血肿微创清除联合脑血疏口服液治疗自发性脑出血的疗效及安全性的Meta分析与质量评价OA北大核心CSTPCD
The effect and safety of minimally invasive surgery combined with Naoxueshu oral liquid on spontaneous cerebral hemorrhage:Meta-analysis and quality evaluation
目的:系统评价颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的疗效及安全性.方法:计算机检索从建库至 2023 年 6 月收录于中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)、维普中文科技期刊数据库(VIP Chinese science and technology journal database,VIP)、万方数据库、中国生物医学文献数据库(The Chinese biomedical literature database,CBM)、PubMed、Embase、the Cochrane Library等中英文数据库,结合纳入与排除标准筛选出所有颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的临床随机对照试验,根据Cochrane系统评价手册对纳入研究进行偏倚风险评价,运用Revman5.4软件进行Meta分析,最后采用GRADE系统对结局指标进行证据质量评价.结果:共纳入9项研究,总样本量739例.其中,对照组371例,试验组368例.Meta分析结果显示,与血肿微创清除后仅予常规西医治疗相比,联合应用脑血疏口服液能够提高自发性脑出血患者临床治疗的总有效率[OR=5.47,95%CI=2.28,13.09,P=0.000 1],在降低患者美国国立卫生研究所卒中量表评分[MD=-3.42,95%CI=-4.97,-1.87,P<0.000 1]和中国脑卒中患者神经功能缺损程度评分[MD=-2.30,95%CI=-3.01,-1.58,P<0.000 01],提高患者格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分[MD= 1.51,95%CI=1.13,1.89,P<0.000 01]和Barthel指数(Barthel index,BI)评分[MD=6.88,95%CI=4.49,9.27,P<0.000 01],降低血清S100蛋白[MD=-0.02,95%CI=-0.03,-0.02,P<0.000 01]和水通道蛋白4水平[MD=-0.02,95%CI=-0.03,-0.01,P=0.002]方面均具有明显优势.安全性方面,所纳研究均无严重不良反应;2项研究报告有恶心、腹胀、腹泻的胃肠道不适症状,其余研究未报告不良反应发生.结论:现有证据表明,颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血疗效确切,能够明显减轻患者神经功能缺损和意识障碍程度,提高患者日常生活能力,改善患者生活质量,且具有一定的安全性.
Objective:To systematically evaluate the efficacy and safety of minimally invasive removal of intracranial hemato-ma combined with Naoxueshu treatment for spontaneous cerebral hemorrhage.Methods:Computer search was conducted on Chi-nese and English databases including CNKI,VIP,Wanfang,CBM,PubMed,Embase and the Cochrane Library from the es-tablishment of the database to June 2023,based on inclusion and exclusion criteria to select randomized controlled trials(RCTS)of minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous in-tracerebral hemorrhage.The risk of bias was evaluated according to the Cochrane Systematic Review Manual,and meta-analysis was performed using Revman5.4 software,and the GRADE system was used to evaluate the evidence quality of outcome indica-tors.Results:Totally 9 RCTs were included,and the total sample size was 739 cases.There were 371 cases in the control group and 368 cases in the experimental group.The results of meta-analysis showed that compared with only conventional West-ern medicine after minimally invasive surgery,combined application of Naoxueshu oral liquid improved the overall clinical effec-tiveness rate[OR=5.47,95%CI=2.28,13.09,P=0.000 1],obviously reduced the score of National Institute of Health Stroke Scale[MD=-3.42,95%CI=-4.97,-1.87,P<0.000 1],and neurological impairment score Chinese stroke patients[MD=-2.30,95%CI=-3.01,-1.58,P<0.000 01],improved Glasgow Coma Scale score[MD=1.51,95%CI=1.13,1.89,P<0.000 01]and Barthel Index(BI)score[MD=6.88,95%CI=4.49,9.27,P<0.000 01],and decreased serum S100 protein[MD=-0.02,95%CI=-0.03,-0.02,P<0.000 01]and AQP4 levels[MD=-0.02,95%CI=-0.03,-0.01,P=0.002].In terms of safety,no serious adverse reactions were reported;gastrointestinal discomfort symptoms includ-ing nausea,abdominal distension and diarrhea were reported in 2 studies;no adverse reactions were reported in the remaining studies.Conclusion:Existing evidence shows that minimally invasive removal of intracranial hematoma combined with Naoxue-shu oral liquid in the treatment of spontaneous cerebral hemorrhage has obvious effects in reducing the degree of neurological im-pairment and consciousness disorder,improving patients'daily living ability,ameliorating patients'quality of life and other as-pects,and has certain safety.
于苗;张丽娜;丁薇;张根明
北京中医药大学东直门医院,北京 100700中国中医科学院眼科医院,北京 100040北京中医药大学中医学院,北京 102488
临床医学
脑出血脑血疏口服液微创血肿清除Meta分析
Cerebral hemorrhageNaoxueshu oral liquidMinimally invasiveHematoma removalMeta-analysis
《海南医学院学报》 2024 (009)
691-699 / 9
This study was supported by Beijing University of Chinese Medicine Dongzhimen Hospital Horizontal Special Project Funding Project(HX-DZM-2018004) 北京中医药大学东直门医院横向专项课题资助项目(HX-DZM-2018004)
评论