高压氧联合依达拉奉治疗急性一氧化碳中毒迟发性脑病的 Meta 分析

Meta analysis of hyperbaric oxygen combined with edaravone in the treatment of delayed encephalopathy after acute carbon monoxide poisoning

目的：系统评价高压氧（hyperbaric oxygen，HBO）联合依达拉奉治疗急性一氧化碳中毒迟发性脑病的有效性和安全性。方法计算机检索 PubMed、Cochrane Library、EMbase、Lancet、CBM、中国知网、维普和万方数据库，并辅以手工检索方法收集国内外公开发表和尚未发表的相关文献，检索时限截止2015年11月。由2位研究者按纳入和排除标准独立筛选文献、提取资料并评价纳入文献方法学质量后，采用 RevMan 5．1软件进行 Meta 分析。结果最终共纳入23个随机对照试验，共计1494例患者。Meta 分析结果显示 HBO 依达拉奉联合组的治疗有效率[OR ＝4．31，95％CI （3．15，5．91），P ＜0．01]、痊愈率[OR ＝1．91，95％CI （1．48，2．47），P ＜0．01]，治疗后长谷川智能量表（HDS）评分[治疗后14 d：标准化均数差（SMD）＝2．22，95％CI （1．26，3．19），P ＜0．01；治疗后30 d：SMD ＝3．46，95％CI （2．75，4．16），P ＜0．01]，治疗后血清丙二醛（MDA）浓度[治疗后2周：SMD ＝0．32，95％CI （0．03，0．61），P ＜0．05；治疗后3 周：SMD ＝0．52，95％CI （0．16，0．88），P ＜0．01；治疗后4周：SMD ＝0．81，95％CI （0．51，1．11），P ＜0．01]方面均优于单用 HBO 组，差异均有统计学意义（P ＜0．01）。结论依达拉奉联合 HBO 治疗急性一氧化碳中毒迟发性脑病的疗效优于单用 HBO，临床医师可据此采用更为合理有效的治疗方案。

Objective To evaluate systematically the effects and safety of edaravone combined with HBO in the treatment of delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）.Methods A computer -aided information retrieval was made by using databases including PubMed,Cochrane Library, EMbase,Lancet,CBM,CNKI,VIP and WanFang Academic Journals Database from the inception to November 2015,and related data were also collected from those published and unpublished sources.The 2 reviewers were recruited to screen and select related literature independently in accordance with the literature selection criteria and exclusion criteria.Then,after evaluation of the quality of included literature,meta -analysis was made by using RevMan5.1 software.Results Finally,a total of 23 randomized control trials （RCTs）involving 1 494 patients were included in the study.The results of meta -analyses indicated that the therapeutic effects of edaravone combined with HBO on the patients of the combined group were [OR =4.31,95% CI （3.15, 5.91）]（P 〈0.01）,its curative effects were [OR =1.91,95%CI （1.48,2.47）]（P 〈0.01）,and HDS scores after treatment were[SMD =2.22,95%CI （1.26,3.19）]14 days after treatment （P 〈0.01）.Thirty＆amp;nbsp;days after treatment,standard measurement deviation （SMD） =3.46,95%CI （2.75,4.16）（P 〈0.001）. The serum levels of MDA after treatment increased[SMD =0.32,95%CI （0.03,0.61 ）],2 weeks after treatment （P 〈0.05）;SMD =0.52,95%CI （0.16,0.88）3 weeks after treatment （P 〈0.01 ）;SMD =0.81,95%CI （0.51,1.11）4 weeks after treatment （P 〈0.01）,which were all superior to those of the HBO group,and statistical significance be seen,when comparisons were made between them （P 〈0.01 ）. Conclusions Evidence showed that the therapeutic effects of edaravone combined with HBO in the treatment of DEACMP were obviously superior to those by HBO therapy alone.Clinicians could adopt more rational and effective treatment regimen accordingly.