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创伤性脑损伤及抗氧化治疗对临床结局影响的系统评价

Systematic Review of Traumatic Brain Injury and the Impact of Antioxidant Therapy on Clinical Outcomes.

作者信息

Shen Qiuhua, Hiebert John B, Hartwell Julie, Thimmesch Amanda R, Pierce Janet D

机构信息

Assistant Professor, University of Kansas, School of Nursing, Kansas City, KS, USA.

Cardiologist, University of Kansas, School of Nursing, Kansas City, KS, USA.

出版信息

Worldviews Evid Based Nurs. 2016 Oct;13(5):380-389. doi: 10.1111/wvn.12167. Epub 2016 May 31.

Abstract

BACKGROUND

Traumatic brain injury (TBI) is an acquired brain injury that occurs when there is sudden trauma that leads to brain damage. This acute complex event can happen when the head is violently or suddenly struck or an object pierces the skull or brain. The current principal treatment of TBI includes various pharmaceutical agents, hyperbaric oxygen, and hypothermia. There is evidence that secondary injury from a TBI is specifically related to oxidative stress. However, the clinical management of TBI often does not include antioxidants to reduce oxidative stress and prevent secondary injury.

AIMS

The purpose of this article is to examine current literature regarding the use of antioxidant therapies in treating TBI. This review evaluates the evidence of antioxidant therapy as an adjunctive treatment used to reduce the underlying mechanisms involved in secondary TBI injury.

METHODS

A systematic review of the literature published between January 2005 and September 2015 was conducted. Five databases were searched including CINAHL, PubMed, the Cochrane Library, PsycINFO, and Web of Science.

FINDINGS

Critical evaluation of the six studies that met inclusion criteria suggests that antioxidant therapies such as amino acids, vitamins C and E, progesterone, N-acetylcysteine, and enzogenol may be safe and effective adjunctive therapies in adult patients with TBI. Although certain limitations were found, the overall trend of using antioxidant therapies to improve the clinical outcomes of TBI was positive.

LINKING EVIDENCE TO ACTION

By incorporating antioxidant therapies into practice, clinicians can help attenuate the oxidative posttraumatic brain damage and optimize patients' recovery.

摘要

背景

创伤性脑损伤(TBI)是一种后天性脑损伤,当突然的创伤导致脑损伤时发生。这种急性复杂事件可在头部受到猛烈或突然撞击、物体穿透颅骨或脑部时发生。目前TBI的主要治疗方法包括各种药物、高压氧和低温治疗。有证据表明,TBI的继发性损伤与氧化应激特别相关。然而,TBI的临床管理通常不包括使用抗氧化剂来减轻氧化应激和预防继发性损伤。

目的

本文旨在研究目前关于抗氧化疗法治疗TBI的文献。本综述评估抗氧化疗法作为辅助治疗用于减少继发性TBI损伤潜在机制的证据。

方法

对2005年1月至2015年9月发表的文献进行系统综述。检索了五个数据库,包括护理学与健康领域数据库(CINAHL)、医学期刊数据库(PubMed)、考科蓝图书馆、心理学文摘数据库(PsycINFO)和科学引文索引数据库(Web of Science)。

结果

对六项符合纳入标准的研究进行的批判性评估表明,氨基酸、维生素C和E、孕酮、N-乙酰半胱氨酸和银叶桉叶素等抗氧化疗法可能是成年TBI患者安全有效的辅助疗法。尽管发现了某些局限性,但使用抗氧化疗法改善TBI临床结果的总体趋势是积极的。

将证据与行动联系起来

通过将抗氧化疗法纳入实践,临床医生可以帮助减轻创伤后脑的氧化损伤,并优化患者的康复。

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