背景:透析不平衡综合征(DDS)是一种罕见的,众所周知,肾脏替代疗法(RRT)的潜在危及生命的并发症,通常涉及脑水肿和颅内压升高(ICP)。然而,RRT对神经外科患者ICP和DDS发生率的影响尚未得到系统评估.
方法:2022年2月,根据PRISMA指南,使用MEDLINE中9个关键词的各种组合进行了系统评价。选择了11篇论文。提取个体患者数据,池化,并分析。
结果:58名患者,44名男性和14名女性,平均年龄48岁(6-78岁),进行了分析。神经外科疾病包括:自发性颅内出血(n=27),创伤性脑损伤(n=16),缺血性卒中/缺氧脑损伤(n=6),颅内肿瘤(n=6),其他(n=3)。神经外科干预措施包括:开颅手术/开颅手术(n=23),外部心室引流或ICP监测仪放置(n=16),毛刺孔或麻花钻颅骨造口术(n=4)。33例患者使用了间歇性透析,20中的连续RRT,以及4中的其组合。在RRT期间,35例患者ICP升高(60.3%),20不变,下降3。34名患者死亡。间歇性透析与ICP增加相关(73%vs.37.5%,p=0.01)和死亡率(75%vs.39.1%,p=0.01)。
结论:在神经外科患者中,RRT期间ICP升高很常见,影响高达60%,并可能危及生命,死亡率高达65%。使用连续而非间歇的RRT技术可以降低这种并发症的风险。前瞻性研究是有必要的。
Dialysis disequilibrium syndrome is a rare, well-known, potentially life-threatening complication of renal replacement therapy (RRT), often involving cerebral edema and increased intracranial pressure (ICP). However, the impact of RRT on ICP and rate of dialysis disequilibrium syndrome in neurosurgical patients have not been systematically assessed.
In February 2022, a systematic
review following PRISMA guidelines was conducted using various combinations of 9 keywords in the MEDLINE database. Eleven papers were selected. Individual patient data were extracted, pooled, and analyzed.
Fifty-eight patients, 44 men and 14 women with a mean age of 48 years (6-78 years), were analyzed. Neurosurgical conditions included the following: spontaneous intracranial hemorrhage (n = 27), traumatic brain injury (n = 16), ischemic stroke/anoxic brain injury (n = 6), intracranial tumor (n = 6), and others (n = 3). Neurosurgical interventions included the following: craniotomy/craniectomy (n = 23), external ventricular drain or ICP monitor placement (n = 16), and burr hole or twist drill craniostomy (n = 4). Intermittent dialysis was used in 33 patients, continuous RRT in 20, and a combination thereof in 4. During RRT, ICP increased in 35 patients (60.3%), remained unchanged in 20, and decreased in 3. Thirty-four patients (65.4%) died. Intermittent dialysis was associated with increased ICP (73% vs. 37.5%, P = 0.01) and mortality (75% vs. 39.1%, P = 0.01).
In neurosurgical patients, ICP increases during RRT are common, affecting up to 60%, and potentially life-threatening, with mortality rates as high as 65%. The use of a continuous rather than intermittent RRT technique may reduce the risk of this complication. Prospective studies are warranted.