高渗盐水对比甘露醇治疗颅内压升高患者的疗效和安全性:基于随机对照试验的Meta分析的伞形Meta分析  

Effects and safety of hypertonic saline versus mannitol in patients with elevated intracranial pressure:an umbrella Meta-analysis of Meta-analysis of randomized controlled trials

作　　者：胡辉平[1] 张昊奇 李奕霖 何建琳 陈嘉[3] 陈文俊 胡双 高雄 毛玲 HU Hui-ping;ZHANG Hao-qi;LI Yi-lin;HE Jian-lin;CHEN Jia;CHEN Wen-jun;HU Shuang;GAO Xiong;MAO Ling(Nuclear Medicine Department,Hunan Tumor Hospital,Hunan Changsha 410013,China;School of Nursing,Changsha Medical University,Hunan Changsha 410219,China;Xiangya Nursing School of Central South University,Hunan Changsha 410013,China;School of Nursing,University of Ottawa,Ontario Ottawa K1H8M5;Neurosurgery Department,Taojiang County People's Hospital,Hunan Yiyang 413400,China)

机构地区：[1]湖南省肿瘤医院核医学科,湖南长沙410013 [2]长沙医学院护理学院,湖南长沙410219 [3]中南大学湘雅护理学院,湖南长沙410013 [4]渥太华大学护理学院,安大略省渥太华市K1G8M5 [5]桃江县人民医院神经外科,湖南益阳413400

出　　处：《中国医院药学杂志》2022年第16期1685-1691,1708,共8页Chinese Journal of Hospital Pharmacy

基　　金：国家癌症中心攀登基金(编号:NCC2018B62);护理学湖南省重点实验室(编号:2017TP1004)。

摘　　要：目的:综合Meta分析中关于高渗盐水对比甘露醇治疗颅内压升高患者的疗效和安全性的证据,为颅内压升高患者治疗方式的选择提供依据。方法:计算机检索Medline、Web of Science、Embase、CNKI、Wanfang、VIP数据库,搜集关于高渗盐水对比甘露醇治疗颅内高压患者疗效的Meta分析,检索时间从2010年9月至2022年2月。由2名研究者独立进行文献筛选、数据提取、文献质量评估,采用Stata 16.0软件进行Meta分析。结果:共纳入9项Meta分析。在平均动脉压下降幅度(P<0.01)、药物降低颅内压持续时间(P<0.01)、血肌酐浓度(P=0.01)方面,高渗盐水的治疗效果优于甘露醇;在颅内压值(P=0.12)、颅内压下降幅度(P=0.53)、脑灌注压值(P=0.66)、脑灌注压下降幅度(P=0.15)、尿素氮水平(P=0.07)、平均动脉压值(P=0.46)、血浆渗透压值(P=0.14)、血浆渗透压下降幅度(P=0.07)、中心静脉压值(P=0.22)、血钠水平(P=0.63)、药物起效时间(P=0.49)方面,高渗盐水和甘露醇的疗效差异无统计学意义。结论:高渗盐水对于颅内压升高患者的疗效和安全性略优于甘露醇,受纳入研究数量和质量的限制,上述结论仍需开展更多高质量研究进行验证。OBJECTIVE Synthesis evidence of effects and safety from meta-analysis on hypertonic saline versus mannitol in patients with elevated intracranial pressure,so as to provide information for the choice of treatment for patients.METHODS Search the databases of MEDLINE,Web of Science,Embase,CNKI,Wanfang and VIP,and collect the Meta-analysis on the effects of hypertonic saline versus mannitol in patients with elevated intracranial pressure from September 2010 to February 2022.Literature screening,data extraction,and quality assessment were carried out independently by two members,and data analysis was carried out by Stata 16.0.RESULTS A total of 9 Meta-analysis were included.The results showed that the effects of hypertonic saline were better than that of mannitol in terms of the decrease of mean arterial pressure(P<0.01),the duration of drug reduction of intracranial pressure(P<0.01),and the serum creatinine concentration(P<0.01).There were no significant difference between hypertonic saline and mannitol in terms of the intracranial pressure(P=0.12),decrease of intracranial pressure(P=0.53),cerebral perfusion pressure(P=0.66),decrease of cerebral perfusion pressure(P=0.15),urea nitrogen level(P=0.07),mean arterial pressure(P=0.46),plasma osmotic pressure(P=0.14),decrease of plasma osmotic pressure(P=0.07),central venous pressure(P=0.22),serum sodium level(P=0.63)and drug onset time(P=0.49).CONCLUSION The efficacy and safety of hypertonic saline are slightly better than that of mannitol in patients with elevated intracranial pressure.Limited by the quantity and quality of included studies,the above conclusion still needs to be verified by more high-quality studies.

关 键 词：高渗盐水 甘露醇 颅内压 META分析 伞形评价 

分 类 号：R91[医药卫生—药学]