背景:创伤性脑损伤(TBI)是全球所有年龄段发病率的主要原因。减压颅骨切除术(DC)是TBI患者的抢救程序。DC后的结果和生活质量值得怀疑。已经提出了基底水箱造口术(BC)以减少水肿并导致大脑松弛。它最初被用作TBI患者的辅助药物,从而改善结果。随着神经外科医生越来越受欢迎,在TBI患者中使用BC作为独立方法。此网络荟萃分析的目的是分析BC作为辅助或作为管理TBI患者的独立方法的作用。
方法:使用使用领域术语和医学副标题术语(MeSH术语)的搜索策略对电子数据库(PubMed和SCOPUS)进行全面搜索,以检索描述BC在TBI患者中作为DC或独立治疗的辅助治疗及其结果的作用的研究。
结果:选择31篇文章进行全文回顾,选择18篇文章进行最终分析。发现仅BC组的住院死亡率最低(比值比[OR],0.348;95%可信区间[CrI],0.254至0.477),其次是DC合并BC组(OR,0.645;95%CrI,0.476至0.875)。DC合并BC组的机械通气时间最短(OR,0.114;95%CrI,0.005至2.451),其次是单独BC组(OR,0.604;95%CrI,0.024至15.346)。DC合并BC组发现有最大格拉斯哥预后量表(GOS)(OR,1.661;95%CrI,0.907至3.041),其次是单纯BC组(OR,1.553;95%CrI,0.907至3.041)。
结论:我们的分析表明,在TBI患者中,仅BC与较低的住院死亡率相关。DC伴BC的机械通气需求降低。然而,需要来自世界其他地区的更大的多中心研究来证实这些发现。
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity in all age groups worldwide. Decompressive craniectomy (DC) is a salvage procedure in patients with TBI. Outcome and quality of life following DC is questionable. Basal cisternostomy (BC) has been proposed to reduce edema and leads to brain relaxation. It was initially used as an adjunct in TBI patients, thereby improving outcome. With gaining popularity among the neurosurgeons, BC was used as a standalone approach in TBI patients. The aim of this network meta-analysis is to analyse the role of BC either as an adjunct or as a standalone approach in managing TBI patients.
METHODS: A comprehensive search of electronic databases (PubMed and SCOPUS) was performed using the search strategy using the field terms and medical subheading terms (MeSH Terms) to retrieve studies describing the role of BC in patients with TBI either as an adjunct with DC or standalone treatment and their outcome.
RESULTS: Thirty-one articles were selected for full text
review and eighteen articles were selected for the final analysis. BC alone group were found to have minimum in-hospital mortality (odds ratio [OR], 0.348; 95% credible interval [CrI], 0.254 to 0.477) followed by DC combined with BC group (OR, 0.645; 95% CrI, 0.476 to 0.875). DC combined with BC group were found to have minimum duration of mechanical ventilation (OR, 0.114; 95% CrI, 0.005 to 2.451) followed by BC alone group (OR, 0.604; 95% CrI, 0.024 to 15.346). DC combined with BC group were found to have maximum Glasgow outcome scale (GOS) (OR, 1.661; 95% CrI, 0.907 to 3.041) followed by BC alone group (OR, 1.553; 95% CrI, 0.907 to 3.041).
CONCLUSIONS: Our analysis showed that BC alone was associated with lower in-hospital mortality rates in TBI patients. DC with BC had decreased requirement of mechanical ventilation. However, larger multicentric studies from other parts of the world are required to confirm these findings.