高渗盐水与甘露醇治疗创伤性颅高压疗效的Meta分析  

Meta-analysis of the efficacy of hypertonic saline and mannitol in treatment of traumatic intracranial hypertension

作　　者：邵继伟[1] 赵永志 陈卫明[1] SHAO Jiwei;ZHAO Yongzhi;CHEN Weiming(Department of Neurosurgery,Hangzhou Xiaoshan District Second People's Hospital,Hangzhou 311241,China;不详)

机构地区：[1]杭州市萧山区第二人民医院神经外科,311241 [2]海宁市中心医院神经外科

出　　处：《浙江医学》2025年第7期739-743,共5页Zhejiang Medical Journal

摘　　要：目的系统评价高渗盐水与甘露醇治疗创伤性颅高压的安全性和有效性。方法利用计算机检索PubMed、Embase、The Cochrane Library、万方数据知识服务平台、中国知网等数据库关于高渗盐水与甘露醇治疗创伤性颅高压疗效的随机对照研究,检索时间截至2023年9月25日。根据异质性检验结果采用固定效应模型或随机效应模型分析高渗盐水与甘露醇降低颅内压效果、血清钠、血清渗透压、血清尿素氮、死亡率和功能预后良好(格拉斯哥预后评分4~5分)率等方面的差异。结果共纳入文献7篇创伤性颅高压患者479例,包括高渗盐水组256例,甘露醇组223例。两组患者在降低颅内压效果[加权平均差(WMD)=-0.19,95%CI:-0.61~0.24]、血清渗透压(WMD=-0.26,95%CI:-2.98~2.47)、血清尿素氮(WMD=-1.42,95%CI:-3.86~1.03)、死亡率(RR=0.71,95%CI:0.43~1.18)、功能预后良好率(RR=0.92,95%CI:0.61~1.38)方面比较,差异均无统计学意义(均P>0.05);高渗盐水组血清钠明显高于甘露醇组,差异有统计学意义(WMD=7.49,95%CI:4.67~10.31,P<0.001)。结论高渗盐水治疗创伤性颅高压具有良好的临床疗效和安全性,可作为甘露醇的替代药物。Objective To evaluate the safety and efficacy of mannitol and hypertonic saline in the treatment of traumatic intracranial hypertension.Methods The randomized controlled trials comparing the efficacy and safety of hypertonic saline and mannitol in the treatment of traumatic intracranial hypertension were searched from databases of PubMed,Embase,The Cochrane Library,Wanfang Data Knowledge Service Platform,and CNKI(China National Knowledge Infrastructure)up to September 25,2023.Based on the results of heterogeneity testing,either a fixed-effects model or a random-effects model was employed to analyze the differences between hypertonic saline and mannitol in terms of intracranial pressure reduction,serum sodium levels,serum osmolality,blood urea nitrogen,mortality,and the rate of favorable functional outcomes(defined as a Glasgow Outcome Scale score of 4-5).Results A total of 7 eligible studies involving 479 patients were included,with 256 patients in the hypertonic saline group and 223 patients in the mannitol group.The Meta-analysis revealed no statistically significant differences between the two groups in terms of intracranial pressure reduction[weighted mean difference(WMD)=-0.19,95%CI:-0.61-0.24],serum osmolality(WMD=-0.26,95%CI:-2.98-2.47),blood urea nitrogen(WMD=-1.42,95%CI:-3.86-1.03),mortality(RR=0.71,95%CI:0.43-1.18),or the rate of favo-rable functional outcomes(RR=0.92,95%CI:0.61-1.38)(all P>0.05).However,the hypertonic saline group demonstrated significantly higher serum sodium levels compared to the mannitol group(WMD=7.49,95%CI:4.67-10.31,P<0.001).Conclusion Hypertonic saline demonstrates favorable clinical efficacy and safety in the treatment of traumatic intracranial hypertension and can be considered as an alternative therapeutic agent to mannitol.

关 键 词：高渗盐水 甘露醇 颅内压 创伤性 META分析 

分 类 号：R651.1[医药卫生—外科学]