目标体温管理在心搏骤停患者中应用效果的系统评价再评价

doi:10.3761/j.issn.2096-7446.2025.02.008

摘要/Abstract

摘要：

目的对目标体温管理（targeted temperature management，TTM）在心搏骤停（cardiac arrest，CA）患者中应用系统评价再评价，为临床医护人员提供证据支持。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library和CINAHL数据库，纳入评估TTM在CA患者中应用效果的系统评价/Meta分析，检索时限为建库至2024年1月15日。由2名研究者独立筛选文献并提取数据，通过计算修正覆盖面积评估原始研究重叠程度，分别通过AMSTAR 2工具、PRISMA 2020报告规范、GRADE证据分级系统评价纳入文献的方法学、报告和证据质量，采用描述性分析的方式对结果进行呈现。结果共纳入23篇系统评价/Meta分析，CCA为10.32%，原始研究高度重叠。AMSTAR 2评价结果显示，高质量文献2篇、中等质量2篇、低质量8篇、极低质量11篇；PRISMA 2020评价结果显示，12篇报告相对完全，11篇报告有一定缺陷；GRADE评价结果显示，55个证据体中等质量8个、低质量25个、极低质量22个。描述性分析结果显示，TTM在改善神经功能恢复、提高生存率、降低病死率和提高生活质量方面对CA患者具有潜在益处，但对成本效益、住院时间等的效果仍需进一步证实。结论 TTM在改善CA患者的神经功能恢复和生存、降低其病死率和提高其生活质量方面具有潜在益处，但目前最佳体温等尚未明确，且相关系统评价/Meta分析质量有待提高。未来学者应着眼于探讨个性化治疗策略，并提高临床护士对TTM的认知水平和实践能力，从而确保TTM治疗效果，改善CA患者预后。

关键词: 目标体温管理, 心搏骤停, 应用效果, 系统评价再评价, 护理

Abstract:

Objective To summarize，evaluate and analyze the related systematic reviews/meta-analyses of the application of targeted temperature management（TTM） in patients with cardiac arrest（CA），so as to provide evidence support for clinical medical staff. Methods CNKI，Wanfang，VIP，CBM，PubMed，Embase，Web of Science，Cochrane Library and CINAHL databases were searched by computer. Systematic reviews/meta-analyses evaluating the application effect of TTM in patients with CA were included. The search time limit was from the establishment of the database to January 15，2024. Two researchers independently screened the literature and extracted the data，assessed the extent of original study overlap by calculating Corrected Covered Area（CCA）. AMSTAR 2 tool，PRISMA 2020 reporting standard and GRADE evidence grading system were used to evaluate the methodology，reporting and evidence quality of the included studies，respectively. Descriptive analysis was used to present the results. Results A total of 23 systematic reviews/meta-analyses were included. The original studies were highly overlapping by calculating a CCA of 10.32%. The results of AMSTAR 2 evaluation showed that 2 articles were of high quality，2 articles were of medium quality，8 articles were of low quality and 11 articles were of very low quality. The results of PRISMA 2020 evaluation showed that 12 reports were relatively complete，and 11 reports had certain defects. The GRADE evaluation results showed that 8 of the 55 evidence bodies were medium quality，25 were low quality，and 22 were very low quality.The results of descriptive analysis showed that TTM has potential benefits for CA patients in terms of improving neurological function recovery，improving survival rate，reducing mortality and improving quality of life，but its effects on cost-effectiveness and length of hospital stay need to be further confirmed. Conclusion TTM has potential benefits in improving neurological recovery and survival，decreasing their death rate and improving their quality of life in CA patients，but the optimal body temperature has not yet been clarified and the quality of related systematic reviews/meta-analyses needs to be improved. Future scholars should aim to explore personalized treatment strategies and improve the level of knowledge and practice of TTM among clinical nurses，so as to ensure the effectiveness of TTM treatment and improve the prognosis of CA patients.

Key words: Targeted Temperature Management, Cardiac Arrest, Application Effect, Overview of Systematic Reviews, Nursing Care

李鑫, 黎张双子, 崔安妮, 徐傲然, 韩亚贤. 目标体温管理在心搏骤停患者中应用效果的系统评价再评价[J]. 中华急危重症护理杂志, 2025, 6(2): 173-180.

LI Xin, LI Zhangshuangzi, CUI Anni, XU Aoran, HAN Yaxian. Effectiveness of targeted temperature management in patients with cardiac arrest：an overview of systematic reviews[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(2): 173-180.

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