颅内压联合脑氧监测技术辅助治疗颅脑创伤患者的Meta分析OA

Objective To systematically evaluate the impact of intracranial pressure(ICP)combined with cerebral oxygen monitoring versus ICP monitoring alone on the prognosis of traumatic brain injury(TBI)patients.Methods This study searched the Cochrane Library,Embase,PubMed,CNKI,Wanfang,and VIP databases for randomized controlled trials(RCTs)and cohort studies comparing ICP combined with cerebral oxygen monitoring(combined group)versus ICP monitoring alone(control group).Primary outcome measures included mean ICP/day,mean CPP/day,total hospital stay,discharge Glasgow coma scale(GCS)score,and mortality.Meta-analysis was performed using RevMan 5.3,with heterogeneity assessed by the I2 statistic.A P-value<0.05 was considered statistically significant.Results A total of 12 studies(5 RCTs and 7 cohort studies)involving 1 890 TBI patients were included.Meta-analysis showed no significant differences between the combined and control groups in mean daily ICP(MD=0.95,95%CI=-1.22-3.13,P=0.390),mean daily CPP(MD=-1.49,95%CI=-4.31-1.32,P=0.300),total hospital stay(MD=-1.77,95%CI=-4.50-0.96,P=0.200),or discharge GCS score(MD=-0.16,95%CI=-0.87-0.55,P=0.670).However,the combined group had a significantly higher overall mortality rate(OR=1.50,95%CI=1.01-2.23,P=0.040).Sensitivity analysis indicated that individual studies might be the primary source of heterogeneity,and after exclusion,the combined group still showed significantly higher mortality(OR=1.58,95%CI=1.21-2.06,P=0.001).Publication bias assessment revealed no significant bias among studies.Conclusions Current evidence suggests that ICP monitoring combined with brain oxygenation monitoring,primarily guided by PbtO2,shows no significant advantage over ICP monitoring alone in improving short-term ICP control,CPP optimization,length of hospital stay,and neurological recovery at discharge among patients mainly with severe TBI.Pooled analysis indicates a higher short-term mortality rate in the combined monitoring group.However,due to the influence of study heterogeneity and confounding factors,it cannot yet be confirmed as a direct effect of combined monitoring.The association between combined monitoring and the risk of mortality in TBI patients remains to be verified.