【摘要】：目的系統(tǒng)評價比較超早期(24 h)與延期(≥24 h)血管內(nèi)栓塞治療顱內(nèi)破裂動脈瘤的安全性和有效性。方法根據(jù)納入、排除標準及檢索策略,檢索Pub Med、Embase、Cochrane圖書館、維普、萬方數(shù)據(jù)和相關期刊論文等,獲得超早期和延期應用血管內(nèi)栓塞治療顱內(nèi)破裂動脈瘤的臨床文獻,采用Review Manager 5.3軟件對治療預后良好率、術后病死率、術后再出血率等進行Meta分析。結(jié)果共納入10篇文獻,其中9篇為回顧性對照研究,1篇為前瞻性對照研究。共納入2 021例患者,其中采用超早期治療的患者970例,采用延期治療患者1 051例。超早期組患者的預后良好率(OR=2.67,95%CI:2.07~3.44)、術后再次出血率(OR=0.23,95%CI:0.11~0.47)與延期組差異均有統(tǒng)計學意義(均P0.01),而兩組術后病死率差異無統(tǒng)計學意義(OR=0.76,95%CI:0.51~1.13,P=0.17)。亞組分析顯示,超早期組的預后良好率與早期組(3 d,OR=1.98,95%CI:1.33~2.95)、中晚期組(≥3 d,OR=4.66,95%CI:2.21~9.81)比較,差異均有統(tǒng)計學意義(均P0.01)。結(jié)論超早期血管內(nèi)栓塞治療顱內(nèi)破裂動脈瘤比延期治療有可能提高預后良好率,減少再出血率,并未增加術后病死率。但尚需更多高質(zhì)量、大樣本的隨機對照試驗證實。
[Abstract]:Objective to evaluate the safety and efficacy of endovascular embolization in the treatment of intracranial ruptured aneurysms. Methods according to the inclusion, exclusion criteria and retrieval strategy, the Pub Med,Embase,Cochrane library, Weip, Wanfang data and the full text database of Chinese Journal were searched to obtain the clinical literature of endovascular embolization in the treatment of ruptured intracranial aneurysms. Review Manager 5.3 software was used to analyze the rate of good prognosis, postoperative mortality and postoperative rebleeding rate by Meta. Results A total of 10 articles were included, of which 9 were retrospective controlled studies and 1 prospective controlled study. A total of 2 021 patients were included, of whom 970 received super early treatment and 1 051 received delayed treatment. The rate of good prognosis (OR=2.67,95%CI:2.07~3.44), postoperative rebleeding rate (OR=0.23,95%CI:0.11~0.47) and delayed group were significantly different (P0.01), but there was no significant difference in mortality (OR=0.76,95%CI:0.51~1.13,P=0.17) between the two groups. The subgroup analysis showed that there were significant differences between the early group and the early group (1.98% CI: 1.33 2.95) and the middle and late stage group (鈮，

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