何海燕 黄华平 康秀华 傅静

[摘要] 目的 探讨亚低温治疗技术对重型创伤性脑损伤（sTBI）患者预后的影响，为临床实践提供循证依据。 方法 通过系统检索PubMed、Cochrane library、clnicaltrials.gov及中国知网数据库从建库至2017年6月间发表的与研究主题相关的所有随机对照临床试验。由两名研究人员独立地阅读、提取入选研究中的数据。研究结局变量为患者死亡率及神经功能恢复状况。运用Review Manager 5.3及CMA3.0对收集的数据进行分析，同时运用TSA 0.9对研究结果的可靠性进行评估。 结果 共计14篇文献纳入本研究，涉及2024例sTBI患者，分为亚低温治疗组与常温治疗组；合并后的结果表明，两组患者死亡率比较，差异无统计学意义（RR = 0.92，95%CI=0.74～1.14，P = 0.43），TSA分析提示该结论较为肯定；同时发现亚低温治疗有利于患者的远期神经功能恢复（RR = 1.23，95%CI=1.02～1.49，P = 0.03），但TSA分析显示该结论还需要更多研究证实。 结论 亚低温治疗有助于改善患者的远期神经功能恢复，但无助于降低患者的死亡率。基于纳入文献的整体质量偏低，需要更多高质量的临床研究对结果进行验证。

[关键词] 亚低温；创伤性脑损伤；预后；系统评价

[中图分类号] R651.1 [文献标识码] A [文章编号] 1673-7210（2018）08（b）-0056-07

[Abstract] Objective To explore the effects of hypothermia on prognosis in severe traumatic brain injury （sTBI） patients， and provide the best evidence to clinical practice. Methods The databases PubMed， the Cochrane library， clnicaltrials.gov and CNKI were systematically searched from their inception to June 2017 to identify relevant randomized controlled trials （RCTs）. Two authors independently reviewed and extracted data from included studies. The outcome variables of the study were mortality and neurologic recovery. All data was analyzed by Review Manager version 5.3 and CMA version 3.0， TSA version 0.9 beta was applied to estimate whether the pooled outcome was conclusive. Results A total of 14 trials involving 2024 sTBI patients divided into subhypothermia treatment group and normal temperature treatment group were included in this study. The pooled results showed that there was no significant statistical difference in mortality between two groups （RR = 0.92， 95%CI=0.74-1.14， P = 0.43）， and TSA indicated that the current available evidence was conclusive. However， patients receiving hypothermia therapy had better neurological outcome than those receiving normothermia therapy （RR=1.23， 95%CI=1.02-1.49， P = 0.03）， and TSA indicated that more studies should be included to clarify this issue. Conclusion Hypothermia can improve long-term neurological recovery for sTBI patients， but which is not helpful to decrease the mortality. Based on the low overall quality of included articles， more high-quality studies are needed to verify these results.

[Key words] Hypothermia； Traumatic brain injury； Prognosis； Systematic review

隨着经济社会的发展，创伤性脑损伤（traumatic brain injury，TBI）已成为死亡率及致残率高、医疗花费高的主要公共问题之一[1]。TBI发生后常产生如电解质紊乱、兴奋性毒性及发热等在内的系列并发症[2]。高热增加脑组织氧代谢、加重脑水肿、升高颅内压导致脑细胞损害甚至不可逆病变，已成为影响患者预后的重要因素之一[3]。有效防止和减轻继发性损伤是降低TBI死残率和提高生存质量的关键。……