Xie Qiang, Wu Hai-Bing, Yan Yu-Feng, Liu Meng, Wang Er-Song
Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
World Neurosurg. 2017 Apr;100:118-127. doi: 10.1016/j.wneu.2016.12.097. Epub 2017 Jan 3.
The combination of brain tissue oxygen and standard intracranial pressure (ICP)/cerebral perfusion pressure (CPP)-guided therapy is thought to improve traumatic brain injury (TBI) prognosis compared with standard ICP/CPP-guided therapy. However, related results of previous observational studies and recently published cohort studies and randomized controlled trials (RCTs) remain controversial. The objective of this study was to compare the effect of the combined therapy with that of standard ICP/CPP-guided therapy on mortality rate, favorable outcome, ICP/CPP, and length of stay (LOS).
We systematically searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science in July 2016 for studies comparing the combined therapy and standard ICP/CPP-guided therapy. Random-effect and fixed-effect models were used for pooled analyses.
After screening 362 studies, 8 cohort studies and 1 RCT were included. Primary outcomes were mortality and favorable outcome. The overall mortality risk ratio showed no obvious advantages between the 2 groups (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.54-1.06) and discharge mortality (RR, 1.01; 95% CI, 0.80-1.26) and 3-month mortality (RR, 0.77; 95% CI, 0.53-1.12). Compared with the ICP/CPP group, the combined group was more likely to achieve better outcome during the 6 months after TBI (RR, 1.26; 95% CI, 1.04-1.52) or exactly at 6 months (RR, 1.34; 95% CI, 1.07-1.68), whereas ICP (standardized mean difference [SMD], -0.19; 95% CI, -0.43 to 0.05), CPP (SMD, 0.13; 95% CI, -0.09 to 0.35), and LOS (SMD, 0.13; 95% CI, -0.11 to 0.37) showed no obvious differences.
Compared with standard ICP/CPP-guided therapy, brain tissue oxygen combined with ICP/CPP-guided therapy improved long-term outcomes without any effects on mortality, ICP/CPP, or LOS.
与标准的颅内压（ICP）/脑灌注压（CPP）引导治疗相比，脑组织氧合与标准ICP/CPP引导治疗相结合被认为可改善创伤性脑损伤（TBI）的预后。然而，先前观察性研究以及最近发表的队列研究和随机对照试验（RCT）的相关结果仍存在争议。本研究的目的是比较联合治疗与标准ICP/CPP引导治疗在死亡率、良好预后、ICP/CPP及住院时间（LOS）方面的效果。
2016年7月，我们系统检索了PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov和Web of Science，以查找比较联合治疗与标准ICP/CPP引导治疗的研究。采用随机效应模型和固定效应模型进行汇总分析。
在筛选的362项研究中，纳入了8项队列研究和1项RCT。主要结局为死亡率和良好预后。两组之间的总体死亡风险比无明显优势（风险比[RR]，0.76；95%置信区间[CI]，0.54 - 1.06），出院死亡率（RR，1.01；95% CI，0.80 - 1.26）和3个月死亡率（RR，0.77；95% CI，0.53 - 1.12）。与ICP/CPP组相比，联合组在TBI后6个月内（RR，1.26；95% CI，1.04 - 1.52）或恰好在6个月时（RR，1.34；95% CI，1.07 - 1.68）更有可能获得更好的预后，而ICP（标准化均数差[SMD]，-0.19；95% CI，-0.43至0.05）、CPP（SMD，0.13；95% CI，-0.09至0.35）和LOS（SMD，0.13；95% CI，-0.11至0.37）无明显差异。
与标准ICP/CPP引导治疗相比，脑组织氧合联合ICP/CPP引导治疗可改善长期预后，且对死亡率、ICP/CPP或LOS无任何影响。
