法舒地尔联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛有效性和安全性Meta分析

A Meta-analysis: Efficacy and Safety of Fasudil Combined with Nimodipine in the Treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage

目的:采用Meta分析方法评价法舒地尔联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛的有效性和安全性。方法:计算机检索Cochrane Library、PubMed、Embase、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(SinoMed)、维普期刊全文数据库(VIP)、中国硕士学位论文全文数据库(CMFD)和中国博士学位论文全文数据库(CDFD)等数据库关于法舒地尔联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛的随机对照试验(randomized controlled trial,RCT)的文献,检索时间从各数据库建库至2017年11月1日。由两名评价者独立评价纳入研究的方法学质量,采用RevMan 5.3软件进行Meta分析。结果:通过关键词初检出1 624篇文献,最终纳入10篇RCTs文献,共777例患者。Meta分析结果显示,在有效性方面:联合组(法舒地尔联合尼莫地平)的有效率与尼莫地平组相比,差异有统计学意义(OR=3.34,95%CI:1.30~8.55,P=0.01);联合组脑血管痉挛发生率低于尼莫地平组,且两组差异有统计学意义(OR=0.37,95%CI:0.17~0.79,P=0.01);联合组在改善大脑中动脉(MCA)血流速度方面与尼莫地平组相比差异无统计学意义(P>0.05)。在安全性方面:联合组的血压下降发生率、不良反应发生率与尼莫地平组相比,差异均无统计学意义(P>0.05)。结论:法舒地尔联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛,在提高临床有效率和降低脑血管痉挛发生率方面优于单用尼莫地平,且血压下降率和不良反应发生率与单用尼莫地平相比未见明显差异,安全性一致,对临床应用具有重要的意义。

Objective：To evaluate the efficacy and safety of fasudil combined with nimodipine in the treatment of cerebral vasospasm （CVS） after subaraehnoid hemorrhage （SAH）. Methods： We obtained the related literatures about fa- sudil combined with nimodipinc on cerebral vasospasm after subaraehnoid hemorrhage from the electronic databases inclu- cling Cochrane Library, PubMed, Embase, CNKI, SinoMed, VIP, CMFD and CDFD. Trial data were evaluated independ- ently by 2 reviewers. Meta-analysis was carried out by RevMan 5.3 software. Results： l 624 references were retrieved by keywords, from which 10 references conformed to inclusion criteria were chosen including 777 patients. Results of Meta- analysis showed that the efficiency was significant difference between combination group and nimodipine group （ OR = 3.34, 95% CI： 1.30--8.55, P =0.01 ）. The incidence rate of CVS of combination group was lower than nimodipine group, and there was significant difference between them （ OR =0.37, 95% CI： 0. 17-0.79, P =0.01 ）. Then, there was no signifi- cant difference in improving the speed of cerebral arteries between two groups （ P 〉 0.05 ）. About safety, compared with nimedipine group, the rate of blood pressure and the incidence rate of ADR in combination group were no significance difference （P 〉 0.05）. Conclusion ：The efficiency and the incidence rate of CVS of fasudil eombined with nimodipine are better than nimodipine, while the safety is equivalent.