托拉塞米与呋塞米治疗脑水肿疗效的Meta分析

目的系统评价托拉塞米和呋塞米治疗脑水肿的有效性。方法检索1989年至2013年中国知网、万方数据库、维普数据库、Cochrane、Pub Med、EBSCO等收集托拉塞米和呋塞米治疗脑水肿的随机对照试验,按纳入和排除标准提取资料,交叉核对并进行方法学质量评估,使用Rev Man 5.2软件进行Meta分析。结果共纳入9项研究,包含674例脑水肿患者,其中托拉塞米组337例,呋塞米组337例。Meta分析显示托拉塞米治疗脑水肿的疗效（优势比为0.6,95%可信区间为2.22~6.17;P〈0.00001）和降低颅内压的效果均明显优于呋塞米（P〈0.01）;而且,托拉塞米组用药后电解质紊乱发生率明显低于呋塞米组（优势比为0.6,95%可信区间为0.38~0.96;P=0.03）。结论托拉塞米降低颅内压和治疗脑水肿优于呋塞米,出现电解质紊乱概率率更小。

A Meta-analysis of curative effects of torasemide and furosemide on cerebral edema

Objective To evaluate the curative effect of torasemide and furosemide on the cerebral edema. Methods CNKI, WanFang database, CQVIP and the databases of Coehrane Library, PubMed and EBSCO were retrieved with computers for collecting randomized controlled trials （RCT） about the treatment of the cerebral edema with torasemide and furosemide from 1989 to 2013. The data were extracted according to inclusion and exclusion criteria, crossly checked and reviewed, and a Meta-analysis of these data was performed by RevMan 5.2 software. Results There were totally included 9 RCT involving 674 patients. The Meta-analysis showed that the curative effect of torasemide on the cerebral edema was significantly better than that of furosemide （OR=3.70, 95% CI： 2.22-6.17, P〈 0.00001）, the effect of torademide on reducing the intracranial pressure （ICP） was significantly better than that of furosemide （P〈0.O1） and the rate of electrolyte disturbanees induced by torasemide was significantly lower than that induced by furosemide （OR=0.6, 95% CI, 0.38~0.96, P=0.03）. Conclusion The curative effect of torasemide on the cerebral edema is better than that of furosemide, but its side-effect such as electrolyte disturbances is less than that of furosemide.