甘油果糖注射液对比甘露醇注射液治疗脑水肿疗效和安全性的Meta分析  

Therapeutic Efficacy and Safety of Glycerol and Fructose Injection vs. Mannitol Injection in the Treatment of Cerebral Edema:A Meta-analysis

作　　者：黎明丽[1] 宋薇[1] 胡汉昆[2] 刘萍[2] 刘薇芝[2] 李玲[1] 

机构地区：[1]武汉大学医院,武汉430071 [2]武汉大学中南医院药学部,武汉430072

出　　处：《中国药房》2014年第44期4140-4143,共4页China Pharmacy

基　　金：国家科技支撑计划子课题(No.2013BAI06B04)

摘　　要：目的:系统评价甘油果糖注射液对比甘露醇注射液治疗脑水肿的疗效和安全性,以为临床治疗提供循证参考。方法:计算机检索Pub Med、Cochrane Library、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库,全面收集甘油果糖注射液(试验组)对比甘露醇注射液(对照组)治疗脑水肿的随机对照试验(RCT),对纳入研究进行质量评价和资料提取后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入10项RCT,包括1 174例患者。Meta分析结果显示,试验组患者总有效率、缓解颅内高压有效率、神经功能损伤改善率、降压幅度与对照组比较,差异均无统计学意义(P>0.05);试验组患者降压起效时间[MD=0.19,95%CI(0.03,0.35),P=0.02]、作用高峰时间[MD=-0.74,95%CI(-0.94,-0.54),P<0.000]、作用持续时间[MD=1.58,95%CI(0.80,2.35),P<0.000]和肾功能损伤发生率[RR=0.31,95%CI(0.21,0.44),P<0.000]均显著优于对照组,两组比较差异有统计学意义;试验组患者除了皮疹发生率与对照组相当以外,其余各项不良反应发生率均显著低于对照组,两组比较差异有统计学意义(P<0.01)。结论:甘油果糖注射液治疗脑水肿在降低患者颅内压及修复神经损伤方面的疗效与甘露醇注射液相当,但前者起效较快、作用更持久稳定,安全性更好。由于纳入研究的质量不高、存在异质性等多种因素的影响,该结论有待高质量、大样本的长期RCT进一步验证。OBJECTIVE：To evaluate therapeutic efficacy and safety of Glycerol and fructose injection vs. Mannitol injection in the treatment of cerebral edema systematically,and to provide evidence-based reference for clinical treatment. METHODS：Retrieved from Pub Med,Cochrane library,Chinese journal full-text database,Chinese scientific journals database,Wanfang database,according to the inclusion and exclusion criteria,developing search strategies,randomized controlled trials（RCT） about Glycerol and fructose injection（trial group）vs. Mannitol injection（control group）in the treatment of cerebral edema for cerebral edema were collected. After evaluating the quality of included studies and extracting data,Meta-analysis was performed by using Rev Man 5.2 statistical software. RESULTS：A total of 10 RCTs were included,involving 1 174 patients. Meta-analysis showed that：the total effective rate,effective rate of relieving intracranial hypertension,the rate of nerve injury improvement and blood pressure amplitude of trial group had no statistical significance（P〉0.05）,compared with control group;onset time of lowering blood pressure [MD=0.19,95%CI（0.03,0.35）,P=0.02],peak hour[MD=-0.74,95%CI（-0.94,-0.54）,P〈0.000],duration of lowering blood pressure[MD=1.58,95% CI（0.80,2.35）,P〈0.000] and the incidence of renal injury [RR=0.31,95% CI（0.21,0.44）,P〈0.000] of trial group were significantly better than those of control group;there was statistical significance. The incidence of rash in trial group was similar to control group,but the incidence of other ADR was significantly lower than control group;there was statistical significance（P〈0.01）. CONCLUSIONS：Therapeutic efficacy of Glycerol and fructose injection is similar to that of Mannitol injection in reducing intracranial pressure and relieving nerve injury,but the former werks rapdily and steadily and has better safety. Due to low quality of included studies,heterogenicity and various factors,the above conclusions need to be validat

关 键 词：甘油果糖注射液 甘露醇注射液 脑水肿 META分析 疗效 安全性 

分 类 号：R742.7[医药卫生—神经病学与精神病学]