不同剂量甘露醇对脑水肿患者临床疗效的Meta分析  

The clinical efficacy of different doses of mannitol on patients with brain edema: A meta-analysis

作　　者：王澍 姚晓宇 张远 王敏忠[4] Wang Shu;Yao Xiaoyu;Zhang Yuan(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093 [2]兰州大学第二临床医学院 [3]大连医科大学 [4]山东大学附属省立医院神经内科

出　　处：《中国现代医药杂志》2019年第12期26-31,共6页Modern Medicine Journal of China

摘　　要：目的 通过Meta分析评价半量(20%,125ml/次或0.5g/kg)和全量(20%,250ml/次或1g/kg)甘露醇治疗脑水肿的有效性和安全性,为临床提供合理的循证指导。方法 检索Cochrane Library、EMbase、MEDLINE、CBM、CNKI、WanFang Data、VIP及灰色文献PROSPERO、Cochrane注册网搜集关于不同剂量甘露醇治疗脑水肿的随机对照试验,对符合纳入标准的文献进行Meta分析。结果 共纳入18篇随机对照试验,包括1 546例患者。结果显示治疗后半量组与全量组患者神经功能情况无统计学差异(RR=1.03,95%CI:0.33~0.70,P=0.45);颅内压无统计学差异(RR=1.02,95%CI:0.91~1.14,P=0.78);降低脑水肿体积效果半量组可能更优;肾功能两组间有统计学差异(RR=0.48,95%CI:0.33~0.70,P<0.05),半量组更优;治疗后半量组不良反应发生率更低。结论 两种不同剂量甘露醇治疗脑水肿颅内压升高后疗效基本无差异,半量组安全性更好,使用半量甘露醇治疗是更优选择。Objective To evaluate the efficacy and safety of half-dose(20%,125ml/time)and full-dose(20%,250ml/time)mannitol in the treatment of brain edema by meta-analysis,which can provide reasonable evidence-based guidance for solving clinical problems.Methods Randomized controlled trials of the different doses of mannitol in the treatment of brain edema were investigated by searching the Cochrane Library,EMbase,MEDLINE,CBM,CNKI,WanFang Data,VIP and grey literatures on the PROSPERO,Cochrane registration network.Meta-analysis was performed for the literatures that met the recruitment criteria.Results 18 randomized controlled trials including 1546 patients were in accordance with the recruitment criteria.There was no significant difference in neurological function between half-dose group and full-dose group(RR=1.03,95%CI:0.33~0.70,P=0.45),there was no significant difference in intracranial pressure after treatment(RR=1.02,95%CI:0.91~1.14,P=0.78),the effect of decreasing the volume of brain edema after treatment was better in half-dose group than full-dose group;after treatment,there was significant difference in renal function between two groups(RR=0.48,95%CI:0.33~0.70,P<0.05),the half-dose group was better;the incidence of adverse reactions after treatment was lower in the half-dose group than the full-dose group.Conclusion There is no difference in the efficacy of two different doses of mannitol,and the half-dose group has better safety.Half-dose mannitol is the better choice.

关 键 词：甘露醇 脑水肿 剂量 META分析 

分 类 号：R74[医药卫生—神经病学与精神病学]