克拉生坦对动脉瘤性蛛网膜下腔出血后脑血管痉挛防治价值的系统评价

发布时间：2018-02-25 17:19

本文关键词： 克拉生坦蛛网膜下腔出血脑血管痉挛随机对照试验　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:系统评价克拉生坦防治动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后脑血管痉挛(cerebral vasospasm,CVS)的疗效及安全性。方法:计算机检索Cochrane图书馆、Medline(OVID)、Embase(OVID)、Cochrane中心临床对照试验注册数据库(CENTRAL)、中国生物医学文献数据库(CBMdisc)、中国学术期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、中文生物医学会议文献数据库(CMCA)等,手工检索中华神经科杂志、临床神经病学杂志、中风与神经疾病杂志、中国神经免疫学和神经病学杂志、中国临床神经科学等相关杂志,时间为2000年-2017年,收集全球关于克拉生坦防治动脉瘤性蛛网膜下腔出血后脑血管痉挛的所有随机对照试验。按Cochrane系统评价的方法,由两名研究者独立进行质量评价和资料提取,对文献的研究结果进行定量综合评价(Meta分析)和定性综合评价。在定量综合评价过程中,根据各文献间异质性检验的结果选择固定效应模型或随机效应模型。Meta分析使用Cochrane协作网提供的RevMan5.3软件进行,估计其综合评价指标95%的置信区间,以α=0.05为检验水准。结果:最终纳入4个随机对照试验,共计2161例aSAH患者。Meta分析结果显示:(1)有效性:?克拉生坦组与对照组相比,治疗组血管痉挛的发生率低于对照组,其差异有统计学意义[RR=0.58,95%CI(0.48,0.71),P0.00001];?治疗组血管痉挛相关的脑梗死的发生率低于对照组,其差异有统计学意义[RR=0.79,95%CI(0.63,1.00),P=0.05];?治疗组血管痉挛所致的迟发性缺血性神经系统缺损(delayed ischemic neurological deficits,DINDs)的发生率低于对照组,其差异有统计学意义[RR=0.75,95%CI(0.62,0.91),P=0.004];(4)治疗组因血管痉挛引起的补救性治疗的使用低于对照组,其差异有统计学意义[RR=0.68,95%CI(0.55,0.83),P=0.0002];(2)安全性:?克拉生坦组与对照组相比,治疗组肺部并发症的发生率高于对照组,其差异有统计学意义[RR=1.79,95%CI(1.52,2.11),P0.00001];?治疗组贫血的发生率高于对照组,其差异有统计学意义[RR=1.44,95%CI(1.17,1.78),P=0.0007];?治疗组低血压的发生率高于对照组,其差异有统计学意义[RR=2.42,95%CI(1.69,3.45),P0.00001]。结论:克拉生坦防治aSAH后的脑血管痉挛,可有效降低CVS,CVS相关的脑梗死,CVS所致迟发性缺血性神经系统缺损以及CVS引起的补救性治疗,疗效较好;克拉生坦会增加肺部并发症、低血压和贫血的不良反应的发生,均不影响继续用药,易处理,无严重不良反应发生,安全性较好。由于纳入文献较少,病人数量较少,克拉生坦的使用量不尽相同等不足,上述结论需要更多设计严格、样本量更大的随机对照试验来验证。
[Abstract]:Objective: to evaluate the efficacy and safety of Krashentam in the prevention and treatment of cerebral vasospasm (CVS) after aneurysm subarachnoid hemorrhage (SAH). China Biomedical Literature Database (CBM), Chinese academic Journals full text Database (CNKI), Chinese Sci-tech Journals Database (VIPN), Chinese Biomedical Conference Literature Database (CMCA), etc. To retrieve by hand the Chinese Journal of Neurology, the Journal of Clinical Neurology, the Journal of Stroke and Neurology, the Chinese Journal of Neuroimmunology and Neurology, the Chinese Journal of Clinical Neuroscience, etc., from 2000 to 2017. To collect all the randomized controlled trials on the prevention and treatment of cerebral vasospasm after aneurysm subarachnoid hemorrhage (SAH) by Clasentan in the world. According to the method of Cochrane system evaluation, the quality evaluation and data extraction were carried out by two researchers independently. In the process of quantitative comprehensive evaluation, According to the results of heterogeneity test among documents, fixed effect model or random effect model. Meta-analysis was carried out using RevMan5.3 software provided by Cochrane cooperation network, and the confidence interval of comprehensive evaluation index 95% was estimated. Results: a total of 2161 patients with aSAH were enrolled in 4 randomized controlled trials. Compared with the control group, the incidence of vasospasm in the treatment group was lower than that in the control group, and the difference was statistically significant. The incidence of cerebral infarction associated with vasospasm in the treatment group was significantly lower than that in the control group. The incidence of delayed ischemic neurological DINDs caused by vasospasm in the treatment group was lower than that in the control group, and the difference was statistically significant. The difference is statistically significant. [RRX 0.6895% CIQ 0.55U 0.83PU 0.0002] Security:? Compared with the control group, the incidence of pulmonary complications in the treatment group was significantly higher than that in the control group. The incidence of anemia in the treatment group was higher than that in the control group, and the difference was statistically significant. The incidence of hypotension in the treatment group was higher than that in the control group, and the difference was statistically significant [RRX 2.42% 95% CI 1.69 ~ 3.45% P0.00001]. Conclusion: crashentam can prevent and treat cerebral vasospasm after aSAH, and the incidence of hypotension in the treatment group is higher than that in the control group. It can effectively reduce the delayed ischemic nervous system defect caused by CVS associated cerebral infarction and the rescue therapy caused by CVS, and can increase the incidence of pulmonary complications, hypotension and anemia. These conclusions need more strict design because of the shortage of less literature, fewer patients and different use of Krashentam. The above conclusions need more strict design, because of the lack of continuous medication, easy treatment, no serious adverse reactions, and better safety, because of the shortage of less literature, fewer patients and different usage of Krashentam, and so on. A larger sample was tested in a randomized controlled trial.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.35

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