动脉瘤性蛛网膜下腔出血患者腰大池引流安全性的Meta分析

doi:10.3969/j.issn.1004-583X.2021.12.002

摘要/Abstract

摘要：

目的评价腰大池引流对动脉瘤性蛛网膜下腔出血(aSAH)的治疗效果。方法计算机检索PubMed、Cochrane Library、Elsevier Science Direct和Springer以及中文知网、万方、中国生物医学文献数据库,检索有关腰大池引流治疗aSAH的随机对照试验(RCTs),选取符合纳入标准的RCTs。采用Cochrane手册质量标准评价纳入文献的方法学质量,运用RevMan 5.2软件进行Meta分析。结果符合纳入标准有11篇文献,共计患者1 216例。Meta分析结果显示,在aSAH治疗的临床有效性和安全性方面,腰大池持续引流组(试验组)优于无引流组(对照组),神经功能缺损的发生率低于对照组[MD=0.33, 95% CI (0.21~0.51),P<0.01],脑血管痉挛的发生率低于对照组[MD=0.20, 95% CI (0.12~0.34),P<0.01],脑积水的发生率低于对照组[MD =0.25, 95% CI (0.14~0.43),P<0.01],死亡率低于对照组[MD =0.40, 95% CI (0.23~0.70),P<0.01],但其他不良事件发生率高于对照组[MD =3.24, 95%CI(1.63~6.47),P=0.008]。结论腰大池持续引流治疗aSAH患者安全性方面优于无引流患者,但需考虑到不安全因素导致不良事件的发生,由于所纳入文献方法学质量偏低,尚需进一步验证腰大池持续引流治疗aSAH的有效性及安全性。

关键词: 蛛网膜下腔出血, 腰大池引流, Meta分析

Abstract:

Objective To evaluate the effect of lumbar drainage (LD) on cerebral aneurysms subarachnoid hemorrhage (aSAH). Methods A randomized controlled trials (RCTs) of LD on cerebral aSAH were searched from PubMed, Cochrane Library, Elsevier Science Direct, Springer, China academic Journal full-text Database (CNKI),Wanfang, China Biomedical Literature Database (CBM), and other databases. Methodological quality of the included literatures were evaluated by using Cochrane Handbook for Systematic Reviews of Interventions, and Meta-analysis was performed by using RevMan 5.2 software. Results Totally 11 literatures were inclused,including 1216 patients.Meta-analysis results showed that in terms of efficacy and safety of clinical treatment for aSAH was better in continuous LD group (experimental group) than control group, the incidence of neurological impairment was lower than in control group (MD =0.33, 95%CI [0.21-0.51], P<0.01), and the incidence of cerebral vasospasm was lower than in control group (MD =0.20, 95%CI [0.12-0.34], P<0.01), the incidence of hydrocephalus was lower than in control group (MD =0.25, 95% CI [0.14-0.43], P<0.01), the mortality was lower than in control group (MD=0.40, 95%CI [0.23-0.70], P<0.01), but other adverse events were higher than those in control group (SMD=3.24, 95%CI [1.63-6.47], P=0.008). Conclusion The safety of continuous LD for aSAH in patients is better than other treatment methods. We need to consider the unsafety factors will lead to adverse events, due to lower methodology quality is in this literature, the efficacy and safety still need to be further verified.

Key words: subarachnoid hemorrhage, lumbar cistern drainage, meta analysis

中图分类号:

R743.35

麻红梅, 李月美, 李晓芳, 潘世琴. 动脉瘤性蛛网膜下腔出血患者腰大池引流安全性的Meta分析[J]. 临床荟萃, 2021, 36(12): 1067-1072.

Ma Hongmei, Li Yuemei, Li Xiaofang, Pan Shiqin. Safety of lumbar drainage on aneurysm subarachnoid hemorrhage in patients: a meta-analysis[J]. Clinical Focus, 2021, 36(12): 1067-1072.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.002

