Psychology, University of Adelaide, Adelaide, South Australia, Australia.
J Clin Psychopharmacol. 2011 Dec;31(6):745-57. doi: 10.1097/JCP.0b013e318235f4ac.
Pharmacological treatments that are administered to adults in the postacute stage after a traumatic brain injury (TBI) (≥4 weeks after injury) have the potential to reduce persistent cognitive and behavioral problems. While a variety of treatments have been examined, the findings have yet to be consolidated, hampering advances in the treatment of TBI. A meta-analysis of research that has investigated the cognitive and behavioral effects of pharmacological treatments administered in the later stage after TBI was therefore conducted. The PubMed and PsycINFO databases were searched, and Cohen d effect sizes, percent overlap, and failsafe N statistics were calculated for each treatment. Both randomized controlled trials and open-label studies (prospective and retrospective) were included. Nineteen treatments were investigated by 30 independent studies, comprising 395 participants with TBI in the treatment groups and 137 control subjects. When treated in the postacute period, 1 dopaminergic agent (methylphenidate) improved behavior (anger/aggression, psychosocial function) and 1 cholinergic agent (donepezil) improved cognition (memory, attention). In addition, when the injury-to-treatment interval was broadened to include studies that administered treatment just before the postacute period, 2 dopaminergic agents (methylphenidate, amantadine) showed clinically useful treatment benefits for behavior, whereas 1 serotonergic agent (sertraline) markedly impaired cognition and psychomotor speed.
在创伤性脑损伤（TBI）后急性期（受伤后≥4 周）对成人进行药物治疗，有可能减轻持续存在的认知和行为问题。虽然已经检查了多种治疗方法，但尚未对这些发现进行整合，这阻碍了 TBI 治疗的进展。因此，对 TBI 后晚期进行药物治疗的认知和行为影响的研究进行了荟萃分析。对 PubMed 和 PsycINFO 数据库进行了检索，并为每种治疗方法计算了 Cohen d 效应大小、重叠百分比和失效安全 N 统计数据。包括随机对照试验和开放标签研究（前瞻性和回顾性）。30 项独立研究调查了 19 种治疗方法，包括治疗组 395 名 TBI 患者和 137 名对照组患者。在急性期后进行治疗时，1 种多巴胺能药物（哌醋甲酯）改善了行为（愤怒/攻击，心理社会功能），1 种胆碱能药物（多奈哌齐）改善了认知（记忆，注意力）。此外，当将治疗的损伤-治疗间隔扩大到包括在急性期前进行治疗的研究时，2 种多巴胺能药物（哌醋甲酯，金刚烷胺）对行为显示出临床有用的治疗益处，而 1 种血清素能药物（舍曲林）显著损害了认知和精神运动速度。
