Zeiler F A, Teitelbaum J, Gillman L M, West M
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada,
Neurocrit Care. 2014 Oct;21(2):332-44. doi: 10.1007/s12028-014-9978-7.
Our goal was to perform a systematic review of the literature on the use of tromethamine (THAM) and its effects on intracranial pressure (ICP) in patients with neurological illness. All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to February 2014), reference lists of relevant articles, and gray literature were searched. Two reviewers independently identified all manuscripts pertaining to the administration of THAM in human patients that recorded effects on ICP. Secondary outcomes of effect on cerebral perfusion pressure, mean arterial pressure, patient outcome, and adverse effects were recorded. Two reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Our search strategy produced a total 2,268 citations. Twelve articles, 9 manuscripts, and 3 meeting proceedings were considered for the review with all utilizing THAM while documenting ICP in neurosurgical patients. All studies were prospective. Across all studies, there were a total of 488 patients studied, with 263 receiving THAM and 225 serving as controls in a variety of heterogeneous studies. All but one study documented a decrease in ICP with THAM administration, with both bolus and continuous infusions. One study documented a reduction in cerebral perfusion pressure. No significant renal dysfunction, hepatocellular injury, or hypoglycemia were reported. Three prospective randomized control trials displayed trends to improved outcome in severe traumatic brain injury (TBI) patients with THAM administration. There currently exists Oxford level 2b, GRADE B evidence to support that THAM reduces ICP in the TBI and malignant ischemic infarct population, with minimal side effects. The literature suggests THAM may be useful for ICP reduction in certain cases, though the safety of the compound in these circumstances is still unclear. Further prospective study is warranted.
我们的目标是对有关氨丁三醇（THAM）的使用及其对神经系统疾病患者颅内压（ICP）影响的文献进行系统综述。检索了MEDLINE、BIOSIS、EMBASE、Global Health、HealthStar、Scopus、Cochrane图书馆、国际临床试验注册平台（截至2014年2月）的所有文章、相关文章的参考文献列表以及灰色文献。两名评审员独立识别了所有与在人类患者中给予THAM并记录其对ICP影响的手稿。记录了对脑灌注压、平均动脉压、患者预后和不良反应的次要影响结果。两名评审员独立提取了包括人群特征和治疗特征的数据。使用牛津方法和GRADE方法对证据强度进行了判定。我们的检索策略共产生了2268条引文。有12篇文章、9篇手稿和3篇会议记录被纳入综述，所有这些都使用了THAM并记录了神经外科患者的ICP。所有研究均为前瞻性研究。在所有研究中，共有488名患者接受研究，其中263名接受THAM治疗，225名在各种不同的研究中作为对照。除一项研究外，所有研究均记录了给予THAM（推注和持续输注）后ICP降低。一项研究记录了脑灌注压降低。未报告明显的肾功能障碍、肝细胞损伤或低血糖。三项前瞻性随机对照试验显示，给予THAM的重度创伤性脑损伤（TBI）患者有预后改善的趋势。目前有牛津2b级、GRADE B级证据支持THAM可降低TBI和恶性缺血性梗死患者的ICP，且副作用最小。文献表明，THAM在某些情况下可能有助于降低ICP，尽管该化合物在这些情况下的安全性仍不清楚。有必要进行进一步的前瞻性研究。
