目的:本研究旨在分析不同脑灌注(MCP)监测方法对脑卒中的影响,死亡,以及在颈动脉内膜切除术(CEA)期间使用管腔内分流。
方法:进行了系统评价和网络荟萃分析,并在PROSPERO注册表(CRD42021246360)中注册。Medline,Embase,中部,搜索了WebofScience。纳入了随机对照试验(RCT)和队列研究,研究对象超过50名,比较了接受CEA的患者不同MCP的临床结果。分析中包括报告以下MCP中的一种或两种的组合的论文:清醒测试(AT),近红外光谱(NIRS),脑电图(EEG),体感诱发电位(SSEP),运动诱发电位(MEP),经颅多普勒(TCD),和树桩压力(SP)。使用二项似然函数进行随机效应网络荟萃分析,并具有指定的logit链接,用于围手术期中风或死亡和分流作为结果。由于缺乏可用于统计分析的研究,近红外光谱被排除在外。
结果:在1834份出版物中,17项研究(15项队列研究和两项随机对照试验),包括21538名参与者纳入定量分析。使用脑电图的参与者最多(7429名参与者,六项研究),而AT用于最多的研究(10项研究)。与AT相比,所有监测模式在卒中或死亡方面的预后较差,对于使用EEG和TCD联合监测的患者,SSEPMEP的OR介于1.3(95%可信间隔[CrI]0.2-10.9)和3.1(CrI0.3-35.0)之间。然而,大范围的CrI表明监测方法之间没有统计学上的显著差异。脑电图和TCD联合监测的患者被分流的几率最低,虽然SP被分流的几率最高,也没有统计学上的显著差异。
结论:文献中缺乏关于这一主题的高质量数据。本研究表明,网络荟萃分析中调查的监测方法之间没有显着差异。
OBJECTIVE: This study aimed to analyse the influence of different methods of monitoring cerebral perfusion (MCP) on stroke, death, and use of intraluminal shunt during carotid endarterectomy (CEA).
METHODS: A systematic review and network meta-analysis was conducted and registered in the PROSPERO registry (CRD42021246360). Medline, Embase, CENTRAL, and Web of Science were searched. Randomised controlled trials (RCTs) and cohort studies with > 50 participants that compared clinical outcomes for different MCP in patients undergoing CEA were included. Papers reporting one or a combination of two of the following MCPs were included in the analysis: awake testing (AT), near infrared spectroscopy (NIRS), electroencephalography (EEG), somatosensory evoked potential (SSEP), motor evoked potential (MEP), transcranial Doppler (TCD), and stump pressure (SP). A random effects network meta-analysis was performed using a binomial likelihood function with a specified logit link for peri-operative stroke or death and shunting as outcomes. Near infrared spectroscopy was excluded due to the lack of studies that could be used for statistical analysis.
RESULTS: Of 1 834 publications, 17 studies (15 cohort studies and two RCTs) including 21 538 participants were incorporated in the quantitative analysis. Electroencephalography was used in the largest number of participants (7 429 participants, six studies), while AT was used in the highest number of studies (10 studies). All monitoring modalities had worse outcomes with respect to stroke or death when compared with AT, with ORs ranging between 1.3 (95% credible interval [CrI] 0.2 - 10.9) for SSEP + MEP and 3.1 (CrI 0.3 - 35.0) for patients monitored with a combination of EEG and TCD. However, the wide CrI indicated that there is no statistically significant difference between the monitoring methods. Patients monitored with a combination of EEG and TCD had the lowest odds of being shunted, while SP had the highest odds of being shunted, also with no statistically significant difference.
CONCLUSIONS: There is a lack of high quality data on this topic in the literature. The present study showed no significant difference between monitoring methods investigated in the network meta-analysis.