From the Department of Neurosurgery (H.D., Z.L.), Chongqing Yubei District People's Hospital; Department of Neurosurgery (L. Liao), Nan'an District People's Hospital of Chongqing, Chongqing; Department of Neurosurgery (Q.W.), People's Hospital of Hejiang City; Department of Neurosurgery (L. Liao, G.X., X.L., L. Liu), and Department of Neurology (X.Z.), Affiliated Hospital of Southwest Medical University; Neurosurgery Clinical Medical Research Center of Sichuan Province (L. Liu); Academician (Expert) Workstation of Sichuan Province (L. Liu); and Neurological Diseases and Brain Function Laboratory (L. Liu), Luzhou, China.
J Trauma Acute Care Surg. 2021 Jun 1;90(6):1077-1085. doi: 10.1097/TA.0000000000003094.
Paroxysmal sympathetic hyperactivity (PSH) and catecholamine surge, which are associated with poor outcome, may be triggered by traumatic brain injury (TBI).β Adrenergic receptor blockers (β-blockers), as potential therapeutic agents to prevent paroxysmal sympathetic hyperactivity and catecholamine surge, have been shown to improve survival after TBI. The principal aim of this study was to investigate the effect of β-blockers on outcomes in patients with TBI.
For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and Cochrane Library databases from inception to September 25, 2020, for randomized controlled trials, nonrandomized controlled trials, and observational studies reporting the effect of β-blockers on the following outcomes after TBI: mortality, functional measures, and cardiopulmonary adverse effects of β-blockers (e.g., hypotension, bradycardia, and bronchospasm). With use of random-effects model, we calculated pooled estimates, confidence intervals (CIs), and odds ratios (ORs) of all outcomes.
Fifteen studies with 12,721 patients were included. Exposure to β-blockers after TBI was associated with a significant reduction in adjusted in-hospital mortality (OR, 0.39; 95% CI, 0.30-0.51; I2 = 66.3%; p < 0.001). β-Blockers significantly improved the long-term (≥6 months) functional outcome (OR, 1.75; 95% CI, 1.09-2.80; I2 = 0%; p = 0.02). Statistically significant difference was not seen for cardiopulmonary adverse events (OR, 0.91; 95% CI, 0.55-1.50; I2 = 25.9%; p = 0.702).
This meta-analysis demonstrated that administration of β-blockers after TBI was safe and effective. Administration of β-blockers may therefore be suggested in the TBI care. However, more high-quality trials are needed to investigate the use of β-blockers in the management of TBI.
Systematic review and meta-analysis, level III.
阵发性交感神经过度兴奋（PSH）和儿茶酚胺激增与不良预后相关，可能由创伤性脑损伤（TBI）引发。β肾上腺素能受体阻滞剂（β 阻滞剂）作为预防阵发性交感神经过度兴奋和儿茶酚胺激增的潜在治疗药物，已被证明可改善 TBI 后的存活率。本研究的主要目的是研究β阻滞剂对 TBI 患者结局的影响。
本系统评价和荟萃分析检索了 MEDLINE、EMBASE 和 Cochrane 图书馆数据库，从建库至 2020 年 9 月 25 日，纳入了报告β阻滞剂对 TBI 后以下结局影响的随机对照试验、非随机对照试验和观察性研究：死亡率、功能测量和β阻滞剂的心肺不良效应（如低血压、心动过缓和支气管痉挛）。使用随机效应模型，我们计算了所有结局的汇总估计值、置信区间（CI）和比值比（OR）。
纳入了 15 项研究共 12721 例患者。TBI 后使用β阻滞剂与调整后的住院死亡率显著降低相关（OR，0.39；95%CI，0.30-0.51；I2 = 66.3%；p < 0.001）。β阻滞剂显著改善了长期（≥6 个月）的功能结局（OR，1.75；95%CI，1.09-2.80；I2 = 0%；p = 0.02）。心肺不良事件无统计学差异（OR，0.91；95%CI，0.55-1.50；I2 = 25.9%；p = 0.702）。
这项荟萃分析表明，TBI 后使用β阻滞剂是安全有效的。因此，在 TBI 治疗中可以建议使用β阻滞剂。然而，需要更多高质量的试验来研究β阻滞剂在 TBI 管理中的应用。
系统评价和荟萃分析，III 级。
