颅内压监测下阶梯式减压治疗重型颅脑损伤的Meta分析  

Stepwise decompression for treatment of patients with severe craniocerebral injury under intracranial pressure monitoring:a meta-analysis

作　　者：徐杰[1] 苏忠周[1] 邱晟[1] 聂小虎 陆斌[1] 沈亮 Xu Jie;Su Zhongzhou;Qiu Sheng;Nie Xiaohu;Lu Bin;Shen Liang(Department of Neurosurgery,Huzhou Cent Hospital,Affiliated Cent Hospital Huzhou University,Huzhou 313000,Zhejiang,China;The Affiliated Changzhou No.2 Hospital of Nanjing Medical University,Changzhou 213000,Jiangsu,China)

机构地区：[1]湖州市中心医院,湖州师范学院附属中心医院,神经外科,浙江湖州313000 [2]南京医科大学附属常州市第二人民医院,江苏常州213000

出　　处：《中国中西医结合急救杂志》2020年第4期431-436,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省湖州市公益性应用研究项目(2016GYB38)。

摘　　要：目的评价颅内压监测下阶梯式减压对重型颅脑损伤患者急性脑膨出、迟发脑血肿、术后脑梗死等严重并发症发生率和预后的影响。方法以脑外伤、颅脑损伤、阶梯式减压为中文检索词,以Traumatic brain injury、Brain injury、Head injury、Cerebral trauma、Stepwise decompression为英文检索词,检索美国国立医学图书馆Pubmed、荷兰医学文摘(Embase)、中国知网(CNKI)、万方数据库和中国生物医学数据库中有关颅内压监测下阶梯式减压治疗对重型颅脑损伤患者急性脑膨出、迟发脑血肿、术后脑梗死发生率及预后影响的随机对照临床试验(RCT),检索时间均为建库至2016年11月。对照组采用常规减压;试验组采用颅内压监测下阶梯式减压;主要结局指标为急性脑膨出、迟发脑血肿、术后脑梗死发生率及预后。由2名研究者独立筛选文献,并对纳入研究进行资料提取和质量评价,对符合标准的RCT研究进行Meta分析。采用Begg和Egger检验和漏斗图分析结局指标的发表偏倚。结果本次Meta分析共纳入17项RCT研究,其中英文文献2篇,中文文献15篇;共纳入1905例患者,试验组1026例,对照组879例。Meta分析显示:颅内压监测下阶梯式减压试验组急性脑膨出〔相对危险度(RR)=0.36,95%可信区间(95%CI)=0.27~0.47〕、迟发脑血肿(RR=0.47,95%CI=0.37~0.60)、术后脑梗死(RR=0.41,95%CI=0.30~0.56)的发生率均较常规减压对照组明显降低;格拉斯哥预后评分(GOS)较常规减压对照组明显升高(RR=1.70,95%CI=1.49~1.94)。Begg检验和Egger检验和漏斗图提示并发症指标中迟发血肿数据可能存在发表偏倚,余指标数据均未见明显的发表偏倚。结论颅内压监测下阶梯式减压可降低重型颅脑损伤患者严重并发症发生率,改善患者长期预后。Objective To evaluate the effect of stepwise decompression under intracranial pressure(ICP)monitoring for treatment of patients with severe craniocerebral injury and observe the influence on the incidences of severe complications including acute craniocele,delayed brain hematoma,and postoperative cerebral infarction and prognosis.Methods The search terms in Chinese of"brain injury","craniocerebral injury","stepwise decompression"were used,and"traumatic brain injury(TBI)","brain injury","head injury","cerebral trauma","stepwise decompression"in English were chosen to look for above related term literatures in American National Medical Library(Pubmed),Holand Medical Digest(Embase),China National Knowledge Infrastructure(CNKI),Wanfang database and Chinese Biomedical Database since the establishment of the respective database up to November 2016.Randomized controlled clinical trials(RCT)using ICP monitoring and stepwise decompression for treatment of patients with severe craniocerebral injury were selected to be in the experimental group,while in the control group,conventional decompression was used.Moreover,the main outcome indexes should include acute craniocele,delayed brain hematoma,postoperative cerebral infarction and prognosis.Two researchers independently screened the literatures,extracted data and evaluated the quality of the articles to carry out meta-analysis of RCTs that met the quality of the study.Begg and Egger tests and funnel plot were used to analyze the publication bias of the outcome indicators.Results A total of 17 RCT studies were included in this meta-analysis,including 2 English and 15 Chinese literatures;there were 1026 patients in the experimental group and 879 patients in the control group,totally accounting for 1905 patients.Meta analysis showed that in ICP monitoring with stepwise decompression experimental group,the incidences of complications such as acute craniocele[relative risk(RR)=0.36,95%confidence interval(95%CI)=0.27-0.47],delayed brain hematoma(RR=0.47,95%CI=0.37-0.60),postopera

关 键 词：阶梯式减压治疗 重型颅脑损伤 脑疝 血肿 脑梗死 META分析 

分 类 号：R65[医药卫生—外科学]