尼莫地平治疗外伤性蛛网膜下腔出血疗效的系统评价

Systematic review on effect of nimodipine for treating traumatic subarachnoid hemorrhage

目的：系统评价尼莫地平治疗外伤性蛛网膜下腔出血（tSAH）的有效性。方法检索PubMed、Cochrane Library、中国期刊网全文数据库（CNKI）、维普（VIP）及万方数据库，检索时间从建库至2013年3月，收集尼莫地平治疗tSAH的随机对照试验（RCT）。由2名研究者严格按照纳入、排除标准筛选文献，提取资料，评价质量并用 RevMan5．1软件对数据进行 Meta分析。结果最终纳入12个研究，合计1184例tSAH患者。Meta分析结果显示：尼莫地平在以下方面优于常规治疗，且差异有统计学意义（P＜0．05）：病死率（OR＝0．47，95％CI：0．32～0．69），不良预后发生率（OR＝0．44，95％CI：0．32～0．59），脑血管痉挛发生率（OR＝0．46，95％CI：0．28～0．78），脑梗死发生率（OR＝0．33，95％CI：0．21～0．52），脑积水发生率（OR＝0．36，95％CI：0．19～0．67）；而再出血发生率差异无统计学意义（OR＝0．68，95％CI：0．20～2．32，P＜0．05）。结论尼莫地平可以降低 tSAH 患者的病死率、不良预后发生率，减少并发症的发生，对患者再出血率和颅内压的变化无明显影响。

Objective To systematically evaluate the effects of nimodipine in the treatment of traumatic subarachnoid hemor-rhage（tSAH）.Methods All Randomized controlled trials（RCT）about nimodipine for the treatment of tSAH were retrieved from the database of PubMed,Cochrane Library,CNKI,VIP and Wanfang database from their establishment to March 2013.Two review-ers independently screened the studies,extracted the data and assessed the quality according to the inclusion and exclusion criteria. The meta-analysis was conducted with RevMan 5.1 software.Results A total of 12 RCTs involving 1 184 tSAH patients were in-cluded.The results of meta-analysis showed that compared with the routine therapies,nimodipine was superior in the following as-pects with statistically differences（P＆lt;0.05）：the case fatality rate（OR=0.47,95%CI：0.32-0.69）,the occurrence rate of adverse prognostic（OR=0.44,95%CI：0.32-0.59）,the rate of cerebral vasospasm（OR=0.46,95%CI：0.28-0.78）,the occurrence rate of cerebral infarction（OR=0.33,95%CI：0.21-0.52）and the hydrocephalus occurrence rate（OR=0.36,95%CI：0.19-0.67）. However,the rebleeding occurrence rate had no statistically significant difference between the two groups（OR=0.68,95%CI：0 .2 0-2 .3 2 ,P＆gt;0 .0 5 ）.Conclusion Nimodipine can reduce the fatality rate and the occurrence rate of adverse prognosis,and decrease the occurrence of complications but without obvious influence on the rebleeding rate and the intracranial pressure in the tSAH patients.