腰大池脑脊液持续引流对蛛网膜下腔出血患者预后影响的Meta分析  

Lumbar continuous drain of cerebrospinal fluid for patients with aneurysmal subarachnoid hemorrhage: a Meta-analysis

作　　者：李文涛[1] 魏艳[1] 张斌飞[1] 宋锦宁[1] 郭小叶[1] 夏明[1] 

机构地区：[1]西安交通大学医学院第一附属医院神经外科,710061

出　　处：《中华脑科疾病与康复杂志（电子版）》2013年第3期39-44,共6页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：国家高技术研究发展计划"863计划"基金资助项目(2006AA02Z4Z4);教育部高层次创造性人才计划"新世纪优秀人才支持计划"基金资助项目(NCET-05-0831);陕西省"13115"重大科技创新专项基金资助项目(2008ZDKG-66)

摘　　要：目的系统评价腰大池持续引流对动脉瘤性蛛网膜下腔出血患者预后情况的影响。方法计算机检索腰大池持续引流用于动脉瘤性蛛网膜下腔出血患者的随机对照试验,时间截止2013年4月。由2位研究者独立评价纳入研究的质量、提取数据,统计分析采用RevMan 5.2.3软件进行。结果纳入15个研究,共1298例患者。Meta分析结果显示:腰大池引流可以降低住院期间患者的病死率[RR=0.27,95%CI(0.17,0.44),P<0.000 01]、降低脑血管痉挛发生率[RR=0.25,95%CI(0.17,0.37),P<0.000 01]、降低再出血[RR=0.50,95%CI(0.28,0.90),P=0.02]和脑积水[RR=0.25,95%CI(0.15,0.40),P<0.000 01]的风险。对于短期临床预后与随访远期预后情况缺乏相关资料,暂时不能准确分析腰大池持续引流对其影响。结论限于当前研究设计的质量的问题,本Meta分析无法提供确切的临床证据。趋势显示腰大池持续脑脊液引流可能降低病死率、减少并发症。期待多中心的随机对照试验进一步研究。Objective To evaluate the effectiveness of lumbar continuous drain of cerebrospinal fluid for patients with aneurysmal subarachnoid hemorrhage. Methods Systematic literature retrieval was carried out to obtain randomized controlled trials of lumbar continuous drain of cerebrospinal fluid for patients with aneurysmal subarachnoid hemorrhage before April 2013. Methodological quality assessment and data collection were performed by two individual reviewers. A Meta-analysis was performed by RevMan 5.2.3 software. Results Fifteen studies with 1298 patients were included. Meta-analysis showed lumbar continuous drain could reduce hospital mortality[ RR =0. 27,95% CI（O. 17,0.44） ,P 〈0. 000 01 ] ,cerebral vasospasm [ RR = 0. 25,95% CI（O. 17,0. 37 ）, P 〈 0. 000 01 ], risk of rebleeding[ RR = 0. 50,95% CI（O. 28,0. 90）, P =0. 02] and hydrocephalus[ RR =0. 25,95% CI（O. 15,0. 40） ,P 〈01 000 01 ]. We were not very clear for the correlation between lumbar continuous drain and short-term and long-term clinical outcome so far because the limited data. Conclusion This Meta-analysis could not provide any confirmed conclusion due to the limition of the included studies. However, lumbar continuous cerebrospinal fluid drain might be benefit for patients with aneurysmal subarachnoid hemorrhage and reduce mortality and complications.

关 键 词：蛛网膜下腔出血 脑脊髓液 引流术 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]