高渗盐水治疗脑损伤性颅高压有效性与安全性的Meta分析

Meta-analysis on efficacy and safety of hypertonic saline for intracranial hypertension following traumatic brain injury

目的运用Meta分析评价高渗盐水对比甘露醇治疗脑损伤性颅高压的有效性与安全性。方法系统检索知网、万方、生物医学、维普筛选高渗盐水比对甘露醇治疗脑损伤性颅高压的随机对照实验(RCTs)并提取相关数据。采用RevMan 5.3软件对相关数据进行合并分析。结果共纳入26篇符合纳入标准的RCTs文献,共1903例患者。Meta分析结果显示,高渗盐水降颅压方案组在给药后多数结局终点的颅内压、药效时长、脑灌注压、不良事件领域与甘露醇组的差异均有统计学意义。亚组分析显示,3%的高渗盐水降颅压效力略低于20%甘露醇;7.5%、10%、23.4%高渗盐水降颅压效力与20%甘露醇相当。针对7.5%高渗盐水不同给药剂量的亚组分析提示,4 mL/kg剂量是降颅压的较优剂量。结论基于中国人群RCTs的合并结果,4 mL/kg剂量的7.5%的高渗盐水可能是较优的降颅压方案,本结论仍需高质量RCTs进一步验证,此外针对不同人群和种族的最佳治疗方案仍需进一步研究。

Objective To evaluate the efficacy and safety of hypertonic saline versus mannitol in the treatment of brain injury induced intracranial hypertension by Meta analysis.Methods The randomized controlled trials(RCTs)of hypertonic saline versus mannitol in the treatment of brain injury intracranial hypertension were systematically searched by CNKI,WFSD,CBM and VIP.The relevant data were extracted.Revman 5.3 software was used to merge and analyze the relevant data.Results The literature search strategies yielded 26 publications(1903 participants)that satisfied our inclusion criteria included in this study.Meta analysis showed that there were significant differences in intracranial pressure(ICP),duration of efficacy,cerebral perfusion pressure and adverse events between hypertonic saline group and mannitol group.Subgroup analysis showed that the effect of 3%hypertonic saline on reducing ICP was slightly lower than that of 20%mannitol.7.5%,10%and 23.4%hypertonic saline had the same effect of reducing ICP as 20%mannitol.The subgroup analysis of different doses of 7.5%hypertonic saline suggested that the dose of 4 mL/kg was the better dose to reduce ICP.Conclusions In view of the pooled findings of RCTs in the Chinese population,7.5%hypertonic saline at a dose of 4 mL/kg may be a optimal protocol to reduce ICP,but the conclusions needs high-quality RCTs to be further clarified.Furthermore,the optimal treatment protocol for different populations and races still needs further research.