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1067

图/表 7

参考文献 22

[1]	Lawton MT, Vates GE. Subarachnoid Hemorrhage[J]. N Engl J Med, 2017, 377(3):257-266. doi: 10.1056/NEJMcp1605827 URL
[2]	Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the american heart association/american stroke association[J]. Stroke, 2012, 43(6):1711-1737. doi: 10.1161/STR.0b013e3182587839 pmid: 22556195
[3]	Qian C, Yu X, Chen J, et al. Effect of the drainage of cerebrospinal fluid in patients with aneurismal subarachnoid hemorrhage: A meta-analysis[J]. Medicine, 2016, 95(41):e5140. doi: 10.1097/MD.0000000000005140 URL
[4]	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[EB/OL](2011-03-01) [2014-07-12].
[5]	Ochiai H, Yamakawa Y. Continuous lumbar drainage for the preoperative management of patients with aneurysmal subarachnoid hemorrhage[J]. Neurol Med Chir, 2001, 41(12):576-580. doi: 10.2176/nmc.41.576 URL
[6]	Kwon OY, Kim YJ, Kim YJ, et al. The utility and benefits of external lumbar CSF drainage after endovascular coiling on aneurysmal subarachnoid hemorrhage[J]. J Korean Neurosurg Soc, 2008, 43(6):281-287. doi: 10.3340/jkns.2008.43.6.281 URL
[7]	Al-Tamimi YZ, Bhargava D, Feltbower RG, et al. Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: A prospective, randomized, controlled trial (LUMAS)[J]. Stroke, 2012, 43(3):677-682. doi: 10.1161/STROKEAHA.111.625731 pmid: 22282887
[8]	Park S, Yang N, Seo E. The effectiveness of lumbar cerebrospinal fluid drainage to reduce the cerebral vasospasm after surgical clipping for aneurysmal subarachnoid hemorrhage[J]. J Korean Neurosurg Soc, 2015, 57(3):167-173. doi: 10.3340/jkns.2015.57.3.167 URL
[9]	Borkar SA, Singh M, Kale SS, et al. Spinal cerebrospinal fluid drainage for prevention of vasospasm in aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled study[J]. Asian J Neurosurg, 2018, 13(2) :238-246. doi: 10.4103/1793-5482.228512 URL
[10]	宋锦宁, 刘守勋, 王拓, 等. 动脉瘤性蛛网膜下腔出血早期病因治疗与保守治疗效果的对照研究[J]. 中国急救医学, 2007, 27(1):12-14.
[11]	肖胜, 王鸿生, 武永康. 腰大池置管外引流术在动脉瘤术后早期应用分析[J]. 中国临床神经外科杂志, 2013, 18(1):52-53.
[12]	王春茹, 陈念, 王立平. 动脉瘤性蛛网膜下腔出血腰大池引流的疗效分析[J]. 中国实用神经疾病杂志, 2014, 17(18):74-76.
[13]	张滨. 腰大池置管持续引流对动脉瘤性蛛网膜下腔出血并发脑积水的防治效果[J]. 中国药物经济学, 2017, 12(7):112-114.
[14]	陈辉, 赖琴, 贾映海, 等. PICC管持续腰大池引流联合尼莫地平鞘内注射治疗动脉瘤性蛛网膜下腔出血的临床研究[J]. 中国老年保健医学, 2018, 83(2):54-56.
[15]	陈绍华. 动脉瘤夹闭术后腰大池引流联合3H治疗蛛网膜下腔出血的效果及对血管活性因子的影响[J]. 医学临床研究, 2018, 35(9):1723-1726.
[16]	Chowdhury T, Petropolis A, Wilkinson M, et al. Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm[J]. Anesthesiol Res Pract, 2014: 595837.
[17]	Chowdhury T, Cappellani RB, Sandu N, et al. Perioperative variables contributing to the rupture of intracranial aneurysm: An update[J]. Scient World J, 2013: 396404.
[18]	Ibrahim GM, Macdonald RL. The effects of flfluid balance and colloid administration on outcomes in patients with aneurysmal subarachnoid hemorrhage: A propensity score-matched analysis[J]. Neurocrit Care, 2013 19(2):140-149. doi: 10.1007/s12028-013-9860-z pmid: 23715669
[19]	Maeda Y, Shirao S, Yoneda H, et al. Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid Hemorrhage[J]. Clin Neurol Neurosurg, 2013, 115(7):965-970. doi: 10.1016/j.clineuro.2012.10.001 URL
[20]	Chen S, Li Q, Wu H, et al. The harmful effects of subarachnoid hemorrhage on extracerebral organs[J]. Biomed Res Int, 2014: 858496.
[21]	Mrozek S, Constantin JM, Geeraerts T. Brain lung crosstalk: Implications for neurocritical care patients[J]. World J Crit Care Med, 2015, 4(3):163-178. doi: 10.5492/wjccm.v4.i3.163 URL
[22]	Van Donkelaar CE, Bakker NA, Veeger NJ, et al. Predictive factors for rebleeding after aneutysmal subarachnoid hemorrhage: Rebleeding aneurysmal subarachnoid hemorrhage study[J]. Stroke, 2015, 46(8):2100-2106. doi: 10.1161/STROKEAHA.115.010037 pmid: 26069261

