腰穿脑脊液持续引流治疗蛛网膜下腔出血的系统评价

目的评价腰穿脑脊液持续引流治疗蛛网膜下腔出血（SAH）的疗效及安全性。方法通过电子检索和手工检索，运用Cochrane协作网系统评价的方法对纳入所有应用腰穿脑脊液持续引流治疗SAH的随机对照试验（RCT）进行系统评价。结果共检出21个RCT，其中7个（390例）符合纳入标准，但试验方法学质量普遍低下。所有试验均未提及随访期末（至少3个月）SAH患者病死、植物状态或残疾等不良结局。其余指标Meta分析结果显示：在治疗和随访期末引流组的总病死率低于对照组，其差异有统计学意义RR=0．32，95％CI（0．15，0．70）]；并发症发生率（除再出血地是如此，其中脑血管痉挛RR=0．1595％CI（0．06，0．33）]、脑积水RR=0．2295％CI（0．10，0．52）]、脑梗死RR=0．2595％CI（0．08，0．82）]；仅1篇文献报道了该疗法的不良反应包括颅内感染和低颅压反应的发生，其余试验未提及不良反应。结论本系统评价纳入RCT质量均低，虽腰穿脑脊液持续引流有降低SAH患者病死率和并发症的趋势，但缺乏评价其远期功能性结局以及不良反应的指标，尚不能对其疗效是否有效、安全得出确切的结论，其疗效和安全性还需要更多设计严格的多中心、大样本的RCT予以进一步证实。

Lumbar Continuous Drainage of the Cerebrospinal Fluid Therapy for Subarachnoid Hemorrhage: A Systematic Review

Objectives To assess the effectiveness and safety of lumbar continuous drainage of the cerebrospinal fluid therapy for subarachnoid hemorrhage （SAH）. Methods The method of Cochrane systematic review was used to evaluate the randomized controlled trials （RCTs） of lumbar contiunous drainage of the cerebrospinal fluid therapy for SAH. Results We included 7 RCTs involving 390 patients. The methodological quality of all the trials was poor. The poor outcome and adverse event evaluation of the SAH patients at the end of long-term follow-up （at least three months） were not reported in all studies. Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance RR=0.32, 95%CI （0.15, 0.70）]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance （except re-bleeding） /cerebral vasospasm RR=0.15, 95%CI （0.06, 0.33）, hydrocephalus RR=0.22, 95%CI （0.10, 0.52）, cerebral infarction RR=0.25, 95%CI （0.08, 0.82）]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid therapy including intracranial infection and intracranial hypotension reaction, while the other trials did not report the adverse events. Conclusion With poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid therapy is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidence.