成年人心脏骤停后的温度控制:更新的系统审查和元分析
Asger Granfeldt1, Mathias J Holmberg2, Jerry P Nolan3
1Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
Resuscitation
|August 9, 2023
概括
这次更新的综述发现,在心脏骤停患者中,在32-34°C的目标温度控制下,没有发现存活率或神经效益. 需要进一步研究最佳温度目标和预防发烧.
科学领域:
- 关键护理医学 关键护理医学
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
背景情况:
- 温度控制是心脏骤停后成年患者的关键干预措施.
- 之前的审查已经探讨了它的有效性,需要更新分析.
研究的目的:
- 对成人心脏骤停幸存者温度控制的有效性进行更新的系统审查和元分析.
- 评估温度管理的各个方面,包括时间,温度目标,持续时间,方法和回暖策略.
主要方法:
- 进行了对PubMed,Embase和Cochrane控制试验中央注册表的更新系统搜索.
- 包括成人心脏骤停患者的随机对照试验.
- 数据使用随机效应模型进行聚合,并使用GRADE评估证据确定性.
主要成果:
- 确定了6项新的试验,增加了更新后元分析中的7项试验,比较了32-34°C和正常热量.
- 针对32-34°C的温度控制在90-180天后没有显著改善存活率 (RR 1.06) 或神经结果 (RR 1.27) (低确定性证据).
- 亚组和灵敏度分析在不同心脏骤停地点或时间点上没有显示出显著的益处.
结论:
- 这份最新的综述表明,在32-34°C的温度控制与成年心脏骤停幸存者的正常热量或36°C相比没有明显的好处.
- 置信区间并不完全排除潜在的好处,强调需要进一步调查.
- 关于最佳的低温目标,回暖率和发烧预防策略,仍然存在重大知识差距.
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