在急性创伤性脊髓损伤患者中优化脊髓输液的干预措施:最新的系统性审查
Nathan Evaniew1, Benjamin Davies2, Farzin Farahbakhsh3
1McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Global spine journal
|March 25, 2024
概括
优化脊髓 perfusion 压力 (SCPP) 可能改善创伤性脊髓损伤 (SCI) 后的神经恢复. 然而,目前的证据质量很低,这突出了对SCI患者血液动力学管理方案的进一步研究的需要.
科学领域:
- 神经科学是一个神经科学.
- 创伤外科 手术 创伤外科
- 关键护理医学 关键护理医学
背景情况:
- 优化脊髓输液对于最小化二次缺血损伤和改善急性创伤性脊髓损伤 (SCI) 的结果至关重要.
- 目前优化脊髓输液和增强SCI患者神经恢复的策略仍然存在争议.
- 这项研究更新了之前的系统审查,以评估急性创伤性SCI的血液动力学管理干预措施.
研究的目的:
- 评估平均动脉压 (MAP) 支持或脊髓输液压 (SCPP) 支持对急性创伤性SCI患者神经恢复的影响.
- 评估与急性创伤性SCI中MAP或SCPP支持相关的不良事件的发生率.
- 为制定急性创伤性SCI的血液动力学管理的临床实践指南提供证据基础.
主要方法:
- 系统审查的更新包括对PubMed/MEDLINE,EMBASE和ClinicalTrials.gov进行全面的搜索,以寻找新的报告.
- 独立选,数据提取,以及由两名审稿人进行偏差风险评估.
- 应用推,评估,开发和评估等级 (GRADE) 方法来评估证据的质量.
主要成果:
- 确定了9项新研究,并将其与19项先前审查的研究结合起来,共计28项研究.
- 低到非常低质量的证据表明,MAP支持对神经恢复的影响是不确定的.
- 增加SCPP可能与神经恢复的改善有关,尽管这两种方法都带有不清楚临床意义的不良事件的潜在风险.
结论:
- 目前的文献缺乏高质量的证据来支持急性创伤性SCI的血液动力学管理的特定方案.
- 虽然避免低血压和维持脊髓 perfusion 是重要的原则,但需要进一步的研究.
- 需要具有验证结果评估的前性,受控研究,以优化急性SCI的脊髓输液干预措施.
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