介入栓塞治疗动脉瘤性蛛网膜下腔出血疗效及安全性的Meta分析  

Analysis of the effectiveness and safety of interventional embolization for aneurysmal subarachnoid hemorrhage

作　　者：王育婷 翁明倩 蔡方晴 王凌 阮君山 Wang Yuting;Weng Mingqian;Cai Fangqing;Wang Ling;Ruan Junshan(School of Pharmacy,Fujian Medical University,Fujian Fuzhou 350108,China;School of Pharmacy,Fujian University of Traditional Chinese Medicine,Fujian Fuzhou 350122,China;Department of Pharmacy,Fuzhou University Affiliated Provincial Hospital,Fujian Fuzhou 350001,China)

机构地区：[1]福建医科大学药学院,福建福州350108 [2]福建中医药大学药学院,福建福州350122 [3]福州大学附属省立医院药学部,福建福州350001

出　　处：《创伤与急诊电子杂志》2024年第3期163-172,共10页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省自然科学基金面上项目(2023J011188);福建省卫生健康中青年骨干人才培养项目(2022GGA001);福建省科技创新联合基金项目引领项目(2023Y9330)。

摘　　要：目的通过Meta分析比较手术夹闭与介入栓塞治疗动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的效果与安全性。方法检索知网、维普、万方、PubMed、Embase、the Cochrane Library和Web of Science数据库,收集使用手术夹闭与介入栓塞治疗aSAH的相关文献,检索时限为建库至2024年5月。根据纳入排除标准筛选文献、提取数据,应用RevMan 5.4软件进行Meta分析。结果共纳入18项研究,包括1630例患者。Meta分析结果表明,与手术夹闭相比,介入栓塞的预后良好率较高(OR=2.71,95%CI:2.19~3.36,P<0.001),术后脑积水(OR=0.44,95%CI:0.27~0.73,P=0.001)、脑血管痉挛(OR=0.23,95%CI:0.16~0.34,P<0.001)、颅内感染(OR=0.27,95%CI:0.16~0.47,P<0.001)及再出血(OR=0.44,95%CI:0.25~0.76,P=0.003)的发生率显著较低;而脑梗死(OR=0.47,95%CI:0.11~1.91,P=0.290)与肺感染(OR=0.54,95%CI:0.12~2.41,P=0.420)的发生率在两组治疗方案中差异无统计学意义。结论介入栓塞治疗aSAH的疗效优于手术夹闭,在降低并发症的发生方面也有一定优势。Objective To compare the efficacy and safety of surgical clamping and interventional embolization for aneurysmal subarachnoid hemorrhage(aSAH)by Meta-analysis.Method CNKI,Wanfang Data,VIP database,PubMed,Embase,the Cochrane Library,Web of Science databases were searched to collect the relevant literature on the use of surgical clamp versus interventional embolization for the treatment of aSAH,from the earliest record up to May 2024.Literature was screened and data were extracted according to the NERF criteria,and Meta-analysis was performed using RevMan 5.4 software.Result A total of 18 cohort studies including 1630 patients were included.Meta-analysis showed that the interventional embolization group had a significantly higher rate of good prognosis compared with the surgical clamp group(OR=2.71,95%CI:2.19—3.36,P<0.001).Interventional embolization group had a significantly lower rate of postoperative hydrocephalus(OR=0.44,95%CI:0.27—0.73,P=0.001),cerebral vasospasm(OR=0.23,95%CI:0.16-0.34,P<0.001),intracranial infection(OR=0.27,95%CI:0.16-0.47,P<0.001),and rebleeding(OR=0.44,95%CI:0.25-0.76,P=0.003)with the surgical clamp group.While the incidence of cerebral infarction(OR=0.47,95%CI:0.11-1.91,P=0.290)and pulmonary infection(OR=0.54,95%CI:0.12-2.41,P=0.420)did not differ significantly between the two treatment groups.Conclusion The efficacy of the interventional embolization group in the treatment of aSAH was superior to that of the surgical clamping group,with some evidence suggesting advantages in reducing the incidence of certain complications.

关 键 词：手术夹闭 介入栓塞 动脉瘤性蛛网膜下腔出血 

分 类 号：R743.35[医药卫生—神经病学与精神病学]