甘露醇对早期高血压性脑出血继续出血影响的Meta分析  

Meta-analysis:the effect of mannitol on re-hematoma in early stage of hypertensive cerebral hemorrhage

作　　者：高岩[1] 张兆辉[1] 

机构地区：[1]武汉大学人民医院神经内科,430060

出　　处：《疑难病杂志》2011年第10期735-738,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的评价脑出血早期应用甘露醇与脑出血后再出血的相关性,探讨使用甘露醇的最佳时机和剂量。方法根据预定的纳入、排除标准,在万方数据库、CNKI知识网络服务平台、中文科技期刊数据库及Pubmed进行相关检索。用Revman 5软件对数据进行整理和分析。对于单变量计数资料用优势比(OR)及其95%可信区间(95%CI)表示。对资料进行异质性检验,以判断多个研究结果的总体效应是否一致,若一致,则采用固定效应模型;反之,则用随机效应模型。对某些可能影响结果的重要因素进行敏感性分析,从而判断结果的稳定性和证据力度。结果共检索出1995—2010年已发表符合要求的12篇RCT,包括1176例患者。Meta分析显示,脑出血6h内使用甘露醇组与未使用甘露醇组比较,明显增加早期血肿扩大率(OR=2.72,95%CI 1.80～4.10,P<0.01);脑出血24 h内使用全量甘露醇组与未使用甘露醇组比较,亦明显增加早期血肿扩大率(OR=4.82,95%CI 2.87～8.10,P<0.01),脑出血24 h内使用半量甘露醇组与未使用甘露醇组比较,有增加早期血肿扩大率趋势,但是差异无统计学意义(OR=1.86,95%CI 0.95～3.65,P=0.07);结论脑出血患者发病6h内、24h内使用甘露醇增加了血肿扩大率。Objective To assess whether mannitol will lead to re-hematoma after cerebral hemorrhage,and investigate the best time and dose of mannitol in the treatment of cerebral hemorrhage.Methods According to predetermined criteria of inclusion and exclusion,data collection was performed in databases of Wanfang,CNKI and Weipu with time limitated from 1995 to 2010,a supplementary data were collected from Pubmed.Data synthesis and analysis was performed with the use of the Cochrane Review Manager software（Revman version 5）.The results were expressed as odds ratio（OR） and 95%confidence interval（CI）.Data were analyzed using fixed elfect model or random effect model according to its nature of homogeneity or heterogeneity.If（he overall effect of the result were consistent,the fixed effect model would be used.Otherwise the random effect model would be selected.Sensitivity analysis would be undertaken in certain important factors which may affect the outcome; accordingly to determine the stability of the result and the strength of the evidence.Results Twelve randomized studies on this topic were evaluated.Among these 12 studies,1176 patients were enrolled.Information of hematoma enlargement within 6 hours alter cerebral hemorrhage or within 24 hours and using the conventional volume or half-normal amount of mannitol were provided.Compared with the group of not using mannitol,the rate of hematoma enlargement of cerebral hemorrhage within 6 hours in group of using mannitol were significantly increased（OR =2.72,95%CI 1.80～4.10,P0.01 ）;the incidence of hematoma enlargement in given full-dose of mannitol in 24 hours appeared to be higher than that of not given mannitol after 24 hours（OR =4.82,95%CI 2.87～8.10,P0.01 ）;a trendy of increase of hematoma enlargement also found in fulldose mannitol group compared with semi-dose usage of mannitol in 24 hours,but there was no significant difference between the two groups（OR = 1.86,95%CI 0.95～3.65,P = 0.07 ）.Conclusion Mannitol therapy in cerebral hemorrhage with

关 键 词：早期脑出血 甘露醇 随机对照试验 META分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]