接受治疗性低温治疗的新生儿缺氧缺血性脑病的血流动力学和神经生理学评估用于预测2年结局：一项系统综述和荟萃分析。
完整摘要 · 中文译文
目的：评估振幅整合脑电图（aEEG）、脑近红外光谱（cNIRS）和靶向新生儿超声心动图（TnECHO）在接受治疗性低温（TH）治疗的缺氧缺血性脑病（HIE）婴儿中预测2年结局（神经发育和/或死亡）的预后准确性。 设计：系统综述和荟萃分析。 数据来源：MEDLINE、Embase、CINAHL和Cochrane Library（2002年至2025年4月16日）。PROSPERO注册号：CRD42023387592。 纳入标准：纳入≥35周胎龄、接受全身治疗性低温治疗的HIE婴儿的预后研究，并报告18-24个月时的神经发育障碍和/或死亡。 数据提取与合成：数据由两人独立提取。采用预后研究质量评价工具评估偏倚风险。采用随机效应模型计算合并灵敏度、特异度、诊断比值比（DOR）和曲线下面积（AUC）估计值。 结果：共纳入37项研究（n=2721）；其中24项（n=1989）纳入荟萃分析。36小时时aEEG背景异常预测2年不良结局的灵敏度为0.83（95% CI 0.70至0.92），特异度为0.88（95% CI 0.79至0.93），DOR为33.06（95% CI 12.87至84.94），AUC为0.88。睡眠-觉醒周期缺失具有高特异度0.93（95% CI 0.88至0.96），DOR为30.19（95% CI 14.47至63.01），AUC为0.88。cNIRS异常在36-48小时显示出潜在的预后价值，36小时时特异度为0.97（95% CI 0.13-1.00），DOR为26.74（95% CI 4.55至157.14），AUC为0.86。急性肺动脉高压 n 显示总体区分度低，DOR 2.17（95% CI 1.35 至 3.47）和（AUC 0.40）。右心室功能障碍显示较高的特异性但存在显著异质性。 结论：36 小时时 aEEG 背景异常可为 HIE 的 2 年结局提供可靠的床旁预后信息。cNIRS 可能提供互补价值，而支持单独使用 TnECHO 效用的证据有限。多模态方法可能改善早期预后评估。
完整摘要 · 英文原文
OBJECTIVE: To evaluate the prognostic accuracy of amplitude-integrated electroencephalography (aEEG), cerebral near-infrared spectroscopy (cNIRS) and targeted neonatal echocardiography (TnECHO) for predicting 2-year outcomes (neurodevelopment and/or death) in infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, CINAHL and the Cochrane Library (2002-16 April 2025). PROSPERO registration: CRD42023387592. ELIGIBILITY CRITERIA: Prognostic studies including infants ≥35 weeks' gestation with HIE treated with whole-body TH and reporting neurodevelopmental impairment at 18-24 months and/or death. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently. Risk of bias was assessed using Quality in Prognosis Studies. Pooled sensitivity, specificity, diagnostic ORs (DORs) and area under the curve (AUC) estimates were calculated using random-effects models. RESULTS: 37 studies (n=2721) were included; 24 (n=1989) contributed to meta-analysis. Abnormal aEEG background at 36 hours predicted adverse 2-year outcomes with sensitivity 0.83 (95% CI 0.70 to 0.92), specificity 0.88 (95% CI 0.79 to 0.93), DOR 33.06 (95% CI 12.87 to 84.94), AUC (0.88). Absence of sleep-wake cycling had high specificity 0.93 (95% CI 0.88 to 0.96), DOR 30.19 (95% CI 14.47 to 63.01) and AUC 0.88. Abnormal cNIRS demonstrated potential prognostic value at 36-48 hours with specificity 0.97 (95% CI 0.13-1.00), DOR 26.74 (95% CI 4.55 to 157.14) and AUC (0.86) at 36 hours. Acute pulmonary hypertension showed low overall discrimination, DOR 2.17 (95% CI 1.35 to 3.47) and (AUC 0.40). Right ventricular dysfunction showed higher specificity but substantial heterogeneity. CONCLUSIONS: Abnormal aEEG background at 36 hours provides reliable bedside prognostic information for 2-year outcomes in HIE. cNIRS may offer complementary value, whereas there is limited evidence supporting the utility of TnECHO alone. Multimodal methods may improve early prognostication.