纳洛酮用于弥漫性轴索损伤患者的有效性和安全性的系统评价  

Efficacy and safety of naloxone on patients with diffuse axonal injury:a systematic review

作　　者：李文涛[1] 张斌飞[1] 宋锦宁[1] 马旭东[1] 刘尊伟[1] 顾华[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,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2014年第6期785-789,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.30471774);教育部新世纪优秀人才支持计划资助项目(No.NCET-05-0831);陕西省自然科学基金资助项目(No.2003C1-16)~~

摘　　要：目的纳洛酮用于弥漫性轴索损伤(DAI)的疗效仍存在疑虑,本研究通过meta分析评价其有效性和安全性。方法计算机检索各数据库,筛选纳洛酮与对照组比较治疗DAI的随机对照研究(RCT)。由研究者独立评价纳入研究的方法学并提取研究数据,采用STATA 12.0软件进行统计分析。结果共纳入12个低质量RCT,包括964例DAI患者。Meta分析结果显示:纳洛酮可以降低DAI患者病死率(RR=0.56,95%CI:0.46~0.68,P<0.001);改善格拉斯哥预后评分(RR=1.56,95%CI:1.14~2.12,P=0.005);并且能缩短患者昏迷时间(WMD=-9.47,95%CI:-13.84^-5.10,P<0.001)。结论由于缺乏高质量的随机双盲对照试验,纳入研究中纳洛酮使用剂量、疗程等存在差异,故纳洛酮改善DAI患者预后的证据尚不充分,其疗效和安全性尚需进一步评价。Objective The role of naloxone in diffuse axonal injury （DAI） remains in doubt. This meta- analysis is to evaluate the efficacy and safety of naloxone. Methods A systematic electronic literature search was conducted to identify from Databases randomized controlled trials （RCTs） comparing the use of naloxone with control group in patients with DAI. Data extraction and quality evaluation of studies were performed by investigators independently. A meta-analysis was performed by STATA 12.0. Results Totally 12 studies involving 964 patients met our inclusion criteria. Meta-analysis showed naloxone could decrease the mortality （RR= 0.56, 95 % CI ： 0.46 - 0.68, P〈0.001 ）, increase Glasgow outcome scale （ RR = 1.56,95 % CI：1.14 - 2.12, P =0.005 ）, and shorten duration of coma （WMD=-9.47,95% CI：-13.84--5.10,P〈0.001）, compared to control group. Oonclusion Due to the lack of high-quality randomized double-blind controlled trials, and variation in dose and duration of naloxone, the evidence that naloxone can improve the prognosis of DAI is insufficient. The efficacy and safety of naloxone on DAI need to be further evaluated.

关 键 词：纳洛酮 弥漫性轴索损伤 系统评价 META分析 

分 类 号：R651.1[医药卫生—外科学]