血肿微创清除联合脑血疏口服液治疗自发性脑出血的疗效及安全性的Meta分析与质量评价  

The effect and safety of minimally invasive surgery combined with Naoxueshu oral liquid on spontaneous cerebral hemorrhage:Meta-analysis and quality evaluation

作　　者：于苗 张丽娜 丁薇 张根明[1] YU Miao;ZHANG Lina;DING Wei;ZHANG Genming(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Eye Hospital,Chinese Academy of Chinese Medical Sciences,Beijing 100040,China;School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 102488,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]中国中医科学院眼科医院,北京100040 [3]北京中医药大学中医学院,北京102488

出　　处：《海南医学院学报》2024年第9期691-699,共9页Journal of Hainan Medical University

基　　金：北京中医药大学东直门医院横向专项课题资助项目(HX-DZM-2018004)。

摘　　要：目的:系统评价颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的疗效及安全性。方法:计算机检索从建库至2023年6月收录于中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)、维普中文科技期刊数据库(VIP Chinese science and technology journal database,VIP)、万方数据库、中国生物医学文献数据库(The Chinese biomedical literature database,CBM)、PubMed、Embase、the Cochrane Library等中英文数据库,结合纳入与排除标准筛选出所有颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的临床随机对照试验,根据Cochrane系统评价手册对纳入研究进行偏倚风险评价,运用Revman5.4软件进行Meta分析,最后采用GRADE系统对结局指标进行证据质量评价。结果:共纳入9项研究,总样本量739例。其中,对照组371例,试验组368例。Meta分析结果显示,与血肿微创清除后仅予常规西医治疗相比,联合应用脑血疏口服液能够提高自发性脑出血患者临床治疗的总有效率[OR=5.47,95%CI=2.28,13.09,P=0.0001],在降低患者美国国立卫生研究所卒中量表评分[MD=−3.42,95%CI=−4.97,−1.87,P<0.0001]和中国脑卒中患者神经功能缺损程度评分[MD=−2.30,95%CI=−3.01,−1.58,P<0.00001],提高患者格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分[MD=1.51,95%CI=1.13,1.89,P<0.00001]和Barthel指数(Barthel index,BI)评分[MD=6.88,95%CI=4.49,9.27,P<0.00001],降低血清S100蛋白[MD=−0.02,95%CI=−0.03,−0.02,P<0.00001]和水通道蛋白4水平[MD=−0.02,95%CI=−0.03,−0.01,P=0.002]方面均具有明显优势。安全性方面,所纳研究均无严重不良反应;2项研究报告有恶心、腹胀、腹泻的胃肠道不适症状,其余研究未报告不良反应发生。结论:现有证据表明,颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血疗效确切,能够明显减轻患者神经功能缺损和意识障碍程度,提高患者日常生活能力,改善Objective:To systematically evaluate the efficacy and safety of minimally invasive removal of intracranial hematoma combined with Naoxueshu treatment for spontaneous cerebral hemorrhage.Methods:Computer search was conducted on Chinese and English databases including CNKI,VIP,Wanfang,CBM,PubMed,Embase and the Cochrane Library from the establishment of the database to June 2023,based on inclusion and exclusion criteria to select randomized controlled trials(RCTS)of minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous intracerebral hemorrhage.The risk of bias was evaluated according to the Cochrane Systematic Review Manual,and meta-analysis was performed using Revman5.4 software,and the GRADE system was used to evaluate the evidence quality of outcome indicators.Results:Totally 9 RCTs were included,and the total sample size was 739 cases.There were 371 cases in the control group and 368 cases in the experimental group.The results of meta-analysis showed that compared with only conventional Western medicine after minimally invasive surgery,combined application of Naoxueshu oral liquid improved the overall clinical effectiveness rate[OR=5.47,95%CI=2.28,13.09,P=0.0001],obviously reduced the score of National Institute of Health Stroke Scale[MD=−3.42,95%CI=−4.97,−1.87,P<0.0001],and neurological impairment score Chinese stroke patients[MD=−2.30,95%CI=−3.01,−1.58,P<0.00001],improved Glasgow Coma Scale score[MD=1.51,95%CI=1.13,1.89,P<0.00001]and Barthel Index(BI)score[MD=6.88,95%CI=4.49,9.27,P<0.00001],and decreased serum S100 protein[MD=−0.02,95%CI=−0.03,−0.02,P<0.00001]and AQP4 levels[MD=−0.02,95%CI=−0.03,−0.01,P=0.002].In terms of safety,no serious adverse reactions were reported;gastrointestinal discomfort symptoms including nausea,abdominal distension and diarrhea were reported in 2 studies;no adverse reactions were reported in the remaining studies.Conclusion:Existing evidence shows that minimally invasive removal of intracrani

关 键 词：脑出血 脑血疏口服液 微创 血肿清除 META分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]