动脉瘤性蛛网膜下腔出血患者腰大池引流安全性的Meta分析

目的评价腰大池引流对动脉瘤性蛛网膜下腔出血(aSAH)的治疗效果。方法计算机检索PubMed、Cochrane Library、Elsevier Science Direct和Springer以及中文知网、万方、中国生物医学文献数据库,检索有关腰大池引流治疗aSAH的随机对照试验(RCTs),选取符合纳入标准的RCTs。采用Cochrane手册质量标准评价纳入文献的方法学质量,运用RevMan 5.2软件进行Meta分析。结果符合纳入标准有11篇文献,共计患者1216例。Meta分析结果显示,在aSAH治疗的临床有效性和安全性方面,腰大池持续引流组(试验组)优于无引流组(对照组),神经功能缺损的发生率低于对照组MD=0.33,95%CI(0.21~0.51),P<0.01],脑血管痉挛的发生率低于对照组MD=0.20,95%CI(0.12~0.34),P<0.01],脑积水的发生率低于对照组MD=0.25,95%CI(0.14~0.43),P<0.01],死亡率低于对照组MD=0.40,95%CI(0.23~0.70),P<0.01],但其他不良事件发生率高于对照组MD=3.24,95%CI(1.63~6.47),P=0.008]。结论腰大池持续引流治疗aSAH患者安全性方面优于无引流患者,但需考虑到不安全因素导致不良事件的发生,由于所纳入文献方法学质量偏低,尚需进一步验证腰大池持续引流治疗aSAH的有效性及安全性。

Safety of lumbar drainage on aneurysm subarachnoid hemorrhage in patients: a meta-analysis

Objective To evaluate the effect of lumbar drainage (LD) on cerebral aneurysms subarachnoid hemorrhage (aSAH). Methods A randomized controlled trials (RCTs) of LD on cerebral aSAH were searched from PubMed, Cochrane Library, Elsevier Science Direct, Springer, China academic Journal full-text Database (CNKI),Wanfang, China Biomedical Literature Database (CBM), and other databases. Methodological quality of the included literatures were evaluated by using Cochrane Handbook for Systematic Reviews of Interventions, and Meta-analysis was performed by using RevMan 5.2 software. Results Totally 11 literatures were inclused,including 1216 patients.Meta-analysis results showed that in terms of efficacy and safety of clinical treatment for aSAH was better in continuous LD group (experimental group) than control group, the incidence of neurological impairment was lower than in control group (MD =0.33, 95%CI 0.21-0.51], P<0.01), and the incidence of cerebral vasospasm was lower than in control group (MD =0.20, 95%CI 0.12-0.34], P<0.01), the incidence of hydrocephalus was lower than in control group (MD =0.25, 95% CI 0.14-0.43], P<0.01), the mortality was lower than in control group (MD=0.40, 95%CI 0.23-0.70], P<0.01), but other adverse events were higher than those in control group (SMD=3.24, 95%CI 1.63-6.47], P=0.008). Conclusion The safety of continuous LD for aSAH in patients is better than other treatment methods. We need to consider the unsafety factors will lead to adverse events, due to lower methodology quality is in this literature, the efficacy and safety still need to be further verified.