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

Decompressive craniectomy and conservative treatment for malignant middle cerebral artery infarction： a Meta-analysis

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1“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Review Mannager 5．2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1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。

Objective To systematically evaluate the efficacy and safety of decompressive craniectomy and conservative treatment within 48 h of onset in malignant middle cerebral artery infarction. Methods Cochrane Library, Pubmed, Embase, CNKI, Chinese Biomedical Database, VIP information database, Wanfang database were searched, and the retrieval time was from the library being built to April 31, 2015. Review Mannager 5.2 statistical analysis software was used to evaluate the treatment efficacy of decompressive craniectomy and conservative therapy, amd modified Rankin scale （mRS） scores were considered as the efficacy evaluation criteria. Results A total of six randomized controlled trial studies and two prospective studies were selected, including 201 patients from the decompressive craniectomy group and 197 patients from the conservative treatment group. The mortality of the two groups after 12 months of treatment was significantly different （mRS scores=6, P=0.000, OR=0.18, 95%CI： 0.12-0.29）. Moderate or severe disability rate after 6 months of treatment was significantly different （mRS scores=4-5,P=-0.000, OR=3.36, 95%CI： 1.95-5.78）, and that after 12 months of treatment was also significantly different （P=0.000, OR=4.62, 95% CI： 2.64-8.07）. The number of patients enjoyed good life quality （mRS scores≤3） 6 and 12 months after treatment between the two groups was statistically significant （P=0.010, OR=2.69, 95%CI： 1.21-5.96; P=0.020, OR=2.07, 95%CI： 1.11-3.87）; mortality rate （mRS scores=6） and disability rate （mRS scores=3-5） of patients aged more than 60 years between the two groups were significantly different （P=0.000, OR=0.20, 95%CI： 0.10-0.42; P=-0.000, OR=4.94, 95%CI： 2.35-10.35）. Conclusion Regardless of age greater or less than 60 years old, decompressive craniectomy can significantly reduce the mortality of patients with malignant middle cerebral artery infarction within 48 hours as compared with conservative treatment, but surgery may increase moderate to severe disability.