急性脑梗死患者发生恶性脑水肿影响因素的meta分析  

Meta-analysis of influencing factors for malignant cerebral edema in patients with acute cerebral infarction

作　　者：杨雯 李君卓 刘光维[1] YANG Wen;LI Junzhuo;LIU Guangwei(Department of Neurology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经内科,重庆400016

出　　处：《中国医药导报》2022年第17期92-95,共4页China Medical Herald

基　　金：重庆市科卫联合医学科研项目(2021MSXM045)。

摘　　要：目的 系统评价急性脑梗死患者发生恶性脑水肿的影响因素。方法 计算机检索PubMed、Web of Science、EMbase、the Cochrane Library、CNKI、维普网和万方数据库,搜集急性脑梗死患者发生恶性脑水肿的影响因素相关研究。检索时限为建库至2021年4月。由2位研究者独立筛选文献、提取资料并评价文献质量,采用Stata 15.0和Revman 5.3软件进行meta分析。结果 共纳入18个研究,包括66 792例患者。meta分析结果显示,基线美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.15,95%CI:1.15~1.16,P <0.01)、心房颤动病史(OR=2.99,95%CI:1.53~5.87,P <0.01)、累及大脑前动脉(OR=5.53,95%CI:2.48~12.34,P <0.01)、颈动脉闭塞(OR=2.12,95%CI:1.04~4.32,P=0.04)是脑梗死发生恶性脑水肿的危险因素。敏感性分析后,结果显示,血管再通成功是其保护因素(OR=0.36,95%CI:0.20~0.66,P <0.01),稳定性改变。Egger检验结果显示无发表偏倚(P> 0.05)。结论 基线NIHSS评分、心房颤动病史、累及大脑前动脉、颈动脉闭塞是脑梗死发生恶性脑水肿的危险因素,临床中应重点关注并及时采取相应措施。血管再通成功与恶性脑水肿的关系仍需进一步研究。Objective To systematically review the influencing factors of malignant cerebral edema in patients with acute cerebral infarction. Methods PubMed, Web of Science, EMbase, the Cochrane Library, CNKI, VIP, and Wanfang Data were searched to collect relevant literatures on influencing factors of malignant cerebral edema in patients with acute cerebral infarction. The retrieval period is from the inception to April 2021. Two reviewers independently screened literatures, extracted data, and assessed the quality of included studies, then, meta analysis was performed by RevMan 5.3 and Stata 15.0 software. Results A total of 18 literatures were included, including 66 792 patients. Metaanalysis results showed baseline National Institute of Health stroke scale(NIHSS) score(OR = 1.15, 95%CI: 1.15-1.16,P < 0.01), history of atrial fibrillation(OR = 2.99, 95%CI:1.53-5.87, P < 0.01), anterior cerebral artery involvement(OR = 5.53, 95%CI: 2.48-12.34, P < 0.01), carotid artery occlusion(OR = 2.12, 95%CI:1.04-4.32, P = 0.04) were the risk factor for malignant cerebral edema after cerebral infarction. Sensitivity analysis showed that successful recanalization was a protective factor(OR = 0.36, 95%CI: 0.20-0.66, P < 0.01), the stability was changed. Egger test results showed no publication bias(P > 0.05). Conclusion Baseline NIHSS score, history of atrial fibrillation, anterior cerebral artery involvement, and carotid artery occlusion are risk factors for malignant cerebral edema after cerebral infarction,which should be paid attention to and timely take corresponding measures in clinical practice. The relationship between successful recanalization and malignant cerebral edema still needs further study.

关 键 词：脑梗死 恶性脑水肿 影响因素 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]