亚低温治疗缺氧缺血性脑病的参数与疗效相关性的系统综述

目的:总结亚低温治疗新生儿缺氧缺血性脑病时的参数调节,为临床医师提供参考.方法:检索PubMed、the Cochrane Library、Web of Science等数据库,收集亚低温治疗缺氧缺血性脑病时参数比较相关文献,应用Cochrane风险评估工具评估随机对照试验(RCT)的方法学质量,使用纽卡斯尔-渥太华量...

Systematic Review of Correlation between Parameters and Efficacy of Mild Hypothermia in the Treatment of Hypoxic-Ischemic Encephalopathy

Objective: To summarize the parameter adjustment of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy, so as to provide reference for clinicians. Methods: PubMed, the Cochrane Library and Web of Science database were retrieved to collect the related literature of mild hypothermia in the treatment of hypoxic-ischemic encephalopathy. Methodological quality of randomized controlled trials (RCT) was assessed by using the Cochrane risk assessment tool, and the quality of observational studies was evaluated by using the Newcastle-Ottawa scale (NOS). Results: Fourteen articles were enrolled in the study, including 6 RCT and 8 observational studies. Mild hypothermia temperature and course of treatment were classified as level I evidence factor, with high credibility that longer and lower temperature did not improve the prognosis, but increased the incidence of adverse events. The onset of mild hypothermia was classified as level II evidence factor, indicating that starting mild hypothermia treatment as early as possible could better improve the prognosis, and it was still partially effective even after 6 h, especially for moderate hypoxic-ischemic encephalopathy. The treatment of mild hypothermia (systemic vs. local mild hypothermia) was classified as level III evidence factor, which might be helpful in predicting the neuroprotective effects of two different mild hypothermia methods. Conclusion: This study preliminarily explores the influence of mild hypothermia parameters on the prognosis of hypoxic-ischemic encephalopathy, and provides reference for the prognosis research. The current study supports the strategy of mild hypothermia from 33.5 to 34.0 °C for 72 h. Regardless of the type of mild hypothermia, it is recommended to start the treatment as soon as possible, even if more than 6 h after birth, therapeutic hypothermia is still partly effective.