重型颅脑损伤院前气管插管：一项系统回顾和Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：柏雪 编辑：周倩 审校：曹莹
严重创伤性脑损伤（TBI）仍然是导致死亡的主要原因，尤其是年轻人。严重TBI造成了巨额的社会经济负担，而继发导致的长期残疾将影响个人及其家庭和更广泛的社会。本研究的目的是与无院前气管插管（即无创气道管理）相比，建立院前气管插管是否有利于降低死亡率和发病率。
方法
在Medline、Embase、Cochrane、EBSCO和Emcare数据库中对所有相关研究进行文献检索，比较院前气管插管与无创气道管理对严重TBI非儿科患者死亡率的影响。共有1025项研究从该搜索中筛选出摘要。本研究是根据系统审查和Meta分析首选报告项目（PRISMA）指南进行的。
结果
我们确定了19项符合纳入标准的研究。纳入的研究表明，院前和未行院前气管插管的死亡率无显著差异，优势比为1.07（95% CI，0.72-1.57；P<0.001）。Meta分析发现，相对于长期发病率，更趋向院前气管插管的趋势，优势比为0.92（95%CI，0.51-1.67；P<0.001）。
创伤性脑损伤的治疗是一个不断发展的领域，治疗目标参数不断变化。根据RCT和最近的研究，越来越多的证据表明，如果由训练有素、经验丰富的从业者按照当前的TBI指南对严重TBI患者进行院前气管插管是有益的。
原始文献：Jordan, Anderson,Annalize, Ebeid,Catrin,Stallwood-Hall,Pre-hospital tracheal intubation in severe traumatic brain injury: a systematic review and meta-analysis.[J] .Br J Anaesth, 2022, 129: 0.
Pre-hospital tracheal intubation in severe traumatic brain injury: a systematic review and meta-analysis
Abstract
Background: Severe traumatic brain injury (TBI) continues to be a leading cause of death, particularly in young adults.
Severe TBI contributes to significant socioeconomic burden secondary to the long-term disability, impacting the individual and their family, and wider society. The aim of this study was to determine whether establishing a pre-hospital definitive airway was beneficial to mortality and morbidity when compared with no pre-hospital airway.
Methods: A literature search for all relevant studies was performed in Medline, Embase, Cochrane, EBSCO, and Emcare databases, with studies comparing effects of pre-hospital tracheal intubation vs noninvasive airway management on mortality in non-paediatric patients with severe TBI. There were 1025 studies that had abstracts screened from this search. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines.
Results: We identified 19 studies that met inclusion criteria. The included studies identified no significant difference in mortality between pre-hospital and no pre-hospital tracheal intubation, with an odds ratio of 1.07 (95% CI, 0.72e1.57; P<0.001). The meta-analysis identified a trend favouring pre-hospital tracheal intubation with respect to long-term morbidity, with an odds ratio of 0.92 (95% CI, 0.51e1.67; P<0.001).
Conclusions: Management of traumatic brain injuries is a constantly evolving field, with ever-changing target parameters regarding management. There is growing evidence, based on the RCTs and recent studies, that pre-hospital tracheal intubation in patients with severe TBI is beneficial if performed by well-trained, experienced practitioners in accordance with current TBI guidelines.