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Randomized controlled trials in adult traumatic brain injury

机译：成人脑外伤的随机对照试验

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Background: To optimize strategies for achieving the effectiveness of interdisciplinary interventions, this study conducted a comprehensive literature review of all Randomized Controlled Trials (RCT) in adults with traumatic brain injury (TBI) over the past 30 years. Method: Three major databases including Medline, PsycINFO and CINAHL were searched, yielding 1176 peer reviewed publications. One hundred RCTs were included, encompassing 55 pharmacologic and non-pharmacologic acute phase trials and 45 rehabilitation and pharmacologic post-acute trials. Results: The majority of acute phase pharmacologic or non-pharmacologic trials (40/55) showed either no effect or adverse effect on TBI outcomes. Several trials involving early nutritional therapy or pre-hospital rapid intubation demonstrated significant treatment effects. The effect of decompressive craniectomy, therapeutic hypothermia and osmotic therapy remained controversial. The majority of post-acute phase trials (36/45), consisting of cognitive rehabilitation, physical rehabilitation and pharmacotherapy, produced various beneficial treatment effects. Conclusion: The data indicate that several active interventions during the acute phase of TBI are likely to be more effective than pharmacotherapy, whereas a comprehensive rehabilitation approach is preferred in post-acute phase TBI management. Great progress has been made in understanding the heterogeneous injury mechanisms as well as the complexity of medical management and rehabilitation following the recovery course of TBI.
机译：背景：为了优化策略以实现跨学科干预的有效性，该研究对过去30年中成人颅脑损伤（TBI）的所有随机对照试验（RCT）进行了全面的文献综述。方法：检索了Medline，PsycINFO和CINAHL等三个主要数据库，产生了1176个同行评审的出版物。包括一百项RCT，包括55项药物和非药物急性期试验以及45项康复和药物后急性期试验。结果：大多数急性期药理或非药理试验（40/55）显示对TBI结果无影响或有不良影响。几项涉及早期营养治疗或院前快速插管的试验证明了显着的治疗效果。减压颅骨切除术，低温治疗和渗透疗法的效果仍存在争议。包括认知康复，身体康复和药物治疗在内的大多数急性后阶段试验（36/45）产生了各种有益的治疗效果。结论：数据表明，在TBI急性期的几种积极干预措施可能比药物治疗更有效，而急性后TBI管理则首选综合康复方法。随着TBI康复过程的深入，人们对异质性损伤机制以及医疗管理和康复的复杂性的理解已取得了巨大的进步。

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