蛛网膜下腔出血后脑血管痉挛的关键预测因素：一项系统综述与荟萃分析。
完整摘要 · 中文译文
背景：蛛网膜下腔出血（SAH）是一种危及生命的疾病，常导致脑血管痉挛等并发症，从而引起迟发性脑缺血并增加死亡率。在重症监护中，护士早期识别血管痉挛的危险因素对于及时干预和改善预后至关重要。 目的：我们旨在系统回顾并综合蛛网膜下腔出血后脑血管痉挛相关危险因素的证据，为重症监护中的早期风险评估和护理策略提供依据。 方法：我们开展了一项针对观察性研究的系统综述和荟萃分析。于2024年8月30日至31日在8个数据库中进行了全面检索。使用乔安娜布里格斯研究所检查表和偏倚风险（RoB 2.0）工具进行质量评估。 结果：系统综述纳入了38项研究，其中27项纳入荟萃分析，涉及19033例患者。临床严重程度指标与脑血管痉挛的相关性最强，包括改良Fisher分级（比值比（OR）= 2.88；95%置信区间（CI），2.04-4.07）、Fisher分级（OR = 2.27；95% CI，1.91-2.69）和血流动力学状态（OR = 2.56；95% CI，1.17-5.59）。动脉瘤相关因素和合并症与脑血管痉挛风险增加相关，而临床生物标志物和炎症标志物的效应量相对较小。 结论：临床严重程度量表和血流动力学状态是蛛网膜下腔出血后脑血管痉挛的最强预测因素。这些发现支持早期风险分层。 以及实施结构化监测策略以改善患者预后。PROSPERO试验注册号：CRD42024605605（https://www.crd.york.ac.uk/PROSPERO/view/CRD42024605605）。
完整摘要 · 英文原文
BACKGROUND: Subarachnoid hemorrhage (SAH) is a life-threatening condition often leading to complications such as cerebral vasospasm, which causes delayed cerebral ischemia and increases mortality. In intensive care, early identification of vasospasm risk factors by nurses is essential for timely intervention and improved outcomes. OBJECTIVES: We sought to review and synthesize evidence on risk factors associated with cerebral vasospasm after SAH and inform early risk assessment and nursing care strategies in intensive care. METHODS: We conducted a systematic review and meta-analysis of observational studies. A comprehensive search was conducted on August 30 to 31, 2024, across 8 databases. Quality was assessed using the Joanna Briggs Institute checklist and the Risk of Bias (RoB 2.0) tool. RESULTS: Thirty-eight studies were included in the systematic review, of which 27 were included in the meta-analysis, involving 19 033 patients. Clinical severity measures were most strongly associated with cerebral vasospasm, including Modified Fisher grade (odds ratio (OR) = 2.88; 95% confidence interval (CI), 2.04-4.07), Fisher grade (OR = 2.27; 95% CI, 1.91-2.69), and hemodynamic status (OR = 2.56; 95% CI, 1.17-5.59). Aneurysm-related factors and comorbid conditions were associated with increased risk of cerebral vasospasm, whereas clinical biomarkers and inflammatory markers showed relatively smaller effect sizes. CONCLUSIONS: Clinical severity scales and hemodynamic status are the strongest predictors of cerebral vasospasm following SAH. These findings support early risk stratification and the implementation of structured monitoring strategies to improve patient outcomes.PROSPERO trial registration number:CRD42024605605 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024605605).