發(fā)布時間：2019-07-04 15:55

【摘要】：目的采用Meta分析方法定性分析影響顱腦創(chuàng)傷后腦積水發(fā)生的危險因素,這里探討兩個因素,分別為單側(cè)與雙側(cè)去骨瓣減壓術,以及去骨瓣減壓術后繼發(fā)于頭顱不同部位的硬膜下積液與創(chuàng)傷后腦積水之間的相關性。方法(1)依據(jù)研究主題設置檢索詞,應用布爾邏輯運算符使其連接成可以運行的檢索式,分別檢索中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)、中國知網(wǎng)、維普、萬方等中文數(shù)據(jù)庫,以及EMBASE,Pub Med,MEDLINE,Web of Knowledge(WOK)and Cochrane Database of Systematic Reviews等外文數(shù)據(jù)庫,并利用學術搜索及全文遞送綜合服務平臺檢索全球其他開放性數(shù)據(jù)資源、專利、會議論文及書信。檢索時間設定為2000年1月至2015年1月公開發(fā)表的,關于探討去骨瓣減壓術及硬膜下積液與顱腦損傷后腦積水相關性的基于病例-對照研究的中、英文文獻。(2)由2名評論員依據(jù)納入及排除標準獨立篩查所選文獻,并提取目標數(shù)據(jù),依據(jù)NOS對各研究進行質(zhì)量評價并計錄得分。采用Comprehensive Meta-Analysis v3軟件進行分析,先行異質(zhì)性檢驗,同質(zhì)性好的數(shù)據(jù)采用固定效應模型進行效應量的合并,異質(zhì)性高的需先處理異質(zhì)性;設置分組變量進行亞組分析;按逐次剔除單個研究的方法行敏感性分析確定單個研究在整體效應量中的比重;按照時間順序進行累積Meta分析,用以觀察時間疊加對OR值的影響;采用漏斗圖及漏斗圖剪補圖檢測發(fā)表偏倚;以NOS得分和OR值分別作為解釋變量、結(jié)局變量進行回歸分析,檢測異質(zhì)性和研究質(zhì)量有無關聯(lián)。結(jié)果針對去骨瓣減壓術與硬膜下積液兩不同暴露因素,這里有兩次獨立的Meta分析。(1)去骨瓣減壓術和創(chuàng)傷后腦積水之間相關性的Meta分析:共納入18篇發(fā)表于2006年至2015年的關于去骨瓣減壓術和創(chuàng)傷后腦積水之間相關性的病例對照研究,其中中文15篇,英文3篇,暴露組與非暴露組共4665例研究對象,研究地區(qū)包含中國、韓國、澳大利亞。(1)不區(qū)分單側(cè)和雙側(cè)去骨瓣減壓行異質(zhì)性檢驗I2=74.955%,采用隨機效應模型合并效應量(OR 5.531;95%CI3.889,7.868;p0.05),發(fā)表偏倚檢測結(jié)果提示存在很明顯的發(fā)表偏倚。(2)設置去骨瓣數(shù)目為分組變量,行亞組分析,其中單側(cè)去骨瓣減壓組合并效應量(OR3.503;95%CI 2.498,4.912;p0.05),雙側(cè)去骨瓣減壓組(OR 21.481;95%CI10.599,43.537;p0.05)。(3)單獨將單側(cè)去骨瓣減壓作為暴露因素進行分析,異質(zhì)性檢驗I2=45.155%,采用固定效應模型得出合并效應量(OR 3.809;95%CI3.074,4.721;p0.05);敏感性分析中,剔除單個研究后其他研究的合并OR值在3.8左右波動,95%CI重合度高;累積Meta分析總體效應量OR值趨于3.8~4.0,隨著時間疊加總體合并效應量變化波動不大;發(fā)表偏倚檢測提示并不存在很明顯的發(fā)表偏倚。(4)雙側(cè)去骨瓣組Meta分析,異質(zhì)性檢驗I2=0,固定效應模型合并效應量(OR 21.481;95%CI 10.599,43.537;p0.05);敏感性分析及累積Meta分析均指示合并效應量較為穩(wěn)健,無發(fā)表偏倚存在,回歸分析結(jié)果無線性關系。(2)硬膜下積液和創(chuàng)傷后腦積水發(fā)生的相關性的Meta分析:納入8篇發(fā)表于2012年至1015年相關文獻,中文5篇,英文3篇,研究地區(qū)包括中國、韓國、澳大利亞。(1)不區(qū)分單側(cè)及縱裂間硬膜下積液,異質(zhì)性檢驗I2=38.894%,采用固定效應模型合并(OR 3.267;95%CI 2.325,4.589;p0.05)。(2)將單側(cè)硬膜下積液作為暴露因素進行分析,異質(zhì)性檢驗I2=47.583%,合并效應量(OR3.259;95%CI 2.312,4.594;p0.05);敏感性分析及累積Meta分析皆較為穩(wěn)健;無發(fā)表偏倚存在。(3)縱裂間硬膜下積液組,異質(zhì)性檢驗I2=0,采用固定效應模型合并效應量(OR 14.895;95%CI 6.296,35.239;p0.05);敏感性分析提示存有差異;累積Meta分析顯示2014年、2015年合并效應量趨于穩(wěn)定;未檢測出明顯發(fā)表偏倚;回歸分析不支持該研究的質(zhì)量評價和異質(zhì)性有關。結(jié)論本次Meta分析結(jié)果顯示顱腦創(chuàng)傷后腦積水與去骨瓣減壓術及硬膜下積液存在相關性,去骨瓣減壓術及繼發(fā)的硬膜下積液是創(chuàng)傷后腦積水發(fā)生的危險因素,而雙側(cè)去骨瓣減壓和縱裂間硬膜下積液更容易導致創(chuàng)傷后腦積水的發(fā)生。因此對于顱腦創(chuàng)傷患者,是否行去骨瓣減壓需慎重選擇,并且早期干預顱腦創(chuàng)傷后硬膜下積液,減少腦積水的發(fā)生。
[Abstract]:Objective To analyze the risk factors of the occurrence of hydrocephalus after head trauma by using a meta-analysis method. And the correlation between the subdural effusion secondary to the different parts of the skull and the post-traumatic hydrocephalus. The method comprises the following steps: (1) setting a search term according to the topic of the study, and connecting the search words into a search type which can be run by using a Boolean logic operator to search the Chinese database (CBM) of the Chinese medicine literature database (CBM), the Chinese knowledge network, the Weipu, the Wanfang and the like, and the EMBASE, the pub Med and the MEDLINE, The Web of Knowledge (WOK) and the Cochrane Database of System Revews and other foreign language databases, and using the academic search and full-text delivery comprehensive service platform to retrieve other open-label data resources, patents, conference papers and letters from the world. The search time was set to be published from January 2000 to January 2015, in the Chinese and English literature on the case-control study of the study of the association of depressor and subdural hydrops with head injury. (2) The selected documents are screened independently by two commentators according to the inclusion and exclusion criteria, and the target data is extracted, and the quality evaluation and the score of each study are carried out according to the NOS. The analysis is carried out by using the Comprehensive Meta-Analysis v3 software, the data of the homogeneity test and the homogeneity are combined with the fixed effect model, the heterogeneity is high, the heterogeneity is first processed, and the grouping variables are set for subgroup analysis; The specific gravity of a single study in the overall effect volume was determined according