联合天幕裂孔切开术较单纯标准大骨瓣减压术治疗重型颅脑损伤疗效的Meta分析

Therapeutic effect of tentorial hiatus incision combine d with simple standard decompressive craniectomy for severe traumatic brain injury:a Meta-analysis

目的评价标准大骨瓣减压联合天幕裂孔切开术治疗重型颅脑损伤（s TBI）的疗效,为s TBI的治疗提供相关循证依据。方法通过对Pub Med、EMbase、Cochran、中国知网（CNKI）、中国生物医学文献服务系统、维普网、万方数据知识服务平台中相关文献进行检索,制定相应的纳入和排除标准筛选文献,应用Jadad质量评分法对已纳入文献进行严格的质量评价,并进行异质性检验。将标准大骨瓣减压联合天幕裂孔切开术作为研究组,单纯标准大骨瓣减压术作为对照组。若多个研究结果的效应一致,采用固定效应模型;反之,采用随机效应模型。结果共纳入16篇文献,共1142例病人。Meta分析结果显示：与对照组相比,研究组病死率更低（P〈0.01）,随访0~3个月、3~6个月、6~12个月,研究组术后预后均更佳（P〈0.01）,脑梗死、脑积水、应激性溃疡发生率也更低（P〈0.01）。结论与单纯标准大骨瓣减压术相比,联合天幕裂孔切开术能改善s TBI病人预后,降低病死率,减少并发症。但本文文献纳入量较少且限于国内,期待更多高质量、大样本研究进一步验证。

Objective To evaluate the therapeutic effect of standard decompressive craniectomy combined with tentorial hiatus incision for severe traumatic brain injury （sTBI） to provide relevant evidence-based basis for treatment of sTBI. Methods The literatures were retrieved from PubMed, EMbase, Cochran, China National Knowledge Infrastructure （CNKI）, China Biological Medicine Database （CBM-disc）, VIP net and Wanfang data knowledge service platform, and the inclusion and exclusion criteria were set up for selecting the literatures. Jadad quality evaluation method was used to evaluate all the included literatures, and heterogeneity test was performed simultaneously. The patients receiving standard decompressive craniectomy with tentorial hiatus incision served as research group, and those receiving simple standard decompressive craniectomy as control group. Fixed effects model was appliedwhen several research results were identical, conversely, a random effects model used. Results Sixteen articles with 1142 patients were included in this research. Meta-analysis results showed that compared with the control group, the mortality was lower, the prognosis of 0 to 3 months, 3 to 6 months, 6 to 12 months were better, and the incidence rates of cerebral infarction, hydrocephalus and stress ulcer were also lower in the research group （P 〈 0.01）. Conclusions Simple standard decompressive craniectomy combined with tentorial hiatus incision can effectively improve the prognosis and reduce mortality and complications. But, the literatures included are less and limited to the domestic articles, and looking forward to more high quality and large sample research to validate it.