NIHR Academic Clinical Fellow Intensive Care Medicine, North Bristol NHS Trust, Southmead Road, BS10 5NB, Bristol, UK.
Clinical Fellow Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK.
Neurocrit Care. 2020 Oct;33(2):508-515. doi: 10.1007/s12028-020-00915-5.
BACKGROUND/OBJECTIVE: Sympathetic nervous system activation after aneurysmal subarachnoid hemorrhage (aSAH) is associated with complications and poor outcome. In this systematic review and meta-analysis, we investigate the effect of beta-blockers on outcome after aSAH.
The review was prospectively registered with PROSPERO (CRD42019111784). We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library, published conference proceedings, and abstracts. Eligible studies included both randomized controlled trials and observational studies up to October 2018, reporting the effect of beta-blocker therapy on the following outcomes in aSAH: mortality, vasospasm, delayed cerebral ischemia, infarction or stroke, cardiac dysfunction, and functional outcomes. Studies involving traumatic SAH were excluded. Citations were reviewed, and data extracted independently by two investigators using a standardized proforma.
We identified 819 records with 16 studies (four were randomized controlled trials) including 6702 patients selected for analysis. Exposure to beta-blockade either before or after aSAH was associated with a significant reduction in unadjusted mortality (RR 0.63, 95% CI 0.42-0.93, p = 0.02). A significant reduction in unadjusted mortality was also seen in prospective trials of post-event beta-blockade (RR 0.51, 95% CI 0.28-0.93, p = 0.03). Statistically significant differences were not seen for other outcomes investigated.
In adult patients with aSAH, beta-blocker therapy is associated with a mortality benefit. Studies are generally of a low quality with considerable clinical heterogeneity. Prospective large interventional trials with patient centered outcomes are required to validate this finding.
背景/目的：动脉瘤性蛛网膜下腔出血（aSAH）后交感神经系统的激活与并发症和不良预后有关。在这项系统评价和荟萃分析中，我们研究了β受体阻滞剂对 aSAH 后结局的影响。
本综述前瞻性地在 PROSPERO（CRD42019111784）注册。我们对 MEDLINE、EMBASE、Cochrane 图书馆、已发表的会议记录和摘要进行了系统的文献检索。纳入的研究包括随机对照试验和观察性研究，截至 2018 年 10 月，报告β受体阻滞剂治疗对 aSAH 以下结局的影响：死亡率、血管痉挛、迟发性脑缺血、梗死或中风、心功能障碍和功能结局。涉及创伤性蛛网膜下腔出血的研究被排除在外。审查了引文，并由两名研究人员使用标准化表格独立提取数据。
我们确定了 819 条记录，其中包括 16 项研究（其中 4 项为随机对照试验），共纳入 6702 例患者进行分析。在 aSAH 之前或之后接触β受体阻滞剂与未调整的死亡率显著降低相关（RR 0.63，95%CI 0.42-0.93，p=0.02）。在事后β受体阻滞剂的前瞻性试验中也观察到未调整的死亡率显著降低（RR 0.51，95%CI 0.28-0.93，p=0.03）。对于其他研究的结局，没有观察到统计学显著差异。
在患有 aSAH 的成年患者中，β受体阻滞剂治疗与死亡率降低相关。这些研究的总体质量较低，存在较大的临床异质性。需要进行前瞻性的大型干预性试验，以患者为中心的结局来验证这一发现。
