颈椎固定器对创伤性脑损伤患者颅内压值的影响：一项前瞻性研究的系统评价和荟萃分析。

Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies.

机构信息

School of Medicine, Faculty of Health Sciences, Pontificia Universidad Javeriana, Cali, Colombia.

Neurosurgery Service - Valle Salud Clinic Network, Meditech Foundation Research Group, Neurosciences Institute, El Bosque University, Bogotá/Cali, Colombia.

出版信息

Neurocrit Care. 2020 Apr;32(2):469-477. doi: 10.1007/s12028-019-00760-1.

DOI:10.1007/s12028-019-00760-1

PMID:31190321

Abstract

BACKGROUND

Spinal cord injury (SCI) is present in around 2-4% of trauma victims. More than half of this injuries are located at the cervical region. Twenty percent of victims with cervical spinal trauma and 5% of patients with severe traumatic brain injury (TBI) will have an SCI. Cervical immobilization with rigid or semirigid collars is routinely used as prophylactic or definitive treatment intervention in general trauma care. An important adverse effect of cervical collars application is the increase in intracranial pressure (ICP) values. This systematic review and meta-analysis aim to estimate the overall magnitude of ICP changes after cervical collar application.

METHODS

Major electronic databases (Ovid/Medline, Embase and Cochrane Library) were systematically searched for prospective studies that assessed ICP changes after cervical collar applications. Study level characteristics and ICP values before, during and after cervical collar application, were extracted. The meta-analysis was performed using random-effects model.

RESULTS

Five studies comprising 86 patients were included in the systematic review and the quantitative synthesis. The overall increase in ICP after collar application was statistically significant (weighted mean difference [WMD] = 4.43; 95%CI 1.70, 7.17; P < 0.01), meaning an overall ICP increase of approximately 4.4 mmHg. The decrease in ICP values after collar removal reached statistical significance (WMD = - 2.99; 95%CI - 5.45, - 0.52; P = 0.02), meaning an overall ICP decrease of approximately 3 mmHg after collar removal. ICP values before and after cervical collar application were not statistically significant (WMD = 0.49; 95%CI - 1.61, 2.59; P = 0.65), meaning no ICP change.

CONCLUSIONS

Heterogeneous studies of application of cervical collars as a partial motion restriction strategy after injuries have demonstrated increases in ICP in TBI patients. Increases in ICP can induce complications in TBI patients. Appropriate selection criteria for cervical motion restriction in TBI patients need to be considered.

摘要

背景

脊髓损伤（SCI）在创伤患者中约占 2-4%。其中一半以上的损伤位于颈椎区域。20%的颈椎创伤患者和 5%的严重创伤性脑损伤（TBI）患者会发生 SCI。在一般创伤护理中，使用刚性或半刚性颈托对颈椎进行固定是一种常规的预防或确定性治疗干预措施。应用颈椎托的一个重要不良影响是颅内压（ICP）值升高。本系统评价和荟萃分析旨在评估颈椎托应用后 ICP 变化的总体幅度。

方法

系统检索主要电子数据库（Ovid/Medline、Embase 和 Cochrane 图书馆），以评估颈椎托应用后 ICP 变化的前瞻性研究。提取研究水平特征和颈椎托应用前后的 ICP 值。使用随机效应模型进行荟萃分析。

结果

系统评价和定量综合共纳入 5 项研究，共 86 例患者。颈椎托应用后 ICP 总体升高具有统计学意义（加权均数差 [WMD] = 4.43；95%CI 1.70，7.17；P < 0.01），即 ICP 总体升高约 4.4mmHg。颈托去除后 ICP 值下降具有统计学意义（WMD = -2.99；95%CI -5.45，-0.52；P = 0.02），即颈托去除后 ICP 总体下降约 3mmHg。颈椎托应用前后的 ICP 值无统计学意义（WMD = 0.49；95%CI -1.61，2.59；P = 0.65），即 ICP 无变化。