高渗盐水治疗颅脑损伤疗效和安全性的系统评价

发布时间：2018-06-27 04:16

本文选题：高渗盐水 + 颅脑损伤　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的：评价高渗盐水用于颅脑损伤早期治疗的疗效及安全性。方法：根据Cochrane系统评价的方法,计算机检索Cochrane图书馆(2013年4月)、Pubmed(2013年4月)、EMBASE(2013年4月)及中国生物医学数据库(2013年4月)、清华同方数据库(2013年4月)、万方数据库(2013年4月),同时手工检索纳入文献中的引用文献。收集所有比较高渗盐水与等渗溶液治疗颅脑损伤的随机对照试验,收集生存率、神经功能结局、凝血功能指标、肾功能指标等数据,采用Cochrane协作网提供软件Revman5.1进行Meta分析。对二分类变量采用相对危险度、数值变量采用加权均数差作为效应量,用X2检验进行异质性检验,固定效应模型采用Mantel-Haens-zel法、随机效应模型采用DerSimonianLaird法分析。对于无法合并的资料进行描述性分析。结果：共检出1346篇文献,最终纳入6个研究共1730例患者。在疗效方面,Meta分析显示：高渗盐水组患者机械通气时间缩短(WMD=-2.54,95%CI[-4.56,-0.53]；I2=0%,P=0.96),但患者出院生存率(RR=1.03,95%CI[0.95,1.11];I2=18%,P=0.30).创伤后6月神经功能缺损发生率(RR=1.04,95%CI[0.96,1.13];12=0%,P=0.61).平均住院日(WMD=1.8,95%CI[-10.27,13.86]；I2=0%,P=0.59)与等渗溶液组比较差异均无统计学意义。在安全性方面仅进行描述性分析,高渗盐水与等渗溶液相比,在医源性神经系统病变、肾功能损害及凝血机制障碍等方面也无明显差异。结论：高渗盐水治疗颅脑损伤与等渗液相比无严重不良反应,尚无临床证据显示高渗盐水用于重型颅脑损伤早期治疗可改善患者的生存率及神经功能结局。
[Abstract]:Objective: to evaluate the efficacy and safety of hypertonic saline in the early treatment of craniocerebral injury. Methods: according to the method of Cochrane systematic evaluation, Computer search of the Cochrane Library (April 2013), Pubmed (April 2013), China Biomedical Database (April 2013), Tsinghua Tongfang Database (April 2013), Wanfang Database (April 2013), and manual retrieval of references included in the literature. The data of survival rate, nerve function outcome, coagulation function index and renal function index were collected in all the randomized controlled trials of hypertonic saline and isosmotic solution for craniocerebral injury. Cochrane collaboration software Revman 5.1 was used for meta-analysis. The relative risk degree was used for the two classification variables, the weighted mean difference was used as the effect quantity, the X2 test was used for the heterogeneity test, the Mantel-Haens-zel method was used for the fixed effect model, and the DerSimonian Laird method was used for the random effect model. A descriptive analysis of data that cannot be merged is carried out. Results: a total of 1346 articles were detected and 1730 patients were included in 6 studies. Meta-analysis showed that the duration of mechanical ventilation was shortened in hypertonic saline group (WMD-2.54U 95 CI [-4.56 卤0.53] I _ 2 + 0.96), but the discharge survival rate was 0.30 (RRN 1.03 + 95 CI [0.951.11] I _ 218P ~ (0.30). Six months after trauma, the incidence of neurological impairment (RRN 1.04 卤95CI [0.96 卤1.13]) was 120.61). There was no significant difference in average hospitalization days (CI = -10.27 卤13.86) and isosmotic solution group (WMD-1.895 CI [-10.27 卤13.86]) and isosmotic solution group (P = 0.59). In terms of safety, there was no significant difference between hypertonic saline and isosmotic solution in iatrogenic neuropathy, renal dysfunction and coagulation mechanism. Conclusion: there is no serious adverse reaction in the treatment of craniocerebral injury with hypertonic saline, and there is no clinical evidence that the early treatment of hypertonic saline for severe craniocerebral injury can improve the survival rate and neurological outcome of patients with severe craniocerebral injury.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15

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