亞低溫治療對(duì)重型顱腦損傷療效及安全性的系統(tǒng)評(píng)價(jià)
發(fā)布時(shí)間：2018-07-16 14:15
【摘要】：目的分析并評(píng)價(jià)亞低溫治療對(duì)重型顱腦損傷患者死亡率、預(yù)后的影響和亞低溫治療的安全性。方法按Cochrane系統(tǒng)評(píng)價(jià)方法,分別檢索Cochrane協(xié)作網(wǎng)、Pubmed、Embase、CBM、CNKI、萬方、維普數(shù)各據(jù)庫(kù),檢索截止日期為2013年7月12日,然后根據(jù)納入和排除標(biāo)準(zhǔn),篩選以重型顱腦損傷為研究對(duì)象的臨床隨機(jī)對(duì)照試驗(yàn),并人工檢索相關(guān)文獻(xiàn)的參考文獻(xiàn)、雜志增刊和會(huì)議摘要。對(duì)納入文獻(xiàn)的質(zhì)量進(jìn)行評(píng)估,提取數(shù)據(jù)后運(yùn)用Rev Man5.2軟件進(jìn)行Meta分析。結(jié)果12個(gè)亞低溫治療重型顱腦損傷的隨機(jī)對(duì)照試驗(yàn)符合納入標(biāo)準(zhǔn),其中3個(gè)為多中心研究,9個(gè)為單中心研究,共包括1003例亞低溫治療組患者,999例對(duì)照組患者。Meta分析顯示:亞低溫組相對(duì)于常溫組降低了總的病死率[RR=0.74,95%CI(0.64,0.85),P0.0001];亞低溫組相對(duì)于常溫組改善了預(yù)后[RR=1.40,95%CI(1.24,1.59),P0.00001];亞低溫治療第1、3、7天顱內(nèi)壓和血糖均低于對(duì)照組P0.05;肺炎發(fā)生率P=0.007,差異有統(tǒng)計(jì)學(xué)意義;心律失常發(fā)生率P=0.06,差異無統(tǒng)計(jì)學(xué)意義,但敏感性分析結(jié)果后差異有統(tǒng)計(jì)學(xué)意義。結(jié)論亞低溫持續(xù)時(shí)間小于3天時(shí)無效,持續(xù)時(shí)間達(dá)到3天時(shí)雖然不能降低病死率但可改善預(yù)后(GOS評(píng)分4~5分),持續(xù)3天以上或持續(xù)至顱內(nèi)壓恢復(fù)正常,可降低病死率,改善神經(jīng)功能預(yù)后;亞低溫治療期間可降低顱內(nèi)壓和血糖,但肺炎發(fā)生率增高,是否增加心律失常發(fā)生率尚待確定。
[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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.15
本文編號(hào)：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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.15
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