尼莫地平联合脑脊液置换治疗蛛网膜下腔出血的系统评价

摘要

Objective To evaluate the efficacy of nimodipine combined with cerebrospinal fluid exchange in treating subarachnoid hemorrhage (SAH) .Methods The electronic databases and manual retrieval ,and the meta-analytic method were used to conduct the systematic evaluation on the efficacies of nimodipine combined with cerebrospinal fluid exchange versus routine internal medicine therapy for treating SAH in all the included randomized controlled trials (RCTs) .Results 16 RCTs(n=1 076) were included .The methodological quality of all included trials was poor .Compared with the routine internal medicine therapy ,nimodipine combined with cerebrospinal fluid exchange could reduce the occurrence of cerebral vasospasm (RR 0 .33 ,95% CI 0 .25-0 .43 ,P<0 .01) ,hy-drocephalus(RR 0 .28 ,95% CI 0 .18-0 .44 ,P<0 .01) and mortality after SAH (RR 0 .41 ,95% CI 0 .24-0 .70 ,P=0 .001) ,while no difference was found in the occurrence of re-bleeding between two groups(RR 0 .89 ,95% CI 0 .53-1 .50 ,P=0 .67) .Conclusion The current clinical research evidences demonstrate that the combination of nimodipine and cerebrospinal fluid exchange can re-duce the occurrence of cerebral vasospasm and hydrocephalus ,decrease the mortality after SAH But further well-designed multi-center RCTs with larger sample should be carried out to confirm our findings due to the influence of the poor quality of included tri-als .%目的：评价尼莫地平联合脑脊液置换治疗蛛网膜下腔出血（SAH）的有效性。方法：通过电子数据库和手工检索，运用Meta分析方法对纳入的所有采用尼莫地平联合脑脊液置换与常规内科治疗比较治疗SAH的随机对照研究进行系统评价。结果共检索到16个研究（1076例）符合纳入标准，但方法学质量均偏低。Meta分析结果表明尼莫地平联合脑脊液置换能减少SAH后脑血管痉挛（RR0．33，95％CI0．25～0．43，P＜0．01）、脑积水（RR0．28，95％CI0．18～0．44，P＜0．01）的发生，不增加再出血的风险（RR0．89，95％CI0．53～1．50，P＝0．67），而且还能减少SAH后的病死率（RR0．41，95％CI0．24～0．70，P＜0．01）。结论：尼莫地平联合脑脊液置换治疗SAH有减少脑血管痉挛、脑积水的发生，降低病死率的趋势，但受纳入研究质量偏低的影响，其有效性还需要更多设计严格的大样本、多中心随机对照试验进一步证实。