对比7.5%高渗氯化钠溶液和20%甘露醇溶液降低颅内压效果的Meta分析

目的 采用meta分析的方法系统比较7.5%高渗氯化钠溶液(hypertonic saline,HS)和甘露醇降低颅内压(intracranial pressure,ICP)的效果，以期为临床应用提供依据。 方法 检索自建库至2016年1月Cochrane Library、PubMed、Embase、中国生物医学文献数据库、中国知网、维普和万方数据库文献中关于7.5% HS与甘露醇降低颅内高压的随机对照试验的相关文献，同时追索纳入文献的参考文献，根据纳入与排除标准进行文献筛选、质量评价和数据提取后，应用Revman 5.3软件对各项指标进行Meta分析。 结果 最终纳入10篇文献共447例患者，其中，应用7.5% HS患者226例(HS组)，应用甘露醇患者221例(甘露醇组)。Meta分析结果显示:7.5% HS在降低ICP效果方面较甘露醇更佳(P=0.020)，且7.5% HS降低ICP维持时间更长(P=0.004)。干预后CVP水平、血浆渗透压以及血清钠水平与甘露醇差异均无统计学意义。干预后MAP水平HS组低于甘露醇(P<0.001)。 结论 7.5% HS和甘露醇均能有效地降低颅内高压且持续时间更长,但维持平均动脉压的效果不如甘露醇。 

A meta-analysis of 7. 5% hypertonic saline contrast mannitol in reducing the intracranial hypertension

Objective Meta-analysis was used to compare the effect of 7.5% hypertonic saline and mannitol in reducing intracranial pressure,in order to provide reference for clinical application. Methods Cochrane Library,PubMed,Medline,Academic Search Premier,the China Biological Medicine Database,CNKI,VIP and Wanfang Database were retrieved.The related literature about randomized controlled trials of comparing intracranial hypertension by 7.5% hypertonic saline and the mannitol from the establishment of databases to January 2016 were collected.Literature screening,data extraction and assessment of methodological quality were retrieved in accordance with the method of a systematic review of evidenced-based medicine.RevMan 5.3 software was used to conduct meta-analysis for each indicator. Results Totally 10 articles were enrolled,including 447 patients,with 226 in the 7.5% HS group and the other 221 in the mannitol group.The value of ICP after the intervention of HS group was lower than the mannitol group(P=0.020),and the maintenance time was longer than the mannitol group as well(P=0.004).There was no significant difference in the CVP,plasma osmotic pressure and the serum sodium after the intervention.The MAP level of HS group was lower than the mannitol group. Conclusion In reducing intracranial pressure 7.5% HS and mannitol are effective and have longer duration,but the effect of maintaining the MAP is not as good as that of mannitol.