去骨瓣减压术与创伤后脑积水相关性的Meta分析

发布时间：2019-07-04 15:55

【摘要】：目的采用Meta分析方法定性分析影响颅脑创伤后脑积水发生的危险因素,这里探讨两个因素,分别为单侧与双侧去骨瓣减压术,以及去骨瓣减压术后继发于头颅不同部位的硬膜下积液与创伤后脑积水之间的相关性。方法(1)依据研究主题设置检索词,应用布尔逻辑运算符使其连接成可以运行的检索式,分别检索中国生物医学文献数据库(CBM)、中国知网、维普、万方等中文数据库,以及EMBASE,Pub Med,MEDLINE,Web of Knowledge(WOK)and Cochrane Database of Systematic Reviews等外文数据库,并利用学术搜索及全文递送综合服务平台检索全球其他开放性数据资源、专利、会议论文及书信。检索时间设定为2000年1月至2015年1月公开发表的,关于探讨去骨瓣减压术及硬膜下积液与颅脑损伤后脑积水相关性的基于病例-对照研究的中、英文文献。(2)由2名评论员依据纳入及排除标准独立筛查所选文献,并提取目标数据,依据NOS对各研究进行质量评价并计录得分。采用Comprehensive Meta-Analysis v3软件进行分析,先行异质性检验,同质性好的数据采用固定效应模型进行效应量的合并,异质性高的需先处理异质性;设置分组变量进行亚组分析;按逐次剔除单个研究的方法行敏感性分析确定单个研究在整体效应量中的比重;按照时间顺序进行累积Meta分析,用以观察时间叠加对OR值的影响;采用漏斗图及漏斗图剪补图检测发表偏倚;以NOS得分和OR值分别作为解释变量、结局变量进行回归分析,检测异质性和研究质量有无关联。结果针对去骨瓣减压术与硬膜下积液两不同暴露因素,这里有两次独立的Meta分析。(1)去骨瓣减压术和创伤后脑积水之间相关性的Meta分析:共纳入18篇发表于2006年至2015年的关于去骨瓣减压术和创伤后脑积水之间相关性的病例对照研究,其中中文15篇,英文3篇,暴露组与非暴露组共4665例研究对象,研究地区包含中国、韩国、澳大利亚。(1)不区分单侧和双侧去骨瓣减压行异质性检验I2=74.955%,采用随机效应模型合并效应量(OR 5.531;95%CI3.889,7.868;p0.05),发表偏倚检测结果提示存在很明显的发表偏倚。(2)设置去骨瓣数目为分组变量,行亚组分析,其中单侧去骨瓣减压组合并效应量(OR3.503;95%CI 2.498,4.912;p0.05),双侧去骨瓣减压组(OR 21.481;95%CI10.599,43.537;p0.05)。(3)单独将单侧去骨瓣减压作为暴露因素进行分析,异质性检验I2=45.155%,采用固定效应模型得出合并效应量(OR 3.809;95%CI3.074,4.721;p0.05);敏感性分析中,剔除单个研究后其他研究的合并OR值在3.8左右波动,95%CI重合度高;累积Meta分析总体效应量OR值趋于3.8~4.0,随着时间叠加总体合并效应量变化波动不大;发表偏倚检测提示并不存在很明显的发表偏倚。(4)双侧去骨瓣组Meta分析,异质性检验I2=0,固定效应模型合并效应量(OR 21.481;95%CI 10.599,43.537;p0.05);敏感性分析及累积Meta分析均指示合并效应量较为稳健,无发表偏倚存在,回归分析结果无线性关系。(2)硬膜下积液和创伤后脑积水发生的相关性的Meta分析:纳入8篇发表于2012年至1015年相关文献,中文5篇,英文3篇,研究地区包括中国、韩国、澳大利亚。(1)不区分单侧及纵裂间硬膜下积液,异质性检验I2=38.894%,采用固定效应模型合并(OR 3.267;95%CI 2.325,4.589;p0.05)。(2)将单侧硬膜下积液作为暴露因素进行分析,异质性检验I2=47.583%,合并效应量(OR3.259;95%CI 2.312,4.594;p0.05);敏感性分析及累积Meta分析皆较为稳健;无发表偏倚存在。(3)纵裂间硬膜下积液组,异质性检验I2=0,采用固定效应模型合并效应量(OR 14.895;95%CI 6.296,35.239;p0.05);敏感性分析提示存有差异;累积Meta分析显示2014年、2015年合并效应量趋于稳定;未检测出明显发表偏倚;回归分析不支持该研究的质量评价和异质性有关。结论本次Meta分析结果显示颅脑创伤后脑积水与去骨瓣减压术及硬膜下积液存在相关性,去骨瓣减压术及继发的硬膜下积液是创伤后脑积水发生的危险因素,而双侧去骨瓣减压和纵裂间硬膜下积液更容易导致创伤后脑积水的发生。因此对于颅脑创伤患者,是否行去骨瓣减压需慎重选择,并且早期干预颅脑创伤后硬膜下积液,减少脑积水的发生。
[Abstract]:Objective To analyze the risk factors of the occurrence of hydrocephalus after head trauma by using a meta-analysis method. And the correlation between the subdural effusion secondary to the different parts of the skull and the post-traumatic hydrocephalus. The method comprises the following steps: (1) setting a search term according to the topic of the study, and connecting the search words into a search type which can be run by using a Boolean logic operator to search the Chinese database (CBM) of the Chinese medicine literature database (CBM), the Chinese knowledge network, the Weipu, the Wanfang and the like, and the EMBASE, the pub Med and the MEDLINE, The Web of Knowledge (WOK) and the Cochrane Database of System Revews and other foreign language databases, and using the academic search and full-text delivery comprehensive service platform to retrieve other open-label data resources, patents, conference papers and letters from the world. The search time was set to be published from January 2000 to January 2015, in the Chinese and English literature on the case-control study of the study of the association of depressor and subdural hydrops with head injury. (2) The selected documents are screened independently by two commentators according to the inclusion and exclusion criteria, and the target data is extracted, and the quality evaluation and the score of each study are carried out according to the NOS. The analysis is carried out by using the Comprehensive Meta-Analysis v3 software, the data of the homogeneity test and the homogeneity are combined with the fixed effect model, the heterogeneity is high, the heterogeneity is first processed, and the grouping variables are set for subgroup analysis; The specific gravity of a single study in the overall effect volume was determined according to the method line sensitivity analysis of the single study by successive elimination; the cumulative meta-analysis was carried out according to the time order to observe the effect of