颅内动脉瘤术后发生脑血管痉挛风险因素的Meta分析

发布时间：2018-04-14 05:01

本文选题：颅内动脉瘤 + 术后　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:脑血管痉挛是颅内动脉瘤术后最为常见、最为严重的并发症之一,充分了解颅内动脉瘤术后发生脑血管痉挛的主要风险因素,防治脑血管痉挛,是提高手术效果和预后的有效措施。而影响脑血管痉挛的风险因素较多,且争议性较强。因此,本文以颅内动脉瘤术后脑血管痉挛的风险因素为中心进行定量综合评价,验证文献结论可靠性的同时皆在寻找风险因素看法不一致的原因,指导患者,积极预防,改善生存质量。方法:不限制年限地检索有关颅内动脉瘤术后脑血管痉挛风险因素的国内外相关文献,根据综合统计进行结果分析。采用比值比(OR)和95%可信区间(95%CI)来描述效应量。从研究文献中总结出性别、年龄、高血压病史、临床分级、动脉瘤位置以及治疗方式等风险指标进行论证阐述。结果:共检索出中文文献19篇,英文文献57篇,高质量文献为11篇,均为英文文献,符合纳入标准和排除标准的最终纳入6篇英文文献,质量均为A级,Jadad≥4分。1)年龄因素结果:4个研究总OR值和95%CI分布在垂直线的左侧(OR 0.45,95%CI 0.34~0.61),差异有统计学意义(P0.05);2)性别因素结果:6篇文献总的OR值、95%CI分布在垂直线的两侧(OR 0.89,95%CI0.70~1.15),差异无统计学意义(P0.05);3)高血压病史因素:3篇文献总的OR值、95%CI分布在垂直线的两侧(OR 1.11,95%CI0.72~1.69),差异无统计学意义(P0.05);4)临床分级因素:3篇文献总的OR值、95%CI分布在垂直线的两侧(OR 1.21,95%CI0.83~1.76),差异无统计学意义(P0.05);5)动脉瘤位置因素:2个研究总OR值、95%CI分布在左侧(OR 0.50,95%CI 0.28~0.91),差异有统计学意义(P0.05);6)治疗方式因素:3篇文献总的OR值、95%CI分布在垂直线的两侧(OR 1.52,95%CI0.97~2.38),差异无统计学意义(P0.05)。结论:1)风险因素中年龄因素和动脉瘤位置因素与发生脑血管痉挛密切相关;2)风险因素中的性别、高血压病史、临床分级(2级)以及不同手术方式的因素与发生脑血管痉挛的关系不密切;3)对于年龄(50岁)、动脉瘤位置(前循环)的患者容易发生脑血管痉挛,建议重点预防。
[Abstract]:Objective: cerebral vasospasm is one of the most common and serious complications after intracranial aneurysm operation.It is an effective measure to improve the effect and prognosis of operation.The risk factors affecting cerebral vasospasm are many and controversial.Therefore, this article takes the risk factors of cerebral vasospasm after intracranial aneurysm operation as the center of quantitative comprehensive evaluation, and verifies the reliability of the literature conclusions while looking for the causes of inconsistent risk factors, guiding the patients and actively preventing.Improve the quality of life.Methods: domestic and international literatures on risk factors of cerebral vasospasm after intracranial aneurysm operation were searched without limitation of years and the results were analyzed according to comprehensive statistics.Ratio ratio (OR) and 95% confidence interval (95 CI) were used to describe the effect amount.Gender, age, history of hypertension, clinical grading, aneurysm location and treatment were summarized in the literature.Results: 19 articles in Chinese, 57 in English and 11 in high quality were found in Chinese literature.Age factor results: 4 studies on total OR and 95%CI distribution on the left side of vertical line, OR 0.4595 CI 0.340.61, the difference was statistically significant (P 0.05 / 0. 01). Results: the total OR value of 6 articles in 6 articles was distributed in the vertical line (P < 0. 05) and the total OR value of the 6 articles was in the vertical line (P < 0. 05 or 0. 05). The results showed that the total OR value of the 6 articles was higher than that of the normal line (P < 0. 05).OR 0.89 + 95 CI 0.70 / 1.15, no significant difference (P 0.05 / 3) Total OR value of 95 CI is distributed on both sides of vertical line or 1.1195 / 1.69 (P 0.054). The total OR value of 95 CI in the vertical line is 95% and 95% CI is distributed in the vertical line. There is no significant difference in clinical grading factors: 3 literature. The total OR value 95 / 95 CI is distributed in the vertical line.There was no significant difference in the location of aneurysm between the two sides (OR 1.21 + 95 CI 0.83 / 1.76): the total OR value of two studies was 0.5095 CI 0.281.91) the difference was statistically significant (P 0.05 / 6)) the total OR value of three literatures was 95 / 95 CI on both sides of the vertical line.The difference was not statistically significant (P 0.05).Conclusion (1) Age and aneurysm location are closely related to cerebral vasospasm.The relationship between the factors of different surgical methods and the occurrence of cerebral vasospasm is not close. For the patients who are 50 years old and the position of aneurysm (anterior circulation) are prone to develop cerebral vasospasm, it is suggested to focus on prevention.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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