术中亚低温对开颅手术患者预后影响的Meta分析

目的采用Meta分析评价术中亚低温对开颅手术患者预后的影响。方法检索中国学术期刊全文数据库(CNKI),中国生物医学文献数据库(CBM)、万方数据库、中文科技期刊数据库、Pubmed及Cochrane Library,检索时间从建库至2016年8月。收集在开颅手术中使用亚低温的随机对照研究(RCT)。采用Rev Man5.3软件对收集的资料进行Meta分析评价。结果共纳入6项研究,包括1306例病人,其中亚低温组657例,正常体温组649例。低温组患者在预后良好、中度残疾、重度残疾、植物生存及死亡状态五个方面与正常体温组相比差异无统计学意义,其合成结果分别为:OR=1.24,95%CI(0.97~1.58),P=0.08]、OR=0.97,95%CI(0.73~1.30),P=0.86]、OR=0.77,95%CI(0.50~1.18),P=0.23]、OR=1.35,95%CI(0.32~5.65),P=0.68]、OR=0.71,95%CI(0.47~1.09),P=0.12];术后并发症在两组间差异无统计学意义(P0.05);AVDO2水平在亚低温组显著降低(P0.05)。结论术中应用亚低温不能改善颅脑手术患者预后,不能减少患者术后并发症的发生。

Effects of intraoperative mild hypothermia on prognosis of patients undergoing craniotomy: a meta-analysis

Objective To evaluate the effects of intraoperative mild hypothermia on the prognosis of patients undergoing craniotomy.Methods A literature search was performed in CNKI, CBM, Wanfang Data, VIP, PubMed, and Cochrane Library to identify the randomized controlled trials (RCTs) about intraoperative mild hypothermia in craniotomy published up to August 2016. The obtained data were subjected to meta-analysis using RevMan5.3 software.Results A total of 6 RCTs involving 1306 patients were enrolled in the meta-analysis. The patients were divided into two groups: mild hypothermia group (n=657) and normothermia group (n=649). There were no significant differences between the two groups in Glasgow Coma Scale score minor or no disability (OR=1.24, 95% CI: 0.97-1.58, P=0.08), moderate disability (OR=0.97, 95% CI: 0.73-1.30, P=0.86), severe disability (OR=0.77, 95% CI: 0.50-1.18, P=0.23), vegetative state (OR=1.35, 95%CI: 0.32-5.65, P=0.68), and death (OR=0.71, 95% CI: 0.47-1.09, P=0.12)] and postoperative complications (P>0.05). However, the mild hypothermia group had a significantly smaller arterio-venous difference of oxygen than the normothermia group (P<0.05).Conclusions Intraoperative mild hypothermia cannot improve the prognosis of patients undergoing craniotomy and reduce the incidence of postoperative complications.