法舒地尔治疗SAH后脑血管痉挛的系统评价

目的系统评价法舒地尔治疗蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法计算机检索Cochrane图书馆(2010年第四期)、Medline(1950～2010年)、Embase(1980～2010年)、中国生物医学文献数据库(CBMdisc,1978～2010年)、中国学术期刊全文数据库(CNKI,1979～2010年)等,手工检索中华神经科杂志、临床神经病学杂志等相关杂志,收集国内外关于法舒地尔治疗SAH后CVS的随机或半随机对照试验。按Cochrane系统评价的方法,由两名研究者独立进行质量评价和资料提取,采用RevMan5.0软件进行Meta分析。结果共纳入18篇文献,包括1322例SAH患者。Meta分析结果显示:①法舒地尔组CVS的发生率明显低于对照组[RR=0.66,95%CI(0.52,0.82),P=0.0003];②法舒地尔组SAH患者的死亡率明显低于对照组[RR=0.58,95%CI(0.35,0.96),P=0.03];③法舒地尔组SAH患者CT显示脑组织新发低密度灶的发生率明显低于对照组[RR=0.67,95%CI(0.52,0.86),P=0.002]。结论法舒地尔治疗可降低SAH后CVS发生率和患者的死亡率,可减少脑组织新发低密度灶的发生。

Curative effect of fasudil on cerebral vasospasm after subarachnoid hemorrhage: a systematic review

Objective To assess the curative effect of fasudil （FSD） on cerebral vasospasm （CVS） after subarachnoid hemorrhage （SAH）.Methods The database of the Cochrane Library （Issue 4,2010）,Medline （1950～2010）,Embase （1980～2010）,CBMdisc （1978～ 2010）,CNKI （1979～2010） and so on were searched by an electronic computer and relevant journals such as Chinese Journal of Neurology and Journal of Clinical Neurology were manually searched to collect randomized controlled trials and quasi-randomized controlled trials of FSD for patients with CVS after SAH.The quality of all the trails was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions and the data were extracted independently from all the trails by two reviewers.Meta-analysis was performed by RevMan 5.0 software.Results Eighteen articles involving 1 322 patients with SAH were gotten.The incidence of CVS in the FSD group was significantly lower than that in the control group （RR=0.66,95% CI 0.52～0.82,P= 0.0003）.The incidence of mortality in the FSD group was significantly lower than that in the control group （RR=0.58,95% CI 0.35～0.96,P=0.03）.The incidence of new cerebral low density area on CT in the FSD group was significantly lower than that in the control group （RR=0.67,95% CI 0.52～0.86,P=0.002）.Conclusion The incidences of CVS and new cerebral low density area,and mortality can be significantly reduced by FSD treatment in the patients with SAH.