轻度和中度创伤性脑损伤的早期预防:系统性审查和元分析
Matthew Pease1, Adi Mittal2, Sara Merkaj3
1Department of Neurosurgery, Indiana University School of Medicine, Indianapolis.
JAMA neurology
|April 8, 2024
概括
对轻度至中度创伤性脑损伤 (TBI) 的发作预防显示,早期创伤后发作 (PTS) 的小但显著减少. 低绝对风险降低需要仔细考虑药物风险与益处.
科学领域:
- 神经学 神经学
- 创伤护理 创伤护理
- 临床研究 临床研究
背景情况:
- 准则建议对严重创伤性脑损伤 (TBI) 进行预防,以预防早期创伤后 (PTS).
- 在轻度或中度TBI中使用抗发作药物的发作预防仍然是争论的主题.
研究的目的:
- 评估预防与轻度或中度TBI患者早期PTS风险降低之间的关联.
- 分析发作预防的有效性,特别是在轻度TBI病例中.
主要方法:
- 从1991年到2023年,在PubMed,谷歌学者和科学网上进行了系统的文献搜索.
- 包括成人患者轻度 (格拉斯哥昏迷尺度[GCS] 13-15) 或中度 (GCS 9-12) TBI的观察性研究,比较早期PTS发病率与没有预防.
- 用随机效应模型进行了元分析,并遵循PRISMA指南.
主要成果:
- 八项涉及5637名患者的研究分析了轻度至中度的TBI.
- 发作预防表明,在轻度至中度TBI中,早期PTS的绝对风险降低率为0.6%,具有统计学意义 (P=.02).
- 仅轻度TBI就观察到类似的0.6%的绝对风险降低 (P=.04),治疗所需数为167.7.
结论:
- 发作预防与轻度和中度TBI早期PTS的小但统计学上显著的减少有关.
- 这种小幅降低风险的临床相关性必须与抗发作药物的潜在急性风险以及长期使用的可能性相平衡.
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