.2软件进行Meta分析。结果12个亚低温治疗重型颅脑损伤的随机对照试验符合纳入标准,其中3个为多中心研究,9个为单中心研究,共包括1003例亚低温治疗组患者,999例对照组患者。Meta分析显示:亚低温组相对于常温组降低了总的病死率[RR=0.74,95%CI(0.64,0.85),P0.0001];亚低温组相对于常温组改善了预后[RR=1.40,95%CI(1.24,1.59),P0.00001];亚低温治疗第1、3、7天颅内压和血糖均低于对照组P0.05;肺炎发生率P=0.007,差异有统计学意义;心律失常发生率P=0.06,差异无统计学意义,但敏感性分析结果后差异有统计学意义。结论亚低温持续时间小于3天时无效,持续时间达到3天时虽然不能降低病死率但可改善预后(GOS评分4~5分),持续3天以上或持续至颅内压恢复正常,可降低病死率,改善神经功能预后;亚低温治疗期间可降低颅内压和血糖,但肺炎发生率增高,是否增加心律失常发生率尚待确定。
[Abstract]:Objective to analyze and evaluate the effect of mild hypothermia therapy on mortality, prognosis and safety of mild hypothermia therapy in patients with severe craniocerebral injury. Methods according to the Cochrane systematic evaluation method, we searched the database of Pubmedmedan Embase CBMKI, Wanfang and Weip respectively, the deadline of retrieval was July 12, 2013, and then according to the inclusion and exclusion criteria, A randomized controlled clinical trial with severe craniocerebral injury was carried out, and references, journal supplements and conference abstracts of related literatures were searched manually. The quality of literature was evaluated and Meta-analysis was carried out by using Rev Man5.2 software. Results 12 randomized controlled trials of mild hypothermia for severe craniocerebral injury met the inclusion criteria, including three multicenter and nine single-center studies. Meta-analysis showed that the mortality rate of mild hypothermia group was lower than that of normothermic group [RRR0.74% 95CI (0.640.85) P 0.0001]; mild hypothermia group improved prognosis compared with normothermic group [RRN1.4095CI (1.241.59) P0.00001]; mild hypothermia group improved prognosis compared with normothermic group (RRRN1.4095CI (1.241.59) P0.00001); mild hypothermia group decreased total mortality compared with normothermia group [RRR0.74 ~ 95CI (0.640.85) P 0.0001]; The internal pressure and blood sugar were lower than those in the control group (P 0.05), the incidence of pneumonia was 0.007, the difference was statistically significant. The incidence of arrhythmia was 0.06, the difference was not statistically significant, but the difference was statistically significant after sensitivity analysis. Conclusion when the duration of mild hypothermia is less than 3 days, the prognosis (GOS score 4 ~ 5) can be improved when the duration of mild hypothermia is less than 3 days, and the mortality can be reduced when the duration of 3 days is less than 3 days, but the prognosis can be improved (GOS score is 4 ~ 5 points), which lasts for more than 3 days or until the intracranial pressure returns to normal. During mild hypothermia treatment, the intracranial pressure and blood glucose were decreased, but the incidence of pneumonia was increased, and whether the incidence of arrhythmia was increased or not is still to be determined.
【学位授予单位】:华北理工大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R651.15
本文编号:2126645
[Abstract]:Objective to analyze and evaluate the effect of mild hypothermia therapy on mortality, prognosis and safety of mild hypothermia therapy in patients with severe craniocerebral injury. Methods according to the Cochrane systematic evaluation method, we searched the database of Pubmedmedan Embase CBMKI, Wanfang and Weip respectively, the deadline of retrieval was July 12, 2013, and then according to the inclusion and exclusion criteria, A randomized controlled clinical trial with severe craniocerebral injury was carried out, and references, journal supplements and conference abstracts of related literatures were searched manually. The quality of literature was evaluated and Meta-analysis was carried out by using Rev Man5.2 software. Results 12 randomized controlled trials of mild hypothermia for severe craniocerebral injury met the inclusion criteria, including three multicenter and nine single-center studies. Meta-analysis showed that the mortality rate of mild hypothermia group was lower than that of normothermic group [RRR0.74% 95CI (0.640.85) P 0.0001]; mild hypothermia group improved prognosis compared with normothermic group [RRN1.4095CI (1.241.59) P0.00001]; mild hypothermia group improved prognosis compared with normothermic group (RRRN1.4095CI (1.241.59) P0.00001); mild hypothermia group decreased total mortality compared with normothermia group [RRR0.74 ~ 95CI (0.640.85) P 0.0001]; The internal pressure and blood sugar were lower than those in the control group (P 0.05), the incidence of pneumonia was 0.007, the difference was statistically significant. The incidence of arrhythmia was 0.06, the difference was not statistically significant, but the difference was statistically significant after sensitivity analysis. Conclusion when the duration of mild hypothermia is less than 3 days, the prognosis (GOS score 4 ~ 5) can be improved when the duration of mild hypothermia is less than 3 days, and the mortality can be reduced when the duration of 3 days is less than 3 days, but the prognosis can be improved (GOS score is 4 ~ 5 points), which lasts for more than 3 days or until the intracranial pressure returns to normal. During mild hypothermia treatment, the intracranial pressure and blood glucose were decreased, but the incidence of pneumonia was increased, and whether the incidence of arrhythmia was increased or not is still to be determined.
【学位授予单位】:华北理工大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R651.15
【参考文献】
相关期刊论文 前9条
1 张呈祥;;亚低温治疗重型颅脑损伤76例临床分析[J];重庆医学;2012年30期
2 孙来广;程振国;王进忠;;亚低温对重型颅脑损伤的治疗作用[J];中国实用神经疾病杂志;2010年02期
3 夏永勤;严丽丽;刘绍明;徐如祥;王向宇;;亚低温治疗重型颅脑损伤后脑血管痉挛的疗效观察[J];中华实用诊断与治疗杂志;2009年12期
4 赖登明;姚杨;裘五四;方晓;徐敏;肖芽;;院前亚低温治疗重型颅脑损伤的应用研究[J];健康研究;2012年03期
5 裘明德;轻低温疗法及脑氧等测定的意义[J];中华神经外科疾病研究杂志;2005年01期
6 张旗林;迟风令;光正耀;张冯佐;;42例重型颅脑损伤患者颅内压动态变化[J];山东医药;2014年20期
7 裘五四,刘伟国,沈宏,王卫民,章志量,张瑛,江素君,杨小锋;Therapeutic effect of mild hypothermia on severe traumatic head injury[J];Chinese Journal of Traumatology;2005年01期
8 郭曲练,谭秀娟,蔡宏伟,李友清,徐启明,雷柏平;亚低温对完全性脑缺血再灌注后丙二醛含量和超氧化物歧化酶活性的影响[J];中华创伤杂志;1997年01期
9 袁利群;贡志刚;兰青;;血管腔内降温新技术在重症颅脑外伤合并高热患者中的初步应用[J];中国医学创新;2011年08期
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