Fatima Nida, Ayyad Ali, Shuaib Ashfaq, Saqqur Maher
Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
Department of Neuroscience, Hamad General Hospital, Doha, Qatar.
Asian J Neurosurg. 2019 Apr-Jun;14(2):382-391. doi: 10.4103/ajns.AJNS_8_19.
This study aims to evaluate the efficacy of hypertonic saline versus crystalloids (normal Saline/lactated Ringers) in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and grey literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case-control studies and prospective cohort studies on decompressive craniectomy in TBI (>18-year-old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS), Extended GCOS, and mortality. Data were extracted to Review Manager Software. A total of 115 articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI who had hypertonic saline had no statistically significant likelihood of having a good outcome at discharge or 6 months than those who had crystalloid (odds ratio [OR]: 0.01; 95% confidence interval (CI): 0.03-0.05; = 0.65). The relative risk (RR) of mortality in hypertonic saline versus the crystalloid at discharge or 6-month is RR: 0.80; 95% CI: 0.64-0.99; = 0.04. The subgroup analysis showed that the group who had hypertonic solution significantly decreases the number of interventions versus the crystalloid group OR: 0.53; 95% CI: 0.48-0.59; < 0.00001 and also reduces the length of intensive care unit stay (OR: 0.46; 95% CI: 0.21-1.01; = 0.05). Hypertonic saline decreases the financial burden, but neither impacts the clinical outcome nor reduces the mortality. However, further clinical trials are required to prove if hypertonic saline has any role in improving the clinical and neurological status of patients with TBI versus the normal saline/lactated Ringers.
本研究旨在评估高渗盐水与晶体液（生理盐水/乳酸林格氏液）相比，对改善创伤性脑损伤（TBI）患者临床结局的疗效。从1990年至今，以不同医学主题词检索了电子数据库和灰色文献（未发表文章）。纳入了关于TBI（年龄>18岁）减压性颅骨切除术的随机对照试验、病例对照研究和前瞻性队列研究。临床结局指标包括格拉斯哥昏迷结局量表（GCOS）、扩展GCOS和死亡率。数据提取至Review Manager软件。共检索并分析了115篇符合纳入标准的文章。最终，五项研究纳入我们的荟萃分析，结果显示，与接受晶体液治疗的TBI患者相比，接受高渗盐水治疗的患者出院时或6个月时获得良好结局的可能性无统计学显著差异（优势比[OR]：0.01；95%置信区间[CI]：0.03 - 0.05；P = 0.65）。高渗盐水组与晶体液组在出院时或6个月时的死亡率相对风险（RR）为RR：0.80；95% CI：0.64 - 0.99；P = 0.04。亚组分析显示，与晶体液组相比，接受高渗溶液治疗的组显著减少了干预次数（OR：0.53；95% CI：0.48 - 0.59；P < 0.00001），并缩短了重症监护病房住院时间（OR：0.46；95% CI：0.21 - 1.01；P = 0.05）。高渗盐水减轻了经济负担，但既不影响临床结局也不降低死亡率。然而，需要进一步的临床试验来证明与生理盐水/乳酸林格氏液相比，高渗盐水在改善TBI患者临床和神经状态方面是否有任何作用。
