选择性头部冷却还是全身冷却?这就是问题所在

Q4 Medicine Revista Romana de Pediatrie Pub Date : 2022-06-30 DOI:10.37897/rjp.2022.2.8
Vlad Dima, R. Bohîlțea, Raluca Mariana Stanescu, A. Toma, V. Varlas, A. Davitoiu
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引用次数: 0

摘要

背景迄今为止的研究支持治疗性低温(TH)对新生儿缺氧缺血性脑病的有益作用。TH可以通过两种方式提供:选择性头部冷却(SHC)或治疗性全身冷却(WBC)。本综述的目的是审查文献,揭示两种方法在诊断为中度或重度HIE的新生儿中进行TH的优缺点,并探讨一种方法是否优于另一种方法。方法。我们从2013年发表的Cochrane综述[1]中的数据开始,我们希望从最近比较两种TH方法(SHC与WBC)的临床研究中获得新的信息。临床研究由一个人进行搜索和分析(通过谷歌学者、PubMed和Scopus等专用搜索引擎)。我们纳入了过去7年的临床研究,比较了两种治疗TH的方法(SHC与WBC)。我们只选择了比较这两种方法的文章,而排除了只描述一种方法的论文。后果在排除不符合资格标准的临床试验后,仍有5项临床试验(n=256名新生儿)。对这些研究的分析支持这样一种观点,即两种治疗性低温模式都能冷却中枢神经系统(CNS)结构,并在存活新生儿中具有相似的神经发育预后。此外,在短期神经预后以及SHC或WBC治疗的中度或重度HIE(缺氧缺血性脑病)新生儿可能发生的不良反应方面没有显著差异;尽管一些研究注意到,与WBC治疗的患者相比,SHC治疗患者存在更严重的、具有统计学意义的病变。结论。需要进行更大规模的前瞻性随机研究,以跟踪这两种HT方法可能对患者产生的不良影响,以及长期的神经和认知预后。到目前为止,还没有明确的证据表明这两种方法中的一种肯定比另一种更安全或更可靠。
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Selective head cooling or whole body cooling? That is the question
Background. Studies to date support the beneficial effect that therapeutic hypothermia (TH) has on neonates with hypoxic-ischemic encephalopathy. TH can be delivered in two ways: selective head cooling (SHC) or therapeutic whole-body cooling (WBC). The purpose of this review is to examine the literature to expose the advantages and disadvantages of the two methods of performing TH in neonates diagnosed with moderate or severe HIE and to investigate whether one method is superior to the other. Methods. We started from the data from the Cochrane review published in 2013 [1] and we want to bring new information from recent clinical studies comparing the two TH methods (SHC vs WBC). Clinical studies were searched and analyzed by a single individual (through dedicated search engines such as Google Scholar, PubMed, and Scopus). We have included clinical studies from the last 7 years comparing the two ways of performing TH (SHC vs. WBC). We selected only the articles that compared the two methods and excluded the articles describing only one method. Results. After excluding the clinical trials that did not meet the eligibility criteria, 5 clinical trials remained (n = 256 neonates). Analysis of these studies supports the idea that both modalities of therapeutic hypothermia cool central nervous system (CNS) structures and have a similar neurodevelopmental prognosis among surviving neonates. Also, there are no significant differences in terms of short-term neurological prognosis, as well as the adverse effects that may occur in neonates with moderate or severe HIE (hypoxic-ischemic encephalopathy) treated with SHC or WBC; although some studies note the presence of more severe, statistically significant lesions among patients treated with SHC compared to those treated with WBC. Conclusions. Prospective, randomized studies on a much larger scale are needed to track the adverse effects that the two HT methods may have on patients, as well as long-term neurological and cognitive prognosis. Until now, there is no clear evidence that one of these two methods is definitely safer or more reliable than the other.
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来源期刊
CiteScore
0.10
自引率
0.00%
发文量
15
审稿时长
4 weeks
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