神经内镜对比脑室外引流治疗脑室出血的荟萃分析  

Meta-analysis of neuroendoscopy versus external ventricular drainage in treatment of intraventricular hemorrhage

作　　者：李强 施炜[2] 张恒柱 李育平 顾建华 白吉南 葛爱亮 杨德福 LI Qiang;SHI Wei;ZHANG Heng-zhu(Department of Neurosurgery,East District of Subei People's Hospital,Yangzhou 225200,China;不详)

机构地区：[1]苏北人民医院东院神经外科,扬州225200 [2]南通大学附属医院神经外科 [3]苏北人民医院神经外科

出　　处：《临床神经外科杂志》2019年第6期500-506,共7页Journal of Clinical Neurosurgery

基　　金：江苏省卫生健康委科研课题(H2018064);2018年度扬州市科技发展计划项目(YZ2018088)

摘　　要：目的系统性评价神经内镜(NE)对比脑室外引流(EVD)治疗脑室出血的有效性及安全性,为临床工作提供依据。方法利用相关关键词在中国知网(CNKI)、万方数据库、维普网(VIP)、Cochrane临床试验数据库、PubMed、EMbase等中英文数据库中进行检索,纳入有关神经内镜对比脑室外引流治疗脑室出血的随机及非随机对照研究。使用RevMan 5.3软件对数据进行合并分析;并对设计类型、随访时间及术前时间进行亚组分析。结果最终纳入19篇文献(共1269例患者),包括9篇随机对照研究和10篇非随机对照研究。Meta分析结果显示,神经内镜组的有效血肿清除率明显高于脑室外引流组(OR=22.30,95%CI:14.35~34.64,P<0.00001);良好功能恢复率优于脑室外引流组(OR=3.07,95%CI:2.26~4.17,P<0.00001),患者的死亡率明显降低(OR=0.48,95%CI:0.32~0.71,P=0.0003)。两组并发症发生率比较,神经内镜组的颅内感染率(OR=0.19,95%CI:0.09~0.43,P<0.0001)、术后再出血率(OR=0.22,95%CI:0.08~0.65,P=0.006)和脑积水发生率(OR=0.16,95%CI:0.11~0.25,P<0.00001)均显著低于脑室外引流组。亚组分析显示,随访时间、术前时间及尿激酶的使用均可能为影响患者死亡率的重要因素。结论神经内镜治疗脑室出血可能比传统的脑室外引流术更加安全有效。Objective The effectiveness and safety of neuroendoscopy(NE)versus external ventricular drainage(EVD)in the treatment of intraventricular hemorrhage was systematically evaluated,which provided a basis for clinical work.Methods The relevant search terms were used to search randomized and non-randomized controlled studies in Chinese and English databases(including CNKI,Wanfang,VIP,the Cochrane Library,PubMed,EMbase).The data was combined and analyzed using RevMan 5.3 software.Subgroup analysis was performed on the type of design,follow-up time,and preoperative time.Results A total of 19 articles(1269 patients)were included(9 randomized controlled trials and 10 non-randomized controlled trials).Meta-analysis showed that NE group could increase the effective hematoma clearance rate(OR=22.30,95%CI:14.35-34.64,P<0.00001),improve the good functional outcome(OR=3.07,95%CI:2.26-4.17,P<0.00001)and reduce patient mortality(OR=0.48,95%CI:0.32-0.71,P=0.0003)significantly when compared with EVD group.In terms of complication incidence,the intracranial infection rate(OR=0.19,95%CI:0.09-0.43,P<0.0001),postoperative rebleeding rate(OR=0.22,95%CI:0.08-0.65,P=0.006)and the incidence of hydrocephalus(OR=0.16,95%CI:0.11 to 0.25,P<0.00001)in the NE group were significantly lower than that in the EVD group.Subgroup analysis showed follow-up time,preoperative time,and use of urokinase may be important factors influencing patients'mortality.Conclusion NE may be safer and more effective in treating ventricular hemorrhage than EVD.

关 键 词：神经内镜 脑室出血 脑室外引流 META分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]