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成人创伤性脑损伤后心肌损伤和心功能障碍的发生率：一项系统综述和荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王婷婷 审校：曹莹
摘要：观察性研究已报告创伤性脑损伤（TBI）后心肌损伤和心功能障碍，但其发生率尚未有可靠估计。我们进行了一项系统性回顾和荟萃分析，以估计成人TBI患者中心肌损伤和心功能障碍的合并发生率。在使用MEDLINE和EMBASE数据库从创刊至2022年11月进行文献检索的基础上，纳入了报告至少一项异常心电图发现、升高的心肌肌钙蛋白水平或成人TBI患者的左室收缩功能或左室壁运动的观察性研究。心肌损伤定义为根据原始研究升高的心肌肌钙蛋白水平，心功能障碍定义为左室射血分数<50%或经超声心动图评估的左室壁运动异常。采用随机效应模型对合并发生率的荟萃分析。综合17项研究（共3,773名参与者）的结果，脑外伤后心肌损伤的合并估计发生率为33%（95%置信区间：27%-39%，I²：93%）；综合9项研究（共557名参与者）的结果，脑外伤后心脏功能障碍的合并估计发生率为16.0%（95%置信区间：9%-25.0%，I²：84%）。尽管各研究之间存在显著的异质性，且可能高估了心肌损伤和心脏功能障碍的发生率，但我们的研究结果表明，大约三分之一的成年人会在脑外伤后出现心肌损伤，大约有1/6的脑外伤患者会出现心脏功能障碍。
Incidence of Myocardial Injury and Cardiac Dysfunction After Adult Traumatic Brain Injury: A Systematic Review and Meta-analysis
Abstract: Myocardial injury and cardiac dysfunction after traumatic brain injury (TBI) have been reported in observational studies, but there is no robust estimate of their incidences. We conducted a systematic review and meta-analysis to estimate the pooled incidence of myocardial injury and cardiac dysfunction among adult patients with TBI. A literature search was conducted using MEDLINE and EMBASE databases from inception to November 2022. Observational studies were included if they reported at least one abnormal electrocardiographic finding, elevated cardiac troponin level, or echocardiographic evaluation of systolic function or left ventricular wall motion in adult patients with TBI. Myocardial injury was defined as elevated cardiac troponin level according to the original studies and cardiac dysfunction was defined as the presence of left ventricular ejection fraction <50% or regional wall motion abnormalities assessed by echocardiography. The meta-analysis of the pooled incidence of myocardial injury and cardiac dysfunction was performed using random-effect models. The pooled estimated incidence of myocardial injury after TBI (17 studies, 3,773 participants) was 33% (95% CI: 27%-39%, I 2 :s 93%), and the pooled estimated incidence of cardiac dysfunction after TBI (9 studies, 557 participants) was 16.% (95% CI: 9%-25.%, I 2 : 84%). Although there was significant heterogeneity between studies and potential overestimation of the incidence of myocardial injury and cardiac dysfunction, our findings suggest that myocardial injury occurs in approximately one-third of adults after TBI, and cardiac dysfunction occurs in approximately one-sixth of patients with TBI.
