目的 系统评价微创血肿穿刺术与小骨窗血肿清除术治疗中等量高血压脑出血的疗效。方法 收集2014年1月至2017年7月中国期刊全文数据库、中国科技期刊数据库、万方电子期刊全文数据库等公开发表的中文文献中所有微创血肿穿刺术与小骨窗血肿清除术治疗高血压脑出血疗效比较的临床对照试验研究资料。按照纳入和排除标准独立筛检文献、提取资料,采用Jadad质量评价量表对纳入研究的文献进行质量评价,采用RevMan 5.0软件进行Meta分析。结果 最终纳入11篇文献,共计1 379例患者。Meta分析结果显示:微创血肿穿刺术组在总有效率[OR=1.96,95%CI(1.34,2.86),P=0.0005]、术后ADL分级(Ⅰ级和Ⅴ级)、术后再出血[OR=0.46,95%CI(0.30,0.72),P=0.0007]、呼吸道感染的发生率[OR=0.67,95%CI(0.48,0.93),P=0.02]和术后病死率[OR=0.56,95%CI(0.36,0.88),P=0.01]方面优于小骨窗血肿清除术组,其差异具有统计学意义。结论 对于中等量高血压脑出血的患者,微创血肿穿刺术较小骨窗血肿清除术总有效率更高,可降低术后并发症和病死率,远期能减少神经功能损伤,提高患者生活能力。
Abstract
Objective To systematically review the efficacy between minimally invasive hematoma aspiration and small bone window hematoma for patients with hypertensive cerebral hemorrhage. Methods Such databases as CNKI,VIP and Wanfang Data was searched to identify on minimally invasive hematoma puncture and small bone window hematoma for patients with hypertensive cerebral hemorrhage from January 2014 to July 2017. According to inclusion and exclusion criteria, independent screening literature, data extraction and evaluation of methodological quality were included in the study. RevMan5.0 software was used for Meta analysis. Results A total of 1 379 patients were included in the final 11 articles. The results of Meta analysis showed that, minimally invasive was superior to small bone window with significant difference in the total effective rate OR=1.96, 95%CI(1.34,2.86,P=0.0005), postoperative ADL grade (grade I and V), postoperative rebleeding OR=0.46,95%CI(0.30,0.72),P=0.0007, incidence of respiratory tract infection OR=0.67,95%CI(0.48,0.93),P=0.02 and postoperative mortality OR=0.56, 95%CI(0.36, 0.88),P=0.01. Conclusion For patients with moderate hypertensive intracerebral hemorrhage, minimally invasive hematoma aspiration surgery is more effective than small bone flap hematoma removal, which can reduce postoperative complications and mortality, and can reduce neurological impairment and improve patients' living ability in the long run.
关键词
微创 /
小骨窗 /
高血压脑出血 /
Meta分析 /
循证医学
Key words
Minimal invasive /
Small bone window /
Hypertensive cerebral hemorrhage /
Meta-analysis
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