本文選題：高滲鹽水 + 顱腦損傷　； 參考：《廣西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：評(píng)價(jià)高滲鹽水用于顱腦損傷早期治療的療效及安全性。 方法：根據(jù)Cochrane系統(tǒng)評(píng)價(jià)的方法,計(jì)算機(jī)檢索Cochrane圖書館(2013年4月)、Pubmed(2013年4月)、EMBASE(2013年4月)及中國生物醫(yī)學(xué)數(shù)據(jù)庫(2013年4月)、清華同方數(shù)據(jù)庫(2013年4月)、萬方數(shù)據(jù)庫(2013年4月),同時(shí)手工檢索納入文獻(xiàn)中的引用文獻(xiàn)。收集所有比較高滲鹽水與等滲溶液治療顱腦損傷的隨機(jī)對(duì)照試驗(yàn),收集生存率、神經(jīng)功能結(jié)局、凝血功能指標(biāo)、腎功能指標(biāo)等數(shù)據(jù),采用Cochrane協(xié)作網(wǎng)提供軟件Revman5.1進(jìn)行Meta分析。對(duì)二分類變量采用相對(duì)危險(xiǎn)度、數(shù)值變量采用加權(quán)均數(shù)差作為效應(yīng)量,用X2檢驗(yàn)進(jìn)行異質(zhì)性檢驗(yàn),固定效應(yīng)模型采用Mantel-Haens-zel法、隨機(jī)效應(yīng)模型采用DerSimonianLaird法分析。對(duì)于無法合并的資料進(jìn)行描述性分析。 結(jié)果：共檢出1346篇文獻(xiàn),最終納入6個(gè)研究共1730例患者。在療效方面,Meta分析顯示：高滲鹽水組患者機(jī)械通氣時(shí)間縮短(WMD=-2.54,95%CI[-4.56,-0.53]；I2=0%,P=0.96),但患者出院生存率(RR=1.03,95%CI[0.95,1.11];I2=18%,P=0.30).創(chuàng)傷后6月神經(jīng)功能缺損發(fā)生率(RR=1.04,95%CI[0.96,1.13];12=0%,P=0.61).平均住院日(WMD=1.8,95%CI[-10.27,13.86]；I2=0%,P=0.59)與等滲溶液組比較差異均無統(tǒng)計(jì)學(xué)意義。在安全性方面僅進(jìn)行描述性分析,高滲鹽水與等滲溶液相比,在醫(yī)源性神經(jīng)系統(tǒng)病變、腎功能損害及凝血機(jī)制障礙等方面也無明顯差異。 結(jié)論：高滲鹽水治療顱腦損傷與等滲液相比無嚴(yán)重不良反應(yīng),尚無臨床證據(jù)顯示高滲鹽水用于重型顱腦損傷早期治療可改善患者的生存率及神經(jīng)功能結(jié)局。
[Abstract]:Objective: to evaluate the efficacy and safety of hypertonic saline in the early treatment of craniocerebral injury. Methods: according to the method of Cochrane systematic evaluation, Computer search of the Cochrane Library (April 2013), Pubmed (April 2013), China Biomedical Database (April 2013), Tsinghua Tongfang Database (April 2013), Wanfang Database (April 2013), and manual retrieval of references included in the literature. The data of survival rate, nerve function outcome, coagulation function index and renal function index were collected in all the randomized controlled trials of hypertonic saline and isosmotic solution for craniocerebral injury. Cochrane collaboration software Revman 5.1 was used for meta-analysis. The relative risk degree was used for the two classification variables, the weighted mean difference was used as the effect quantity, the X2 test was used for the heterogeneity test, the Mantel-Haens-zel method was used for the fixed effect model, and the DerSimonian Laird method was used for the random effect model. A descriptive analysis of data that cannot be merged is carried out. Results: a total of 1346 articles were detected and 1730 patients were included in 6 studies. Meta-analysis showed that the duration of mechanical ventilation was shortened in hypertonic saline group (WMD-2.54U 95 CI [-4.56 鹵0.53] I _ 2 + 0.96), but the discharge survival rate was 0.30 (RRN 1.03 + 95 CI [0.951.11] I _ 218P ~ (0.30). Six months after trauma, the incidence of neurological impairment (RRN 1.04 鹵95CI [0.96 鹵1.13]) was 120.61). There was no significant difference in average hospitalization days (CI = -10.27 鹵13.86) and isosmotic solution group (WMD-1.895 CI [-10.27 鹵13.86]) and isosmotic solution group (P = 0.59). In terms of safety, there was no significant difference between hypertonic saline and isosmotic solution in iatrogenic neuropathy, renal dysfunction and coagulation mechanism. Conclusion: there is no serious adverse reaction in the treatment of craniocerebral injury with hypertonic saline, and there is no clinical evidence that the early treatment of hypertonic saline for severe craniocerebral injury can improve the survival rate and neurological outcome of patients with severe craniocerebral injury.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R651.15

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本文編號(hào)：2072626