微创联合阿替普酶治疗脑出血疗效的Meta分析

Meta-analysis of Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage

目的本研究旨在系统评价微创联合阿替普酶治疗脑出血的疗效。方法通过全面检索国内外数据库,筛选有关微创联合阿替普酶治疗脑出血的随机对照试验,提取的数据结果采用Revman 5.3统计软件对其进行Meta分析,Cochrane风险偏移分析工具进行质量评估。结果检索到5篇符合纳入标准的文献,共对794例患者进行研究分析。Meta分析结果显示,微创联合阿替普酶组在治疗脑出血的血肿体积方面显著优于标准药物治疗组(MD=-24.38,95%CI:-31.29^-17.48,P <0.01),但在30天内死亡率(OR=0.71,95%CI:0.43~1.15,P=0.17)、最后一次导管给阿替普酶72小时内症状性再出血(OR=2.47,95%CI:0.89~6.90,P=0.08)、治疗后30天内中枢神经系统感染率(OR=1.26,95%CI:0.30~5.29,P=0.75)方面,微创联合阿替普酶组与标准药物治疗组相比差异无统计学意义。结论脑出血患者行微创联合阿替普酶治疗仅能显著改善血肿体积,但对患者死亡率、症状性再出血率、中枢系统感染方面似乎并不推荐,仍需更大的样本量进一步评估微创联合阿替普酶在治疗脑出血方面的疗效和安全性。

Objectives To systematically evaluate the efficacy of minimally invasive surgery plus alteplase for intracerebral hemorrhage. Methods Through the comprehensive retrieval of domestic and foreign databases, random controlled trials of minimally invasive surgery plus alteplase for intracerebral hemorrhage were screened. The extracted data were analyzed by Revman 5.3 statistical software, and the quality was assessed using Cochrane risk of bias analysis tools. Results Five studies with 794 patients met the inclusion criteria. Meta-analysis showed that the volume of hematomas in minimally invasive surgery plus alteplase group was significantly improved than that in standard medical treatment group(MD=-24.38, 95%CI :-31.29^-17.48, P < 0.001), but there were no significant difference in the mortality within 30 days(OR =0.71, 95%CI : 0.43 ~1.15, P = 0.17), symptomatic brain bleeds within 72 h after last dose(OR=2.47, 95%CI : 0.89 ~6.90, P = 0.08), the bacterial brain infection rate within 30 days(OR=1.26, 95%CI: 0.30 ~5.29, P = 0.75), between minimally invasive surgery plus alteplase group and standard medical group. Conclusion Minimally invasive surgery plus alteplase can only significantly improve the volume of hematomas in patients with intracerebral hemorrhage, but it does not seem to be recommended for mortality, symptomatic rebleeding and central system infection. A larger sample size is needed to further evaluate the efficacy and safety of minimally invasive surgery plus alteplase for intracerebral hemorrhage.