Shin Hong Kyung, Park Jin Hoon, Roh Sung Woo, Jeon Sang Ryong
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Neurospine. 2022 Sep;19(3):748-756. doi: 10.14245/ns.2244444.222. Epub 2022 Sep 30.
Acute spinal cord injury (SCI) can result in debilitating motor, sensory, and autonomic dysfunction. As a treatment option, therapeutic hypothermia has been researched to inadequate pharmaceutical treatment, except for methylprednisolone. In this article, we systematically meta-analyzed to clarify the effect of hypothermia in acute SCI on neurological outcomes.
The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until June 30, 2022. The proportion of cases with improved neurological status after hypothermia in acute SCI were pooled with a random-effects model. Subgroup analyses for the method of hypothermia and injury level were conducted.
Eight studies with a total of 103 patients were included. Hypothermia in acute SCI improved neurological function by 55.8% (95% confidence interval [CI]: 39.4%-72.1%). The subgroup analysis revealed that the pooled proportion of cases showing neurological improvement was higher with systemic hypothermia (70.9%) (95% CI, 14.9%-100%) than with local hypothermia (52.5%) (95% CI, 40.4%-64.5%), although the subgroup difference was not statistically significant (p = 0.53). Another subgroup analysis revealed that the proportion of cases with neurological improvement did not differ statistically between the cervical spine (61.4%) (95% CI, 42.2%-80.6%) and thoracic spine injury groups (59.4%) (95% CI, 34.8%-84.0%) (p = 0.90).
This meta-analysis identified that more than 50% of patients showed neurological improvement after hypothermia following acute SCI in general. A multicenter, randomized, double-blind study with larger sample size is necessary to validate the findings further.
急性脊髓损伤（SCI）可导致使人衰弱的运动、感觉和自主神经功能障碍。作为一种治疗选择，除甲基强的松龙外，针对药物治疗效果不佳的情况，人们对治疗性低温进行了研究。在本文中，我们进行了系统的荟萃分析，以阐明低温治疗对急性SCI神经功能结局的影响。
系统检索了PubMed、Embase、Web of Science和Cochrane临床试验数据库，检索截至2022年6月30日的文献。采用随机效应模型汇总急性SCI低温治疗后神经功能改善病例的比例。对低温治疗方法和损伤水平进行亚组分析。
纳入8项研究，共103例患者。急性SCI低温治疗使神经功能改善率达55.8%（95%置信区间[CI]：39.4%-72.1%）。亚组分析显示，全身低温治疗（70.9%）（95%CI，14.9%-100%）使神经功能改善的病例汇总比例高于局部低温治疗（52.5%）（95%CI，40.4%-64.5%），尽管亚组差异无统计学意义（p = 0.53）。另一亚组分析显示，颈椎损伤组（61.4%）（95%CI，42.2%-80.6%）和胸椎损伤组（59.4%）（95%CI，34.8%-84.0%）神经功能改善病例的比例差异无统计学意义（p = 0.90）。
该荟萃分析表明，总体而言，超过50%的急性SCI患者在低温治疗后神经功能得到改善。有必要开展一项样本量更大的多中心、随机、双盲研究以进一步验证这些发现。