the time overlap on the OR value; The NOS score and the OR value were used as an explanatory variable, and the outcome variable was returned to the regression analysis, and the heterogeneity and the quality of the study were detected. Results Two independent meta-analysis was performed on the two different exposure factors of depressor and subdural effusion. (1) Meta-analysis of the correlation between depressor and post-traumatic hydrocephalus: a total of 18 case-control studies published between 2006 and 2015 on the correlation between depressor and post-traumatic hydrocephalus, of which 15 in Chinese and 3 in English, A total of 4665 subjects were studied in the exposed and non-exposed groups, including China, South Korea and Australia. (1)2 = 74.955% of the two-sided and two-sided depressor line were not distinguished, and the combined effect of the random effect model was used (OR 5.531;95% CI 3.889, 7.868; p0.05). (2) The number of deboned flaps was set to be a group variable, and the subgroup analysis was performed, with one-sided debonectomy combined with the effect amount (ORR3.503;95% CI 2.498, 4.912; p0.05), and the bilateral debonectomy group (OR 21.481;95% CI 10.599, 43.537; p0.05). (3) The decompression of one-sided deboned valve was performed as an exposure factor, the heterogeneity test was 2 = 45.155%, and the combined effect was obtained by the fixed-effect model (OR 3.809;95% CI 3.074, 4.721; p0.05); in the sensitivity analysis, the combined OR value of the other studies after the single study was changed to about 3.8 and the 95% CI was high; The cumulative effect of cumulative meta-analysis tended to be 3.8 ~ 4.0, and the change of total combined effect was not large with time. (4) Meta-analysis of bilateral debonectomy group, heterogeneity test I2 = 0, fixed effect model combined effect (OR 21.481;95% CI 10.599, 43.537; p0.05); sensitivity analysis and cumulative meta-analysis both indicate that the combined effect is more robust, no publication bias exists, and the regression analysis result has no linear relationship. (2) Meta-analysis of the correlation between subdural effusion and post-traumatic hydrocephalus:8 articles published in 2012-1015,5 in Chinese and 3 in English, including China, South Korea and Australia. (1) There was no differentiation between unilateral and longitudinal subdural effusion, the heterogeneity of I2 = 38.894%, and the combination of fixed effect model (OR 3.267;95% CI 2.325, 4.589; p0.05). (2) The single-sided subdural effusion was analyzed as an exposure factor, the heterogeneity test was 2 = 47.583%, the combined effect (OR3.259;95% CI 2.312, 4.594; p0.05); the sensitivity analysis and the cumulative meta-analysis were all robust; no publication bias exists. (3) In the subdural effusion group, the heterogeneity test of I2 = 0, the combined effect of the fixed effect model (OR 14.895;95% CI 6.296, 35.239; p0.05); the sensitivity analysis suggested there was a difference; the cumulative meta-analysis showed that the combined effect in 2014 and 2015 was stable; no apparent bias was detected; The regression analysis does not support the quality evaluation and heterogeneity of the study. Conclusion The results of this meta-analysis show that the risk factors of post-traumatic hydrocephalus and subdural hydrops are related to the decompression and subdural hydrops of the patients with head trauma, and the risk factors of the occurrence of post-traumatic hydrocephalus after the decompression and the subdural hydrops are the risk factors of the post-traumatic hydrocephalus. However, bilateral depressor and longitudinal subdural hydrops can lead to the occurrence of post-traumatic hydrocephalus. Therefore, for the patients with head trauma, whether to go to the decompression of the bone flap is to be carefully selected, and the early intervention of the subdural effusion after the head injury can reduce the occurrence of hydrocephalus.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R651.1

【相似文献】