急性缺血性脑卒中的治疗性低温——系统评价和荟萃分析。
Therapeutic Hypothermia in Acute Ischemic Stroke-a Systematic Review and Meta-Analysis.
机构信息
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Psychology, University of Alberta, Edmonton, AB, Canada.
出版信息
Curr Neurol Neurosci Rep. 2020 May 5;20(5):13. doi: 10.1007/s11910-020-01029-3.
PURPOSE OF REVIEW
Therapeutic hypothermia (TH) in stroke demonstrates robust neuroprotection in animals but clinical applications remain controversial. We assessed current literature on the efficacy of TH in ischemic stroke.
RECENT FINDINGS
We conducted a meta-analysis comparing TH versus controls in studies published until June 2019. Controlled studies reporting on ≥ 10 adults with acute ischemic stroke were included. Primary outcome was functional independence (modified Rankin Scale [mRS] ≤ 2). Twelve studies (n = 351 TH, n = 427 controls) were included. Functional independence did not differ between groups (RR 1.17, 95% CI 0.93-1.46, random-effects p = 0.2). Five studies reported individual mRS outcomes and demonstrated a shift toward better outcome with TH (unadjusted cOR 1.57, 95% CI 1.01-2.44, p = 0.05). Overall complications were higher with TH (RR 1.18, 95% CI 1.06-1.32, p < 0.01). We did not observe an overall beneficial effect of TH in this analysis although some studies showed a shift toward better outcome. TH was associated with increased complications.
目的综述
动物实验表明，治疗性低温（therapeutic hypothermia，TH）对脑卒中具有显著的神经保护作用，但临床应用仍存在争议。本研究旨在评估目前关于缺血性脑卒中应用 TH 的疗效的文献。
最近的发现
我们对截至 2019 年 6 月发表的研究进行了 TH 与对照组的荟萃分析。纳入了报告≥10 例急性缺血性脑卒中成人患者的对照研究。主要结局为功能独立性（改良 Rankin 量表评分≤2）。共纳入 12 项研究（n=351 例 TH，n=427 例对照组）。两组间功能独立性无差异（RR 1.17，95%CI 0.93-1.46，随机效应 p=0.2）。5 项研究报告了个体改良 Rankin 量表评分结局，表明 TH 治疗后结局更好（未校正比值比 1.57，95%CI 1.01-2.44，p=0.05）。TH 组总体并发症更高（RR 1.18，95%CI 1.06-1.32，p<0.01）。虽然部分研究显示结局有改善趋势，但本分析未观察到 TH 的总体获益效应。TH 与并发症增加相关。
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