自发性脑室出血单纯脑室外引流与脑室外引流联合腰大池引流治疗的meta分析

Efficacy of external ventricular drainage alone and external ventricular drainage combined with lumbar cerebrospinal fluid drainage for spontaneous intraventricular hemorrhage: a meta-analysis

摘要:

目的 自发性脑室出血病情危重,常危及患者生命安全。目前治疗自发性脑室出血方法的优缺点仍有争议。本荟萃分析旨在评估自发性脑室出血单纯脑室外引流与脑室外引流联合腰大池引流治疗的安全性及疗效。方法 通过检索PubMed/Medline,Cochrane Library和Google Scholar,万方数据库、中国知网及中国生物医学文献数据库,搜集自2000年10月至2015年1月间关于自发性脑出血脑室外引流及腰大池引流治疗的随机对照试验的文献,采用RevMan 5.1软件对手术资料和预后等进行荟萃分析。结果 7篇^[5-12]随机对照试验满足文献纳入标准,共计510例患者,其中采用单纯脑室外引流患者239例,采用脑室外引流联合腰大池引流者271例。荟萃分析显示,相对于单纯脑室外引流,脑室外引流联合腰大池引流可加快血肿清除(p<0.00001);提高患者术后恢复率(p<0.00001);降低患者死亡率(p<0.00001)。结论 对于自发性脑出血患者,脑室外引流联合腰大池引流治疗安全、有效,较单纯脑室外引流更具优势。

Abstract:

Objective To evaluate the safety and efficacy of external ventricular drainage alone and external ventricular drainage combined with lumbar cerebrospinal fluid drainage for the treatment of spontaneous intraventricular hemorrhage (SIVH) by meta-analysis.Methods Literature on randomized controlled trials (RCTs) of external ventricular drainage and lumbar cerebrospinal fluid drainage for the treatment of SIVH from October 2000 to January 2015 was collected by searching PubMed/Medline, Cochrane Library, Google Scholar, Wanfang Data, CNKI, and CBM. The meta-analyses of surgical data and prognosis were performed using RevMan 5.1 software.Results Seven articles reporting RCTs were enrolled according to the literature inclusion criteria. These articles studied a total of 510 patients, including 239 patients treated with external ventricular drainage alone and 271 patients treated with external ventricular drainage and lumbar cerebrospinal fluid drainage. The results of meta-analysis showed that compared with external ventricular drainage alone, external ventricular drainage combined with lumbar cerebrospinal fluid drainage could significantly accelerate hematoma clearance (P<0.00001), improve postoperative recovery (P<0.00001), and reduce mortality (P<0.00001).Conclusions External ventricular drainage combined with lumbar cerebrospinal fluid drainage is safe and effective in the treatment of SIVH, which is superior to external ventricular drainage alone.