强化血压管理对急性脑出血患者影响的系统评价

发布时间：2018-03-02 10:15

本文关键词： 血压强化血压管理脑出血系统综述　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景：脑出血急性期血压控制的合适目标存在争议。本文主要评价自发性脑出血急性期强化降压与标准血压管理相比是否安全有益。方法：在Medline及Embase系统的检索1990年至2013年期间发表的有关脑出血急性期强化降压与标准血压管理相比的临床随机对照研究。评价各个纳入研究的质量。应用随机效应模型进行数据合并。计算合并的比值比和95%置信区间。结果：共纳入4项研究，包括3350例患者，其中强化降压组1630例，标准血压管理组1662例共三项研究报告了两组平均血肿增加量的数据。三项研究中的两组血肿增加的差异均未达到统计学意义。把三项研究的数据进行合并后表明，强化降压组血肿增加的量显著低于标准血压管理组(平均差为-1.54,95%置信区间为-2.92至-0.16, p＜0.05)。共三项研究报告了两组90天死亡率的数据。三项研究中的两组90天死亡率差异均未达到统计学意义。把三项研究的数据进行合并后表明，两组90天死亡率无显著差异(比值比为0.97,95%置信区间0.79到1.20, p0.05)。共三项研究报告了两组90天不良预后的数据。三项研究中的两组90天不良预后的差异均未达到统计学意义。把三项研究的数据进行合并后表明，强化血压管理组90天不良预后的发生率低于标准血压管理组(比值比为0.89,95%置信区间0.77到1.02)，，但差异未达统计学意义(p0.05)。共四项研究报告了两组血肿明显增加的患者的例数。四项研究中的两组血肿明显增加的患者的比例差异均未达到统计学意义。把四项研究的数据进行合并后表明，两组血肿明显增加的患者比例无显著差异(比值比为0.91,95%置信区间0.59到1.50, p0.05)。共四项研究报告了两组早期神经功能恶化的患者的例数。四项研究中的两组早期神经功能恶化的患者发生率差异均未达到统计学意义。把四项研究的数据进行合并后表明，两组早期神经功能恶化的患者比例无显著差异(比值比为0.97,95%置信区间0.80到1.18,p0.05)。共两项研究报告了两组早期严重不良反应的发生率。两项研究中的两组早期严重不良反应的发生率的差异均未达到统计学意义。把两项研究的数据进行合并后表明，两组早期严重不良反应的患者比例无显著差异(比值比为0.98,95%置信区间0.83到1.16, p0.05)。异质性检验显示无异质性(pQ0.10, I250%)。结论：该研究表明，脑出血急性期强化降压与标准血压管理相比安全性无差别，但可能能获得较好的预后。还需要以后的研究以进一步明确脑出血急性期强化降压的效果和安全性。
[Abstract]:Background:. The appropriate target of blood pressure control in acute stage of intracerebral hemorrhage is controversial. This paper mainly evaluates whether intensive hypotension in the acute stage of spontaneous cerebral hemorrhage is safe and beneficial compared with standard blood pressure management. Methods:. A randomized controlled clinical study on intensive hypotension in acute phase of intracerebral hemorrhage compared with standard blood pressure management, published between 1990 and 2013 in Medline and Embase systems, was conducted to evaluate the quality of each study. The ratio ratio and 95% confidence interval are calculated. Results:. A total of 4 studies were included, including 3350 patients, including 1630 patients in the enhanced hypotension group. Three studies of 1662 patients in the standard blood pressure management group reported data on the mean hematoma increase in the two groups. The difference in hematoma increase between the two groups in the three studies was not statistically significant. The increase of hematoma in the enhanced hypotension group was significantly lower than that in the standard blood pressure management group (mean difference was -1.54 卤95% confidence interval -2.92 to -0.16, p < 0.05). Three studies reported two groups of 90-day mortality data. The difference in 90-day mortality was not statistically significant in two of the three studies. There was no significant difference in 90-day mortality between the two groups (the ratio ratio was 0.97% 95% confidence interval 0.79 to 1.20, p 0.05). A total of three studies reported data on 90 days of poor prognosis in two groups. The difference in 90 days was not statistically significant between the two groups in the three studies. Combining the data from the three studies showed that, The incidence of adverse prognosis in the intensive blood pressure management group was lower than that in the standard blood pressure management group (the ratio ratio was 0.89% 95% confidence interval from 0.77 to 1.02), but the difference was not statistically significant (P 0.05). Four studies reported the number of patients with a significant increase in hematoma in two groups. The difference in the proportion of patients with a significant increase in hematoma was not statistically significant between the two groups of patients in the four studies. Data from the four studies were combined to show that, There was no significant difference between the two groups in the proportion of patients with significantly increased hematoma (the ratio ratio was 0.91% 95% confidence interval 0.59 to 1.50, p 0.05). A total of four studies reported the number of patients with early neurological deterioration in two groups. There was no statistically significant difference in the incidence of early neurological deterioration between the two groups in the four studies. There was no significant difference between the two groups in the proportion of patients with early neurological deterioration (the ratio ratio was 0.97 95% confidence interval 0.80 to 1.18 渭 p 0.05). Two studies reported the incidence of early severe adverse reactions in both groups. There was no statistically significant difference in the incidence of early severe adverse reactions between the two groups. There was no significant difference between the two groups in the proportion of patients with early severe adverse reactions (the ratio ratio was 0.9895% confidence interval 0.83 to 1.16, p0.050.The heterogeneity test showed no heterogeneity: pQ0.10, I250). Conclusion:. This study shows that intensive hypotension in acute stage of intracerebral hemorrhage is no different from standard blood pressure management, but it may be able to obtain better prognosis. Further study is needed to further determine the effect and safety of intensive hypotension in acute stage of intracerebral hemorrhage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

【共引文献】