【摘要】：目的分析并評價亞低溫治療對重型顱腦損傷患者死亡率、預后的影響和亞低溫治療的安全性。方法按Cochrane系統(tǒng)評價方法,分別檢索Cochrane協(xié)作網(wǎng)、Pubmed、Embase、CBM、CNKI、萬方、維普數(shù)各據(jù)庫,檢索截止日期為2013年7月12日,然后根據(jù)納入和排除標準,篩選以重型顱腦損傷為研究對象的臨床隨機對照試驗,并人工檢索相關文獻的參考文獻、雜志增刊和會議摘要。對納入文獻的質(zhì)量進行評估,提取數(shù)據(jù)后運用Rev Man5.2軟件進行Meta分析。結(jié)果12個亞低溫治療重型顱腦損傷的隨機對照試驗符合納入標準,其中3個為多中心研究,9個為單中心研究,共包括1003例亞低溫治療組患者,999例對照組患者。Meta分析顯示:亞低溫組相對于常溫組降低了總的病死率[RR=0.74,95%CI(0.64,0.85),P0.0001];亞低溫組相對于常溫組改善了預后[RR=1.40,95%CI(1.24,1.59),P0.00001];亞低溫治療第1、3、7天顱內(nèi)壓和血糖均低于對照組P0.05;肺炎發(fā)生率P=0.007,差異有統(tǒng)計學意義;心律失常發(fā)生率P=0.06,差異無統(tǒng)計學意義,但敏感性分析結(jié)果后差異有統(tǒng)計學意義。結(jié)論亞低溫持續(xù)時間小于3天時無效,持續(xù)時間達到3天時雖然不能降低病死率但可改善預后(GOS評分4~5分),持續(xù)3天以上或持續(xù)至顱內(nèi)壓恢復正常,可降低病死率,改善神經(jīng)功能預后;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.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.15

【參考文獻】

相關期刊論文 前9條

1 張呈祥;;亞低溫治療重型顱腦損傷76例臨床分析[J];重慶醫(yī)學;2012年30期

2 孫來廣;程振國;王進忠;;亞低溫對重型顱腦損傷的治療作用[J];中國實用神經(jīng)疾病雜志;2010年02期

3 夏永勤;嚴麗麗;劉紹明;徐如祥;王向宇;;亞低溫治療重型顱腦損傷后腦血管痙攣的療效觀察[J];中華實用診斷與治療雜志;2009年12期

4 賴登明;姚楊;裘五四;方曉;徐敏;肖芽;;院前亞低溫治療重型顱腦損傷的應用研究[J];健康研究;2012年03期

5 裘明德;輕低溫療法及腦氧等測定的意義[J];中華神經(jīng)外科疾病研究雜志;2005年01期

6 張旗林;遲風令;光正耀;張馮佐;;42例重型顱腦損傷患者顱內(nèi)壓動態(tài)變化[J];山東醫(yī)藥;2014年20期

7 裘五四,劉偉國,沈宏,王衛(wèi)民,章志量,張瑛,江素君,楊小鋒;Therapeutic effect of mild hypothermia on severe traumatic head injury[J];Chinese Journal of Traumatology;2005年01期

8 郭曲練,譚秀娟,蔡宏偉,李友清,徐啟明,雷柏平;亞低溫對完全性腦缺血再灌注后丙二醛含量和超氧化物歧化酶活性的影響[J];中華創(chuàng)傷雜志;1997年01期

9 袁利群;貢志剛;蘭青;;血管腔內(nèi)降溫新技術在重癥顱腦外傷合并高熱患者中的初步應用[J];中國醫(yī)學創(chuàng)新;2011年08期

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