3%高滲鹽水對比7.5%高滲鹽水降低顱內壓治療的Meta分析

Efficacy of reducing intracranial hypertension with 3%hypertonic saline vs.7.5% hypertonic saline:a Meta analysis

目的系統評價3%高滲鹽水和7.5%高滲鹽水降低顱內壓的療效。方法檢索網絡數據庫Cochrane Library、PudMed、Medline、中國知網、維普網和萬方數據庫,收集採用3%HS和7.5%HS降低ICP的相關文獻,時間為2008年1月1日~2018年12月31日,採用RevMan5.3軟件對納入的研究進行處理。結果共納9個研究進行系統Meta分析,共計412例病人,其中3%HS206例,7.5%HS206例。3%HS和7.5%HS在干預後的CVP、CPP、MAP、血漿滲透壓、血清鈉的差異均無統計學意。7.5%HS在治療顱內高壓較3%HS更有效降低ICP(95%CI:0.37~5.13,Z=2.26,P=0.02),ICP下降幅度(95%CI:-4.87~-2.50,Z=6.09,P<0.0001)更大,有效降低ICP持續時間長(95%CI:-1.77~-0.65,Z=4.21,P<0.0001),起效時間快(95%CI:2.34~5.71,Z=4.69,P<0.0001)。結論7.5%HS在治療顱內高壓較3%HS更有效降低ICP。

Objective To systemically compare the effectiveness of 3%hypertonic saline(HS)and 7.5%HS in reducing intracranial hypertension.Methods Randomized clinical trials about reducing intracranial hypertension with 3%HS compared to 7.5%HS from January 2008 to December 2018 were collected from databases including Cochrane Library,PudMed,Medline,CNKI,VIP and Wanfang.RevMan 5.3 software was used for data analyses.Results 9 articles were enrolled for meta-analysis,including a total of 412 patients with 206 patients in both 3%HS and 7.5%HS group.There were no significant differences in central venous pressure(CVP),cerebral perfusion pressure(CPP),mean arterial pressure(MAP),plasma osmotic pressure and serum sodium after intervention between the 2 groups.Whereas,the 7.5%HS group was significantly more effective in lowering intracranial pressure(ICP)(95%CI:0.37~5.13,Z=2.26,P=0.02),decreasing magnitude of ICP(95%vCI:-4.87~-2.50,Z=v6.09,P<0.0001),delivering long lasting effect on ICP(95%CI:-1.77~-0.65,Z=4.21,P<0.0001)and was a faster acting agent(95%CI:2.34~5.71,Z=4.69,P<0.0001),compared to the 3%HS group.Conclusion Treatment of intracranial hypertension with 7.5%HS was more effective than 3%HS in decreasing ICP levels.