去骨瓣减压术与保守疗法治疗恶性大脑中动脉脑梗死疗效的Meta分析

被引:11
作者
王艳
肖哲曼
陈康
黄丽芳
康玉琪
樊尚华
尹皓
机构
[1] 武汉大学人民医院神经内科
关键词
去骨瓣减压术; 保守疗法; 恶性大脑中动脉脑梗死; Meta分析;
D O I
暂无
中图分类号
R651.1 [颅脑];
学科分类号
摘要
目的系统评价发病48h内行去骨瓣减压术与保守疗法治疗恶性大脑中动脉脑梗死的疗效和安全性。方法计算机检索Cochrane图书馆、Pubmed、Embase、CNKI、CBM、维普、万方数据库,检索时间为自建库至2015年4月31日,文献语种为中文或英文,英文检索词为"decompressive craniectomy"AND"middle cerebral artery infarctions"OR"surgical decompression for cerebral oedema in acute stroke"OR"hemicraniectomy for middle cerebral artery infarctions",中文检索词为"恶性大脑中动脉脑梗死"和(或)"缺血性脑卒中"和(或)"脑梗死"和(或)"去骨瓣减压术"和(或)"随机对照试验"。采用ReviewMannager5.2软件统计分析去骨瓣减压术与保守疗法的疗效差异,疗效评估标准为改良Rankin量表(mRS)评分。结果共纳入6项随机对照试验研究及2项前瞻性研究,共包括去骨瓣减压术组患者201例和保守疗法组患者197例。去骨瓣减压术组与保守疗法组治疗后12月的死亡率(mRS评分6分)差异有统计学意义(P=0.000,OR=0.18,95%CI:0.12~0.29),治疗后6月的中重度致残率(mRS评分4~5分)差异有统计学意义(P=0.000,OR=3.36,95%CI:1.95~5.78),治疗后12月的中重度致残率(mRS评分4~5分)差异有统计学意义(P=0.000,OR=4.62,95%CI:2.64~8.07),治疗后6月的较好生存质量(mRS评分≤3分)差异有统计学意义(P=0.010,OR=2.69,95%CI:1.21~5.96),治疗后12月的较好生存质量(mRS评分≤3分)差异有统计学意义(P=0.020,OR=2.07,95%CI:1.11~3.87)。去骨瓣减压术组与保守疗法组中大于60岁患者治疗后12月的死亡率(mRS评分6分)差异有统计学意义(P=0.000,OR=0.20,95%CI:0.10~0.42),治疗后12月的致残率(mRS评分3~5分)差异有统计学意义(P=0.000,OR=4.94,95%CI:2.35~10.35)。结论无论患者年龄是大于60岁还是小于60岁,与保守疗法相比,发病48h内行去骨瓣减压术能够明显降低恶性大脑中动脉脑梗死患者治疗后12月的死亡率,但会增加中重度致残率。
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页码:1122 / 1127
页数:6
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