西洛他唑治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的Meta分析

目的系统评价西洛他唑治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的有效性以及安全性。方法检索PubMed、Cochrane Library、EMBASE、中国生物医学文献、维普及万方数据库,检索时间从建库至2018年09月,收集西洛他唑治疗动脉瘤性患者的临床对照试验。由2名研究者严格制定纳入标准、筛选文献,提取资料,评价质量并用RevMan5.3软件进行Meta分析。结果最终纳入临床研究6项,共618例动脉瘤性蛛网膜下腔出血患者.Meta分析结果显示西洛他唑在以下方面优于常规治疗,且差异有统计学意义(P<0.05),西洛他唑能降低症状性脑血管痉挛(OR=0.31,95%CI:0.21-0.48),重度脑血管痉挛(OR=0.47,95% CI:0.31-0.69),迟发性脑梗塞(OR=0.32,95% CI:0.20-0.52)的发生率,且能够改善患者预后(OR=2.65,95% CI:1.66-4.21)。结论西洛他唑可以降低动脉瘤性蛛网膜下腔出血所致脑血管痉挛的发生率,并对改善预后有一定帮助。

Clinical effect of cilostazol in treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A meta-analysis

Objective To systematically review the clinical effect and safety of cilostazol in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). Methods PubMed, the Cochrane Library, CNKI, EMBASE, CBM, VIP, and Wanfang Data were searched for controlled clinical trials of cilostazol in the treatment of patients with aSAH published up to September 2018. Two investigators were responsible for the development of inclusion criteria, screening of articles, data extraction, and quality assessment, and then RevMan 5.3 software was used to perform the meta-analysis. Results Six controlled clinical trials were included in the meta-analysis, with a total of 618 patients with aSAH. The meta-analysis showed that compared with conventional treatment, the difference was statistically significant (P<0.05).Cilostazol significantly reduced the incidence rates of symptomatic cerebral vasospasm (odds ratio[OR]=0.31,95% confidence interval[CI]:0.21-0.48), severe cerebral vasospasm (OR=0.47, 95%CI:0.31-0.69), and delayed cerebral infarction (OR=0.32,95%CI:0.20-0.52) and significantly improved the prognosis of aSAH patients (OR=2.65, 95%CI:1.66-4.21). Conclusions Cilostazol can reduce the incidence rate of cerebral vasospasm caused by aSAH and improve the prognosis of aSAH patients.