| 摘要: |
| 目的：总结亚低温治疗新生儿缺氧缺血性脑病时参数调节，为临床医生提供参考。方法：搜索PubMed、Cochrane Library、Web of Science等数据库，搜索亚低温治疗缺氧缺血性脑病时参数比较相关文献，使用科克伦（Cochrane）风险评估工具评估随机对照实验（RCT）的方法学质量，使用纽卡斯尔-渥太华量表（NOS）评估观察性研究质量。结果：14篇文章纳入研究，包括6篇RCT和8篇观察性研究。亚低温温度及疗程被归为Ⅰ级证据因素，具有较高可信度表明更长时间、更深温度不能更好改善预后，相反可能会增加不良事件发生率。亚低温开始时间被归为Ⅱ级证据因素，表明尽早开始亚低温治疗能更好改善预后，即使超过6 h开始仍部分有效，特别对中度缺氧缺血性脑病。亚低温治疗方式（全身vs局部亚低温）被归为Ⅲ级证据因素，在预测两种不同亚低温方式神经保护作用方面可能有一定帮助。结论：本研究初步探讨亚低温参数对缺氧缺血性脑病预后的影响，填补了预后研究中的一些空白。目前研究支持亚低温策略为33.5~34.0 °C持续72 h。无论哪种亚低温治疗方式，均建议尽早开始，即使超过生后6 h，仍有一定疗效。但缺乏meta分析，结论可靠性仍需要更多大样本、多中心研究去证实。 |
| 关键词: 缺氧缺血性脑病 亚低温 参数 系统综述 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.12.001 |
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| 基金项目: |
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| Systematic Review of Correlation between Parameters and Efficacy of Mild Hypothermia in the Treatment of Hypoxic-Ischemic Encephalopathy |
| Zou Xian, Miao Jingkun, Li Chun, Chen Qixiong |
| (Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China) |
| Abstract: |
| 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. |
| Key words: hypoxic-ischaemic encephalopathy mild hypothermia parameters systematic review |
