不同剂量甘露醇治疗急性脑出血的有效性和安全性荟萃分析

A meta-analysis of clinical efficacy and safety of different doses of mannitol in the treatment of acute cerebral hemorrhage

目的通过荟萃分析评价不同剂量甘露醇治疗急性脑出血的有效性和安全性。方法通过网络检索、人工检索或向厂家索取信息等多种途径收集高剂量和低剂量甘露醇治疗急性脑出血的临床疗效和(或)安全性的随机对照试验,经荟萃分析比较高剂量和低剂量甘露醇治疗急性脑出血的有性效和安全性。结果 18项随机对照试验均符合本研究录用标准,共计1444例患者。疗效性荟萃分析显示:治疗结束后低剂量组患者神经功能改善率与高剂量组比较无明显差异(RR=1.07,95%CI:0.99~1.15,P=0.10)。定性分析提示:低剂量组患者神经功能缺损恢复情况稍优于高剂量组;治疗期间,低剂量组降颅压效果与高剂量组无明显差异(RR=1.05,95%CI:0.93~1.19,P=0.42)。安全性荟萃分析显示:低剂量组患者肾功能异常发生率低于高剂量组(RR=0.36,95%CI:0.24~0.52,P<0.01)。结论经低剂量甘露醇治疗的急性脑出血患者近期神经功能缺损评分低于高剂量甘露醇治疗患者,疗效可能优于高剂量组。低剂量甘露醇治疗急性脑出血的安全性高于高剂量甘露醇。但缺乏足够的数据支持两种剂量甘露醇对急性脑出血远期功能性指标的评价和比较,仍需进一步开展大样本和高质量的随机对照试验。

Objective To evaluate the efficacy and safety of different doses of mannitol in the treatment of acute cerebral hemorrhage by meta-analysis. Method Randomized controlled trials of the clinical efficacy and （or） safety of high and low doses of mannitol in the treatment of acute cerebral hemorrhage were investigated by web search, manual retrieval or information from manufacturers. Meta-analysis was used in comparison of clinical efficacy and safety of high and low doses of mannitol in the treatment of acute cerebral hemorrhage. Result 18 randomized controlled trials were in accordance with the recruitment criteria. The improvement rate of neurological function between low dose group and high dose group had no significantly difference （RR = 1.07, 95%CI： 0.99 ~ 1.15, P = 0.10）. But further analysis showed that the improvement rate of neurological function in low dose group was higher than that in high dose group. There was no significant difference between low dose group and high dose group in reduction of intracranial pressure （RR =1.05, 95%CI： 0.93 ~ 1.19, P = 0.42）. Meta-analysis showed that the incidence of renal dysfunction in low dose group was lower than that in high dose group （RR = 0.36, 95%CI： 0.24 ~ 0.52, P 〈 0.01）. Conclusion The short-term neurologic impairment score of patients with acute intracerebral hemorrhage treated with low dose mannitol is lower than that of high dose mannitol, and the curative effect may be better than that of high dose. And compared with high dose mannitol, low dose mannitol in the treatment of acute cerebral hemorrhage is more safe. But the lack of sufficient data to support the two doses of mannitol in the treatment of acute cerebral hemorrhage on the long-term functional indicators of the evaluation and comparison, which still needs further large samples and highquality randomized controlled trials.