亚低温联合颅内血肿微创清除术对高血压性脑出血患者神经功能影响的Meta分析-现代医学

亚低温联合颅内血肿微创清除术对高血压性脑出血患者神经功能影响的Meta分析

单位：1. 川北医学院附属医院急诊医学科, 四川南充 637000;
2. 绵阳市第三人民医院外科, 四川绵阳 621000;
3. 川北医学院基础医学与法学院, 四川南充 637000;
4. 四川大学华西医院急诊医学科, 四川成都 610000;
5. 川北医学院附属三台医院重症医学科, 四川绵

关键词：亚低温微创血肿清除术高血压性脑出血神经功能 Meta分析

分类号：R563.8

出版年·卷·期（页码）：2024·52·第二期（200-208）

摘要：

目的：通过Meta分析评价亚低温联合颅内血肿微创清除术对高血压性脑出血患者神经功能保护的临床疗效。方法：利用计算机检索 PubMed、Embase、Cochrane对照试验中央注册库、Web of Science、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WANFANG)和中国科技期刊(VIP)数据库，基于已建立的关于高血压性脑出血患者在微创血肿清除术后应用亚低温治疗的临床研究数据库，对随机对照试验(RCT)相关文献进行筛选，并进行质量评估，通过 Revman 5.3软件进行 Meta分析。结果：共纳入12篇文献，全部为单中心RCT研究，共1 093例患者。高血压性脑出血患者血肿微创清除术后联合应用亚低温治疗(以下简称联合治疗组)较常规治疗组(对照组)相比，9篇文献显示，联合治疗可有效降低美国国立卫生研究院卒中量表(NIHSS)评分(MD=-4.29，95%CI-5.27~-3.23，P＜0.001)；3篇文献显示，联合治疗可有效提高Fugl-Meyer评估表(FMA)评分(MD=27.66，95%CI 18.45~36.86，P＜0.001)；3篇文献显示，联合治疗可有效提高格拉斯哥昏迷(GCS)评分(MD=34.79，95%CI 33.19~36.39，P＜0.001)；8篇文献显示，联合治疗可有效提高日常生活活动能力量表(BI)指数(MD=8.72，95%CI 6.89~10.54，P＜0.001)；纳入文献均显示联合治疗可提高有效率(RR=1.28，95%CI 1.20~1.36，P＜0.001)；5篇文献显示，联合治疗对不良反应的发生率无显著降低作用(MD=0.52，95%CI 0.32~0.85)。结论：亚低温联合颅内血肿微创清除术对高血压性脑出血患者具有促进神经功能恢复的效果。

Objective: The purpose of this study was to evaluate the clinical efficacy of subcooling combined with minimally invasive hematoma removal on the protection of neurological function in patients with hypertensive intracerebral hemorrhage through Meta-analysis. Methods: Computer searches was conducted in multiple databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Network(CNKI), China Biomedical Literature Database(CBM), Wanfang Database(WANFANG), and China Science and Technology Periodical databases(VIP). Based on the established database of hypertensive intracerebral hemorrhage patients treated with subcooling therapy after minimally invasive hematoma removal, the literatures related to its randomized controlled trials(RCTs) were screened and assessed for quality. Meta-analysis was performed with the Revman 5.3 software. Results: There were a total of 12 papers included in this study, all of which were single-center RCT studies that involved 1 093 patients. Compared to the conventional treatment group(control group), patients with hypertensive intracerebral hemorrhage after minimally invasive hematoma removal combined with subcooling therapy(hereinafter referred to as the combined treatment group), 9 papers showed that the combined treatment had a significant impact on decreasing the National Institute of Health stroke scale(NIHSS) scores (MD=-4.29, 95%CI-5.27--3.23, P＜0.001); 3 papers showed that the combined treatment could effectively improve the Fugl-Meyer assessment scale(FMA) scores(MD=27.66, 95%CI 18.45-36.86,P＜0.001); 3 papers showed that the combined treatment was effective in improving the Glasgow coma scale(GCS) scores(MD=34.79, 95%CI 33.19-36.39, P＜ 0.001); and 8 papers showed that the combined treatment was effective in improving the Barthel Index(BI)(MD=8.72, 95%CI 6.89-10.54, P＜0.001); all of the included literature showed that the combination therapy could enhance the efficiency(RR=1.28, 95%CI 1.20-1.36, P＜0.001); while 5 papers showed that the combination therapy did not have any significant reduction in the incidence of adverse effects(MD=0.52, 95%CI 0.32-0.85). Conclusion: The combination of subcooling and minimally invasive hematoma removal has the effect of promoting the recovery of neurological function in patients with hypertensive intracerebral hemorrhage.

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