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综合分析比较心脏骤停后患者的低温与正常热

Sanchit Duhan¹, Bijeta Keisham², Sahib Singh¹

¹Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.

The American journal of cardiology

|June 29, 2023

概括

向性低温 (TH) 改善了昏迷状态心脏骤停幸存者的神经学结果,尽管它没有显著降低死亡率. 这一元分析支持TH.

科学领域:

心脏病学心脏病学
关键护理医学关键护理医学
神经学神经学

背景情况:

目前的美国心脏协会2022年指南建议在昏迷患者心脏骤停后预防发烧 (温度≤37.5°C).
随机对照试验 (RCT) 关于针对性低温 (TH) 的好处的结果存在矛盾.
需要更新的元分析来澄清TH在心脏骤停后护理中的作用.

研究的目的:

评估向性低温 (TH) 在改善心脏骤停后患者的治疗结果中的作用.
综合最近随机对照试验 (RCT) 的证据,将TH与正常热量进行比较.

主要方法:

对RCT进行了更新的元分析,搜索了Cochrane,MEDLINE和EMBASE数据库,截至2022年12月.
包括的试验涉及随机分配到目标温度监测的患者,报告了神经学和死亡结果.
统计分析使用随机效应模型和Mantle-Haenszel方法来计算聚合风险比率.

主要成果:

总共有12个涉及4,262名患者的RCT被纳入了审查.
针对性低温 (TH) 组与正常热量组相比,显著改善了神经学结果 (风险比0.90,95% CI 0.83-0.98).
在TH和正常热量组之间没有观察到死亡率的显著差异 (风险比0.97,95%CI0.90至1.06).

结论:

这一元分析支持在心脏骤停后的患者使用向性低温 (TH).
似乎TH的主要好处是改善神经系统的结果.
进一步的研究可能是有必要的,以探索特定的患者亚组或最佳的TH协议.

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