超早期血管内栓塞颅内破裂动脉瘤效果的Meta分析

目的系统评价比较超早期(24 h)与延期(≥24 h)血管内栓塞治疗颅内破裂动脉瘤的安全性和有效性。方法根据纳入、排除标准及检索策略,检索Pub Med、Embase、Cochrane图书馆、维普、万方数据和中国期刊全文数据库等,获得超早期和延期应用血管内栓塞治疗颅内破裂动脉瘤的临床文献,采用Review Manager 5.3软件对治疗预后良好率、术后病死率、术后再出血率等进行Meta分析。结果共纳入10篇文献,其中9篇为回顾性对照研究,1篇为前瞻性对照研究。共纳入2 021例患者,其中采用超早期治疗的患者970例,采用延期治疗患者1 051例。超早期组患者的预后良好率(OR=2.67,95%CI:2.07~3.44)、术后再次出血率(OR=0.23,95%CI:0.11~0.47)与延期组差异均有统计学意义(均P0.01),而两组术后病死率差异无统计学意义(OR=0.76,95%CI:0.51~1.13,P=0.17)。亚组分析显示,超早期组的预后良好率与早期组(3 d,OR=1.98,95%CI:1.33~2.95)、中晚期组(≥3 d,OR=4.66,95%CI:2.21~9.81)比较,差异均有统计学意义(均P0.01)。结论超早期血管内栓塞治疗颅内破裂动脉瘤比延期治疗有可能提高预后良好率,减少再出血率,并未增加术后病死率。但尚需更多高质量、大样本的随机对照试验证实。

Efficacy of ultra-early endovascular embolization for ruptured intracranial aneurysms:a Meta-analysis

Objective To compare the effectiveness and safety of ultra-early (< 24 h)and delayed (≥ 24 h ) endovascular embolization of ruptured intracranial aneurysms with systematic review. Methods PubMed,Embase,the Cochrane Library,VIP,Wanfang Data,and China National Knowledge Internet (CNKI)were retrieved according to inclusion,exclusion criteria and retrieval strategies,and the clinical literature of ultra-early and delayed endovascular embolization for the treatment of ruptured intracranial aneurysms were obtained. The Review Manager 5. 3 software was used to conduct Meta-analysis for good prognosis rate,postoperative mortality,and postoperative rebleeding rate. Results A total of 10 articles were included,9 of them were retrospective control studies and 1 was prospective control study. A total of 2 021 patients were enrolled,including 970 patients treated with ultra-early treatment;1 051 patients treated with delayed treatment. There was significant difference in the good prognosis rate (OR,2. 67,95% CI 2. 07 -3. 44,P < 0. 01)and the postoperative rebleeding rate (OR,0. 23,95% CI 0. 11 -0. 47)between the ultra - early embolization group and the delayed embolization group (all P < 0. 01). There were no significant difference in the mortality between the two groups (OR,0. 76,95% CI 0. 51 -1. 13,P = 0. 17). The subgroup analysis showed that there were significant differences in the good prognosis rate in the ultra-early group compared with the early group (< 3 d,OR,1. 98,95% CI 1. 33 -2. 95)and the middle and late group (≥3 d,OR,4. 66,95% CI 2. 21 -9. 81,all P < 0. 01). Conclusion Compared with the delayed group, ultra-early embolization of ruptured intracranial aneurysms may improve the good prognosis rate,reduce the rebleeding rate,and not increase the mortality after procedure at the same time. However,more high quality and large sample randomized controlled trials are needed to confirm them.