to the method line sensitivity analysis of the single study by successive elimination; the cumulative meta-analysis was carried out according to the time order to observe the effect of the time overlap on the OR value; The NOS score and the OR value were used as an explanatory variable, and the outcome variable was returned to the regression analysis, and the heterogeneity and the quality of the study were detected. Results Two independent meta-analysis was performed on the two different exposure factors of depressor and subdural effusion. (1) Meta-analysis of the correlation between depressor and post-traumatic hydrocephalus: a total of 18 case-control studies published between 2006 and 2015 on the correlation between depressor and post-traumatic hydrocephalus, of which 15 in Chinese and 3 in English, A total of 4665 subjects were studied in the exposed and non-exposed groups, including China, South Korea and Australia. (1)2 = 74.955% of the two-sided and two-sided depressor line were not distinguished, and the combined effect of the random effect model was used (OR 5.531;95% CI 3.889, 7.868; p0.05). (2) The number of deboned flaps was set to be a group variable, and the subgroup analysis was performed, with one-sided debonectomy combined with the effect amount (ORR3.503;95% CI 2.498, 4.912; p0.05), and the bilateral debonectomy group (OR 21.481;95% CI 10.599, 43.537; p0.05). (3) The decompression of one-sided deboned valve was performed as an exposure factor, the heterogeneity test was 2 = 45.155%, and the combined effect was obtained by the fixed-effect model (OR 3.809;95% CI 3.074, 4.721; p0.05); in the sensitivity analysis, the combined OR value of the other studies after the single study was changed to about 3.8 and the 95% CI was high; The cumulative effect of cumulative meta-analysis tended to be 3.8 ~ 4.0, and the change of total combined effect was not large with time. (4) Meta-analysis of bilateral debonectomy group, heterogeneity test I2 = 0, fixed effect model combined effect (OR 21.481;95% CI 10.599, 43.537; p0.05); sensitivity analysis and cumulative meta-analysis both indicate that the combined effect is more robust, no publication bias exists, and the regression analysis result has no linear relationship. (2) Meta-analysis of the correlation between subdural effusion and post-traumatic hydrocephalus:8 articles published in 2012-1015,5 in Chinese and 3 in English, including China, South Korea and Australia. (1) There was no differentiation between unilateral and longitudinal subdural effusion, the heterogeneity of I2 = 38.894%, and the combination of fixed effect model (OR 3.267;95% CI 2.325, 4.589; p0.05). (2) The single-sided subdural effusion was analyzed as an exposure factor, the heterogeneity test was 2 = 47.583%, the combined effect (OR3.259;95% CI 2.312, 4.594; p0.05); the sensitivity analysis and the cumulative meta-analysis were all robust; no publication bias exists. (3) In the subdural effusion group, the heterogeneity test of I2 = 0, the combined effect of the fixed effect model (OR 14.895;95% CI 6.296, 35.239; p0.05); the sensitivity analysis suggested there was a difference; the cumulative meta-analysis showed that the combined effect in 2014 and 2015 was stable; no apparent bias was detected; The regression analysis does not support the quality evaluation and heterogeneity of the study. Conclusion The results of this meta-analysis show that the risk factors of post-traumatic hydrocephalus and subdural hydrops are related to the decompression and subdural hydrops of the patients with head trauma, and the risk factors of the occurrence of post-traumatic hydrocephalus after the decompression and the subdural hydrops are the risk factors of the post-traumatic hydrocephalus. However, bilateral depressor and longitudinal subdural hydrops can lead to the occurrence of post-traumatic hydrocephalus. Therefore, for the patients with head trauma, whether to go to the decompression of the bone flap is to be carefully selected, and the early intervention of the subdural effusion after the head injury can reduce the occurrence of hydrocephalus.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R651.1

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