探究亚低温治疗小儿重度创伤性脑损伤的安全性和有效性：一项系统评价与Meta分析

Investigating the Safety and Efficacy of Therapeutic Hypothermia in Pediatric Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

作者信息

Naseri Alavi Seyed Ahmd, Habibi Mohammad Amin, Majdi Alireza, Hajikarimloo Bardia, Rashidi Farhang, Fathi Tavani Sahar, Minaee Poriya, Eazi Seyed Mohammad, Kobets Andrew J

机构信息

Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA 30033, USA.

Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14399, Iran.

出版信息

Children (Basel). 2024 Jun 7;11(6):701. doi: 10.3390/children11060701.

DOI:10.3390/children11060701

PMID:38929280

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11201645/

Abstract

BACKGROUND

Prior guidelines recommended maintaining normothermia following traumatic brain injury (TBI), but recent studies suggest therapeutic hypothermia as a viable option in pediatric cases. However, some others demonstrated a higher mortality rate. Hence, the impact of hypothermia on neurological symptoms and overall survival remains contentious.

METHODS

We conducted a systematic review and meta-analysis to evaluate the effects of hypothermia on neurological outcomes in pediatric TBI patients. The PubMed/Medline, Scopus, and Web of Science databases were searched until 1 January 2024 and data were analyzed using appropriate statistical methods.

RESULTS

A total of eight studies, comprising nine reports, were included in this analysis. Our meta-analysis did not reveal significant differences in mortality (RR = 1.58; 95% CI = 0.89-2.82, = 0.055), infection (RR = 0.95: 95% CI = 0.79-1.1, = 0.6), arrhythmia (RR = 2.85: 95% CI = 0.88-9.2, = 0.08), hypotension (RR = 1.54: 95% CI = 0.91-2.6, = 0.10), intracranial pressure (SMD = 5.07: 95% CI = -4.6-14.8, = 0.30), hospital length of stay (SMD = 0.10; 95% CI = -0.13-0.3, = 0.39), pediatric intensive care unit length of stay (SMD = 0.04; 95% CI = -0.19-0.28, = 0.71), hemorrhage (RR = 0.86; 95% CI = 0.34-2.13, = 0.75), cerebral perfusion pressure (SMD = 0.158: 95% CI = 0.11-0.13, = 0.172), prothrombin time (SMD = 0.425; 95% CI = -0.037-0.886, = 0.07), and partial thromboplastin time (SMD = 0.386; 95% CI = -0.074-0.847, = 0.10) between the hypothermic and non-hypothermic groups. However, the heart rate was significantly lower in the hypothermic group (-1.523 SMD = -1.523: 95% CI = -1.81--1.22 < 0.001).

CONCLUSIONS

Our findings challenge the effectiveness of therapeutic hypothermia in pediatric TBI cases. Despite expectations, it did not significantly improve key clinical outcomes. This prompts a critical re-evaluation of hypothermia's role as a standard intervention in pediatric TBI treatment.

摘要

背景

先前的指南建议创伤性脑损伤（TBI）后维持正常体温，但最近的研究表明治疗性低温在儿科病例中是一种可行的选择。然而，其他一些研究显示死亡率更高。因此，低温对神经症状和总体生存的影响仍存在争议。

方法

我们进行了一项系统评价和荟萃分析，以评估低温对儿科TBI患者神经结局的影响。检索了PubMed/Medline、Scopus和Web of Science数据库直至2024年1月1日，并使用适当的统计方法分析数据。

结果

本分析共纳入八项研究，包括九份报告。我们的荟萃分析未发现低温组和非低温组在死亡率（RR = 1.58；95%CI = 0.89 - 2.82，P = 0.055）、感染（RR = 0.95：95%CI = 0.79 - 1.1，P = 0.6）、心律失常（RR = 2.85：95%CI = 0.88 - 9.2，P = 0.08）、低血压（RR = 1.54：95%CI = 0.91 - 2.6，P = 0.10）、颅内压（SMD = 5.07：95%CI = -4.6 - 14.8，P = 0.30）、住院时间（SMD = 0.10；95%CI = -0.13 - 0.3，P = 0.39）、儿科重症监护病房住院时间（SMD = 0.04；95%CI = -0.19 - 0.28，P = 0.71）、出血（RR = 0.86；95%CI = 0.34 - 2.13，P = 0.75）、脑灌注压（SMD = 0.158：95%CI = 0.11 - 0.13，P = 0.172）、凝血酶原时间（SMD = 0.425；95%CI = -0.037 - 0.886，P = 0.07）和活化部分凝血活酶时间（SMD = 0.386；95%CI = -0.074 - 0.847，P = 0.10）方面存在显著差异。然而，低温组的心率显著更低（SMD = -1.523：95%CI = -1.81 - -1.22，P < 0.001）。