The Role of Transcranial Doppler in Traumatic Brain Injury: A Systemic Review and Meta-Analysis.
The Role of Transcranial Doppler in Traumatic Brain Injury: A Systemic Review and Meta-Analysis.
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DOI：
10.4103/ajns.ajns_42_19
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发表时间：
2019-07-01
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影响因子：
--
通讯作者：
Saqqur, Maher
中科院分区：
文献类型：
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作者：
Fatima, Nida;Shuaib, Ashfaq;Saqqur, Maher
评估经颅多普勒（TCD）监测是否作为一种预后指标，作为外伤性脑损伤（TBI）中颅内压升高和脑血管痉挛（VSP）的诊断和监测工具。从1990年至今，在不同的MeSH术语下检索电子数据库和灰色文献（未发表的文章）。TCD在TBI患者中的随机对照试验、病例对照研究和前瞻性队列研究（bb - 18岁）。临床结果测量包括格拉斯哥昏迷结果量表（GCOS）和扩展GCOS和死亡率。数据被提取到Review Manager软件中。对符合纳入标准的25篇文献进行检索和分析。最终，我们的荟萃分析纳入了5项研究，结果显示TCD异常的TBI患者（平均流速[MFV] >120 cm/sec或MFV 1.2）与TBI和TCD正常监测的患者相比，其临床预后不良的可能性要高出>3倍（优势比[or]: 3.87； 95%可信区间[CI]: 2.97-5.04; P < 0.00001）。亚组分析显示，TCD异常的患者死亡率高9倍（OR: 9.96; 95% CI: 4.41 ~ 22.47; P < 0.00001）。此外，基于TCD结果的亚组分析显示，TCD（大脑中动脉[MCA] 120 cm/s）灌注不足与功能不良预后的可能性增加三倍相关（OR: 3.64; 95% CI: 1.55-8.52; P = 0.003）。TCD是一种不断发展的诊断工具，可能在确定TBI患者的预后方面发挥作用。需要进一步的前瞻性研究来证明TCD在TBI中的作用。
To evaluate whether transcranial Doppler (TCD) monitoring plays a role as a prognostic indicator, by being both a diagnostic as well as a monitoring tool for increased intracranial pressure and cerebral vasospasm (VSP), in traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to the present. Randomized control trials, case-control studies, and prospective cohort studies on TCD in TBI (>18 years old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and Extended GCOS and mortality. Data were extracted to Review Manager Software. Twenty-five articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI with abnormal TCD (mean flow velocity [MFV] >120 cm/sec or MFV 1.2) have a >3-fold higher likelihood of having poor clinical outcome in comparison to patients with TBI and normal TCD monitoring (odds ratio [OR]: 3.87; 95% confidence interval [CI]: 2.97-5.04; P < 0.00001). Subgroup analysis revealed that abnormal TCD has a 9-fold higher likelihood of mortality (OR: 9.96; 95% CI: 4.41-22.47; P < 0.00001). Further, subgroup analysis based on TCD findings revealed that the presence of hypoperfusion on TCD (middle cerebral artery [MCA] 120 cm/s) is associated with three-fold higher likelihood of poor functional outcome (OR: 3.64; 95% CI: 1.55-8.52; P = 0.003). TCD is an evolving diagnostic tool that might play a role in determining the prognosis of patients with TBI. Further prospective study is needed to prove the role of TCD in TBI.