脑出血硬通道与软通道微创穿刺术的Meta分析

摘要

Objective To compare the efficacy of hard channel and soft channel of minimally invasive craniopuncture for intracerebral hemorrhage (ICH) by Meta analysis.Methods The literatures in terms of randomized controlled trials (RCT) and case control studies on the hard channel and soft channel for ICH were searched in CNKI,Wanfang,VIP,Pubmed and Embase databases and screened according to the specific inclusion and exclusion criteria.The quality evaluation was made for selected literatures by Newcastle-Ottawa and the original data were extracted.The difference in hematoma clearance rate,postoperative rebleeding,intracranial infection,pulmonary infection,operation time and mortality rate between the two groups were analyzed and compared by Meta analysis using fixed-effect model or random-effect model.Results Thirteen RCT and 5 case control studies were included.There were 849 patients in hard channel group and 853 in soft channel group.Meta analysis showed that the hematoma evacuation rate was higher and the operation time was shorter in the hard channel group than in soft channel group (P ＜ 0.05).No statistical difference was found in postoperative rebleeding,intracranial and lung infections,and mortality between the two groups (P ＞ 0.05).Conclusions The minimally invasive craniopuncture by either hard channel or soft channel is effective method for ICH.However,the former is superior over the latter in hematoma evacuation rate and operation time.%目的 通过Meta分析比较硬通道与软通道微创穿刺术治疗脑出血的疗效.方法 检索CNKI数据库、万方数据库、维普网、Pubmed、Embase数据库,搜集硬通道与软通道微创穿刺术治疗脑出血的随机对照研究(randomized controlled trial,RCT)或病例对照研究,并按特定的纳入标准和排除标准进行筛选.采用纽卡斯尔-渥太华量表对所选文献进行质量评价,提取原始数据,使用固定效应模型或随机效应模型Meta分析比较两组的血肿清除率以及术后再出血、颅内感染、肺部感染、手术时间、病死率的差异.结果 纳入13篇RCT和5篇病例对照研究,其中硬通道组849例,软通道组853例.Meta分析结果显示:硬通道组的血肿清除率高于软通道组(P＜0.05),且手术时间短于软通道组(P＜0.05).两者在术后再出血、颅内感染、肺部感染、病死率方面无统计学差异(P＞0.05).结论 硬通道与软通道微创穿刺术均是治疗脑出血的有效术式,硬通道在血肿清除率、手术时间上优于软通道.