作者	发表年份	国家	人种	临床特征	例数		干预方法		结局指标
作者	发表年份	国家	人种	临床特征	干预组	对照组	对照组	干预组	结局指标
Ochiai ^[5]	2001	美国	高加索	Fisher分级Ⅰ-Ⅴ级	33	17	常规治疗	腰大池引流	⑤
Kwon^[6]	2008	印度	亚裔	Fisher分级Ⅱ-Ⅳ级	30	30	常规治疗	腰大池引流	②⑤⑥
Al-Tamimi^[7]	2012	德国	高加索	Fisher分级Ⅱ-Ⅳ级	105	105	常规治疗	腰大池引流	①④⑤
Park^[8]	2015	韩国	亚裔	Fisher分级Ⅱ-Ⅳ级	126	108	常规治疗	腰大池引流	②⑤⑥
Borkar ^[9]	2018	印度	亚裔	Hunt-Hess分级Ⅱ-Ⅳ级	30	30	常规治疗	腰大池引流	①②④⑤
宋锦宁^[10]	2007	中国	亚裔	Hunt-Hess分级Ⅰ-Ⅴ级	42	42	常规治疗	腰大池引流	①③
肖胜^[11]	2013	中国	亚裔	Hunt-Hess分级Ⅰ-Ⅳ级	39	33	常规治疗	腰大池引流	⑤
王春茹^[12]	2014	中国	亚裔	未说明	105	105	常规治疗	腰大池引流	①③⑤
张滨^[13]	2017	中国	亚裔	Fisher分级Ⅱ-Ⅳ级	34	34	常规治疗	腰大池引流	②③
陈辉^[14]	2018	中国	亚裔	未说明	26	26	常规治疗	腰大池引流	②
陈绍华^[15]	2018	中国	亚裔	Fisher分级Ⅰ-Ⅲ	58	58	常规治疗	腰大池引流	②③⑤

作者	发表年份	国家	人种	临床特征	例数		干预方法		结局指标
作者	发表年份	国家	人种	临床特征	干预组	对照组	对照组	干预组	结局指标
Ochiai ^[5]	2001	美国	高加索	Fisher分级Ⅰ-Ⅴ级	33	17	常规治疗	腰大池引流	⑤
Kwon^[6]	2008	印度	亚裔	Fisher分级Ⅱ-Ⅳ级	30	30	常规治疗	腰大池引流	②⑤⑥
Al-Tamimi^[7]	2012	德国	高加索	Fisher分级Ⅱ-Ⅳ级	105	105	常规治疗	腰大池引流	①④⑤
Park^[8]	2015	韩国	亚裔	Fisher分级Ⅱ-Ⅳ级	126	108	常规治疗	腰大池引流	②⑤⑥
Borkar ^[9]	2018	印度	亚裔	Hunt-Hess分级Ⅱ-Ⅳ级	30	30	常规治疗	腰大池引流	①②④⑤
宋锦宁^[10]	2007	中国	亚裔	Hunt-Hess分级Ⅰ-Ⅴ级	42	42	常规治疗	腰大池引流	①③
肖胜^[11]	2013	中国	亚裔	Hunt-Hess分级Ⅰ-Ⅳ级	39	33	常规治疗	腰大池引流	⑤
王春茹^[12]	2014	中国	亚裔	未说明	105	105	常规治疗	腰大池引流	①③⑤
张滨^[13]	2017	中国	亚裔	Fisher分级Ⅱ-Ⅳ级	34	34	常规治疗	腰大池引流	②③
陈辉^[14]	2018	中国	亚裔	未说明	26	26	常规治疗	腰大池引流	②
陈绍华^[15]	2018	中国	亚裔	Fisher分级Ⅰ-Ⅲ	58	58	常规治疗	腰大池引流	②③⑤