本文關(guān)鍵詞： 血壓 強(qiáng)化血壓管理 腦出血 系統(tǒng)綜述　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景： 腦出血急性期血壓控制的合適目標(biāo)存在爭議。本文主要評價自發(fā)性腦出血急性期強(qiáng)化降壓與標(biāo)準(zhǔn)血壓管理相比是否安全有益。 方法： 在Medline及Embase系統(tǒng)的檢索1990年至2013年期間發(fā)表的有關(guān)腦出血急性期強(qiáng)化降壓與標(biāo)準(zhǔn)血壓管理相比的臨床隨機(jī)對照研究。評價各個納入研究的質(zhì)量。應(yīng)用隨機(jī)效應(yīng)模型進(jìn)行數(shù)據(jù)合并。計算合并的比值比和95%置信區(qū)間。 結(jié)果： 共納入4項研究，包括3350例患者，其中強(qiáng)化降壓組1630例，標(biāo)準(zhǔn)血壓管理組1662例共三項研究報告了兩組平均血腫增加量的數(shù)據(jù)。三項研究中的兩組血腫增加的差異均未達(dá)到統(tǒng)計學(xué)意義。把三項研究的數(shù)據(jù)進(jìn)行合并后表明，強(qiáng)化降壓組血腫增加的量顯著低于標(biāo)準(zhǔn)血壓管理組(平均差為-1.54,95%置信區(qū)間為-2.92至-0.16, p＜0.05)。 共三項研究報告了兩組90天死亡率的數(shù)據(jù)。三項研究中的兩組90天死亡率差異均未達(dá)到統(tǒng)計學(xué)意義。把三項研究的數(shù)據(jù)進(jìn)行合并后表明，兩組90天死亡率無顯著差異(比值比為0.97,95%置信區(qū)間0.79到1.20, p0.05)。 共三項研究報告了兩組90天不良預(yù)后的數(shù)據(jù)。三項研究中的兩組90天不良預(yù)后的差異均未達(dá)到統(tǒng)計學(xué)意義。把三項研究的數(shù)據(jù)進(jìn)行合并后表明，強(qiáng)化血壓管理組90天不良預(yù)后的發(fā)生率低于標(biāo)準(zhǔn)血壓管理組(比值比為0.89,95%置信區(qū)間0.77到1.02)，，但差異未達(dá)統(tǒng)計學(xué)意義(p0.05)。 共四項研究報告了兩組血腫明顯增加的患者的例數(shù)。四項研究中的兩組血腫明顯增加的患者的比例差異均未達(dá)到統(tǒng)計學(xué)意義。把四項研究的數(shù)據(jù)進(jìn)行合并后表明，兩組血腫明顯增加的患者比例無顯著差異(比值比為0.91,95%置信區(qū)間0.59到1.50, p0.05)。 共四項研究報告了兩組早期神經(jīng)功能惡化的患者的例數(shù)。四項研究中的兩組早期神經(jīng)功能惡化的患者發(fā)生率差異均未達(dá)到統(tǒng)計學(xué)意義。把四項研究的數(shù)據(jù)進(jìn)行合并后表明，兩組早期神經(jīng)功能惡化的患者比例無顯著差異(比值比為0.97,95%置信區(qū)間0.80到1.18,p0.05)。 共兩項研究報告了兩組早期嚴(yán)重不良反應(yīng)的發(fā)生率。兩項研究中的兩組早期嚴(yán)重不良反應(yīng)的發(fā)生率的差異均未達(dá)到統(tǒng)計學(xué)意義。把兩項研究的數(shù)據(jù)進(jìn)行合并后表明，兩組早期嚴(yán)重不良反應(yīng)的患者比例無顯著差異(比值比為0.98,95%置信區(qū)間0.83到1.16, p0.05)。異質(zhì)性檢驗顯示無異質(zhì)性(pQ0.10, I250%)。 結(jié)論： 該研究表明，腦出血急性期強(qiáng)化降壓與標(biāo)準(zhǔn)血壓管理相比安全性無差別，但可能能獲得較好的預(yù)后。還需要以后的研究以進(jìn)一步明確腦出血急性期強(qiáng)化降壓的效果和安全性。
[Abstract]:Background:. The appropriate target of blood pressure control in acute stage of intracerebral hemorrhage is controversial. This paper mainly evaluates whether intensive hypotension in the acute stage of spontaneous cerebral hemorrhage is safe and beneficial compared with standard blood pressure management. Methods:. A randomized controlled clinical study on intensive hypotension in acute phase of intracerebral hemorrhage compared with standard blood pressure management, published between 1990 and 2013 in Medline and Embase systems, was conducted to evaluate the quality of each study. The ratio ratio and 95% confidence interval are calculated. Results:. A total of 4 studies were included, including 3350 patients, including 1630 patients in the enhanced hypotension group. Three studies of 1662 patients in the standard blood pressure management group reported data on the mean hematoma increase in the two groups. The difference in hematoma increase between the two groups in the three studies was not statistically significant. The increase of hematoma in the enhanced hypotension group was significantly lower than that in the standard blood pressure management group (mean difference was -1.54 鹵95% confidence interval -2.92 to -0.16, p < 0.05). Three studies reported two groups of 90-day mortality data. The difference in 90-day mortality was not statistically significant in two of the three studies. There was no significant difference in 90-day mortality between the two groups (the ratio ratio was 0.97% 95% confidence interval 0.79 to 1.20, p 0.05). A total of three studies reported data on 90 days of poor prognosis in two groups. The difference in 90 days was not statistically significant between the two groups in the three studies. Combining the data from the three studies showed that, The incidence of adverse prognosis in the intensive blood pressure management group was lower than that in the standard blood pressure management group (the ratio ratio was 0.89% 95% confidence interval from 0.77 to 1.02), but the difference was not statistically significant (P 0.05). Four studies reported the number of patients with a significant increase in hematoma in two groups. The difference in the proportion of patients with a significant increase in hematoma was not statistically significant between the two groups of patients in the four studies. Data from the four studies were combined to show that, There was no significant difference between the two groups in the proportion of patients with significantly increased hematoma (the ratio ratio was 0.91% 95% confidence interval 0.59 to 1.50, p 0.05). A total of four studies reported the number of patients with early neurological deterioration in two groups. There was no statistically significant difference in the incidence of early neurological deterioration between the two groups in the four studies. There was no significant difference between the two groups in the proportion of patients with early neurological deterioration (the ratio ratio was 0.97 95% confidence interval 0.80 to 1.18 渭 p 0.05). Two studies reported the incidence of early severe adverse reactions in both groups. There was no statistically significant difference in the incidence of early severe adverse reactions between the two groups. There was no significant difference between the two groups in the proportion of patients with early severe adverse reactions (the ratio ratio was 0.9895% confidence interval 0.83 to 1.16, p0.050.The heterogeneity test showed no heterogeneity: pQ0.10, I250). Conclusion:. This study shows that intensive hypotension in acute stage of intracerebral hemorrhage is no different from standard blood pressure management, but it may be able to obtain better prognosis. Further study is needed to further determine the effect and safety of intensive hypotension in acute stage of intracerebral hemorrhage.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.34

【共引文獻(xiàn)】

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