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| Title: | 低溫治療對創傷性腦損傷患者治療成效之系統性文獻回顧 |
| Other Titles: | Effect of Hypothermia Therapy for Traumatic Brain Injury Patients: Systematic Review |
| Authors: | 姚雅馨
YAO, YA-HSIN |
| Contributors: | 喬佳宜;黃士滋
CHIAO, CHIA-YI;HUANG, SHIH-TZU
護理學系碩士班 |
| Keywords: | 低溫治療;創傷性腦損傷;系統性文獻回顧
hypothermia;traumatic brain injury;systematic review |
| Date: | 2023 |
| Issue Date: | 2023-11-22 02:10:40 (UTC+0) |
| Abstract: | 背景：臨床上創傷性腦損傷病患術後往往會出現出血、腫脹或水腦等合併症，導致腦組織體積增加進而導致顱內壓上升，治療方式之一為使用低溫治療以降低因腦水腫導致的顱內壓上升。然而，現今在臨床將低溫治療應用於創傷性腦損傷病患治療的預期成效結果不一致。目的：本研究目的為探討使用低溫治療對創傷性腦損傷病患之治療成效。方法：本文以系統性文獻方式搜尋PubMed、Medline Ovid、Cochrane、CINAHL complete、和Embase等英文資料庫，以及「華藝線上圖書館CEPS/Airiti Library 中文電子資料庫」、「臺灣碩博士論文知識加值系統」中文資料庫之文獻。中文關鍵字為腦損傷、頭部外傷、低溫治療、顱內壓、死亡率；英文關鍵字為cerebrovascular trauma, brain injury, brain trauma, encephalopathy, traumatic brain hemorrhage, induced hypothermia, hypothermia therapeutic, targeted temperature management, intracranial pressure, mortality rate以及其MeSH term。經由輸入上述關鍵字搜尋資料庫至2022年12月31前已發表之文獻，去除不符合文獻納入條件之研究，並使用Cochrane Risk of Bias Tool第二版(RoB 2.0)進行文獻品質評讀，最後透過文獻統整以整合創傷性腦損傷病患使用低溫治療之成效。結果：經文獻搜尋、篩選、及評讀流程後共納入9篇隨機試驗研究。統整其研究之成效評量為測量顱內壓監測、功能性預後狀態、及死亡率。在介入成效方面，2篇研究顯示創傷性腦損傷術後患者在使用低溫治療後的功能性預後狀態有顯著改善、3篇結果實驗組創傷性腦損傷術後患者之死亡率較對照組有顯著降低、3篇研究結果顯示低溫治療對於顱內壓之緩解無論實驗組或對照組之病患均無顯著差異；此外，所有納入的研究結果顯示創傷性腦損傷術後患者早期的顱內壓無論在實驗組或對照組中皆無顯著差異。結論：經本研究發現創傷性腦損傷患者若顱內壓大於25mmHg或從腦部電腦斷層顯示腦腫或中線偏移情形使用低溫治療後對於緩解其顱內壓具有顯著成效，而在改善長期功能性預後狀態及死亡率之成效則無明顯差異，在整體住院時間無論有無使用低溫治療皆無明顯差異。低溫治療設定方式則建議介入時間須於在腦部受損6~12小時內、目標溫度設定為33~35℃、維持時間至少48小時、回溫速率以緩慢回溫速率為宜。
Background:Clinically, postoperative traumatic brain injury patients often have complications such as hemorrhage, swelling, or hydrocephalus, resulting in increased brain tissue volume and intracranial pressure. One treatment option is using hypothermia therapy to reduce the increase in intracranial pressure due to cerebral edema. However, the results of the clinical application of hypothermia therapy in treating traumatic brain injury patients are inconsistent. Purpose: The purpose of this study aimed to integrate the effects of hypothermia therapy on traumatic brain injury patients.Methods:This article systematically searched English databases such as PubMed, Medline Ovid, Cochrane, CINAHL Complete, Embaseu, and "Huayi Online Library CEPS/Airiti Library Chinese Electronic Database", "Taiwan Master and Doctoral Dissertation Knowledge Value-Added System "Documents of the Chinese Database. Chinese keywords were brain injury, head trauma, hypothermia therapy, intracranial pressure, and mortality; English keywords were cerebrovascular trauma, brain injury, brain trauma, encephalopathy, traumatic brain hemorrhage, induced hypothermia, hypothermia therapeutic, targeted temperature management, intracranial pressure, mortality rate, and its MeSH term. The above keywords were entered to search the databases for published literature before December 31, 2022. Studies that did not meet the inclusion criteria in the literature were removed. The second edition of the Cochrane Risk of Bias Tool (RoB 2.0) was applied for literature quality evaluation. Finally, the literature review was integrated to examine the effectiveness of hypothermia therapy in patients with traumatic brain injury.Results: A total of 9 randomized controlled trials articles were included. According to the studies, outcome measures included intracranial pressure monitoring, functional prognostic status, and mortality. Regarding the effectiveness of the intervention, two studies showed significant improvement in functional outcome status of post-traumatic brain injury patients treated with hypothermia. The results of 3 papers showed that compared with the control group, the mortality rate of patients with traumatic brain injury in the experimental group was significantly reduced. The results of 3 studies showed that hypothermia therapy had no significant difference in the relief of intracranial pressure, regardless of whether the patients were in the experimental or control groups. In addition, the results of all the included studies showed no significant difference in the early intracranial pressure of patients after traumatic brain injury, whether in the experimental or control groups.Conclusion:This systematic review confirmed that if the intracranial pressure is higher than 25mmHg or brain CT shows brain swelling or midline shift, hypothermia can significantly reduce intracranial pressure. But there was no significant difference in the favorable outcomes, mortality, and overall length of hospital stay. The setting method of hypothermia therapy: after 6-12 hours after brain injury, the target temperature is set at 33-35�C, maintenance is 48 hours at least, and used a slow temperature recovery rate. |
| Appears in Collections: | [護理學系] 博碩士論文
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