Shen Liang, Wang Zhuo, Su Zhongzhou, Qiu Sheng, Xu Jie, Zhou Yue, Yan Ai, Yin Rui, Lu Bin, Nie Xiaohu, Zhao Shufa, Yan Renfu
Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China.
Department of Medical College, Nursing College of Huzhou University, Huzhou, Zhejiang, China.
PLoS One. 2016 Dec 28;11(12):e0168901. doi: 10.1371/journal.pone.0168901. eCollection 2016.
The Brain Trauma Foundation (BTF) guidelines published in 2007 suggest some indications for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). However, some studies had not shown clinical benefit in patients with severe TBI; several studies had even reported that ICP monitoring was associated with an increased mortality rate. The effect of ICP monitoring has remained controversial, regardless of the ICP monitoring guidelines. Here we performed a meta-analysis of published studies to assess the effects of ICP monitoring in patients with severe TBI.
We searched three comprehensive databases, the Cochrane Library, PUBMED, and EMBASE, for studies without limitations published up to September 2015. Mortality, ICU LOS, and hospital LOS were analyzed with Review Manager software according to data from the included studies.
Eighteen eligible studies involving 25229 patients with severe TBI were included in our meta-analysis. The results indicated no significant reduction in the ICP monitored group in mortality (hospitalized before 2007), hospital mortality (hospitalized before 2007), mortality in randomized controlled trials. However, overall mortality, mortality (hospitalized after 2007), hospital mortality (hospitalized after 2007), mortality in observational studies (hospitalized after 2007), 2-week mortality, 6-month mortality, were reduced in ICP monitored group. Patients with an increased ICP were more likely to require ICP monitoring.
Superior survival was observed in severe TBI patients with ICP monitoring since the third edition of "Guidelines for the Management of Severe Traumatic Brain Injury," which included "Indications for intracranial pressure monitoring," was published in 2007.
2007年发布的脑创伤基金会（BTF）指南提出了重度创伤性脑损伤（TBI）患者颅内压（ICP）监测的一些指征。然而，一些研究并未显示出对重度TBI患者有临床益处；一些研究甚至报告称ICP监测与死亡率增加有关。无论ICP监测指南如何，ICP监测的效果一直存在争议。在此，我们对已发表的研究进行了荟萃分析，以评估ICP监测对重度TBI患者的影响。
我们检索了三个综合数据库，即考克兰图书馆、PUBMED和EMBASE，查找截至2015年9月发表的无限制研究。根据纳入研究的数据，使用Review Manager软件分析死亡率、重症监护病房住院时间（ICU LOS）和住院时间（医院LOS）。
我们的荟萃分析纳入了18项符合条件的研究，涉及25229例重度TBI患者。结果表明，在ICP监测组中，死亡率（2007年前住院）、医院死亡率（2007年前住院）、随机对照试验中的死亡率没有显著降低。然而，ICP监测组的总体死亡率、死亡率（2007年后住院）、医院死亡率（2007年后住院）、观察性研究中的死亡率（2007年后住院）、2周死亡率、6个月死亡率有所降低。ICP升高的患者更有可能需要进行ICP监测。
自2007年发布《重度创伤性脑损伤管理指南》第三版（其中包括“颅内压监测指征”）以来，对重度TBI患者进行ICP监测可观察到更好的生存率。
