腰池持续引流与腰穿释放脑脊液治疗外伤性蛛网膜下腔出血的疗效评价  

Effectiveness and safety of lumbar continuous drainage with lumbar puncture for traumatic subarachnoid hemorrhage:A Meta-analysis

作　　者：王强平[1] 曾令春[1] 曾义军[1] 余水[1] 淡冰[1] 彭宗清[1] 

机构地区：[1]都江堰市医疗中心神经外科,四川都江堰611830

出　　处：《西部医学》2012年第2期326-329,共4页Medical Journal of West China

摘　　要：目的系统评价比较腰池持续引流(LCD)与腰穿释放脑脊液(LP)治疗外伤性蛛网膜下腔出血(tSAH)的疗效与安全性。方法计算机及手工检索相关文献,纳入比较LCD与LP治疗tSAH的随机对照试验进行系统评价。结果共纳入16个研究进行分析,合计1488例tSAH患者。Meta分析显示,LCD组远期疗效明显高于LP组[RR=1.38,95%CI(1.22,1.56)];LCD组治疗及随访期末脑积水发生率[RR=0.29,95%CI(0.19,0.45)]、死亡率[RR=0.33,95%CI(0.20,0.54)]明显低于LP组,但颅内感染率明显高于LP组[RR=9.77,95%CI(1.27,74.93)]。结论腰池持续引流治疗tSAH疗效优于腰穿释放脑脊液,且操作简便,值得推广运用,但发生颅内感染风险明显增高,临床应用中应作相应防范。同时因存在纳入研究总体质量不高等易致偏倚的因素,影响论证真实性,期待更多高质量的多中心临床随机对照试验进一步验证。Objective To compare the efficacy and safety of lumbar continuous drainage（LCD） with lumbar puncture（LP） in treatment of patients suffered from traumatic subarachnoid hemorrhage（tSAH）.Methods We searched out all the randomized controlled trials confirmed to treat tSAH with LCD and LP,and performed a meta-analysis.Results A total of 16 trials involving 1488 patients with tSAH were included.The results of meta-analysis showed that： The long-term efficacy（duration of 6 months） of LCD groups was significantly higher than LP groups.The LCD was with a lower risk of hydrocephalus and death,but a higher risk of intracranial infection than LP.Conclusions The present studies showed that LCD was more effective than LP for tSAH,but likely apt to suffer from intracranial infection.Multi-factors such as low quality of included studies which lead to bias affected the authenticity of our review,so further large-scale trials are required.

关 键 词：腰大池 持续引流 外伤性蛛网膜下腔出血 随机对照试验 系统评价 Meta分析 

分 类 号：R743.35[医药卫生—神经病学与精神病学]