摘要
目的系统评价纳洛酮治疗病毒性脑炎的疗效与安全性。方法计算机检索Medline、Cochrane图书馆、EMbase、CBM、CNKI、万方从建库至2012年2月收录的相关中英文文献,收集所有关于在抗病毒、肾上腺皮质激素以及脱水、止惊、降温等综合治疗的基础上,辅助应用纳洛酮治疗病毒性脑炎对照试验。根据纳入与排除标准筛选文献、评价质量、提取资料,采用RevMan 5.1软件进行Meta分析。结果共纳入5个对照试验,包括279例病毒性脑炎患者。Meta分析结果显示:纳洛酮的应用对13岁以上病毒性脑炎患者的总有效率[RR=1.15,95%(0.94,1.42),P=0.18]及死亡率[RR=0.45,95%(-0.17,1.16),P=0.10]并无影响,但可以缩短退热时间[WMD=0.85,95%(-1.74,0.03),P=0.06]、头痛消失时间[WMD=0.40,95%(-0.55,0.25),P<0.000 01]、抽搐停止时间[WMD=0.87,95%(-1.09,-0.66),P<0.000 01]、意识恢复时间[WMD=1.10,95%(-2.05,-0.15),P=0.02]、脑膜刺激征消失时间[WMD=0.15,95%(-0.73,0.29),P<0.000 01]、呼衰纠正时间[WMD=1.22,95%(-2.11,-0.33),P=0.007]及病程[WMD=1.38,95%(-2.65,-0.11),P=0.03]。结论现有证据表明,纳洛酮不能提高病毒性脑炎的疗效,但对改善症状有一定帮助。受本系统评价纳入研究数量和质量的限制,上述结论尚需更多高质量的随机对照试验验证。
Objective To assess the efficacy and safety of naloxone on viral encephalitis systematically.Methods We searched the Medline,Cochrane Library,EMbase,CBM,CNKI,Wan Fang Data until February 2012 to collect all controlled trials of naloxone-assisted therapy including anti-virus,adrenal cortex hormone,dehydration,anti-convulsion and hypothermy for viral encephalitis.The language was confined to English and Chinese.We screened the retrieved studies according to the predefined inclusion and exclusion criteria,evaluated the quality of included studies,extracted information,and performed meta-analyses by using the RevMan 5.1 software.Results Five controlled trails involving 279 patients with viral encephalitis were included and assessed.Meta-analysis showed that naloxone had no effect on efficacy [RR=1.15,95%（0.94,1.42）,P=0.18] and mortality [RR=0.45,95%（0.17,1.16）,P=0.10] of patients with viral encephalitis older than 13 years of age.However,it shortened the pyretolysis [WMD=0.85,95%（-1.74,0.03）,P=0.06],headache extinction [WMD=0.40,95%（-0.55,0.25）,P0.00001],convulsion extinction [WMD=0.87,95%（-1.09,-0.66）,P0.00001],consciousness recovery time [WMD=1.10,95%（-2.05,-0.15）,P=0.02],meningeal irritation sign extinction [WMD=0.15,95%（-0.73,0.29）,P0.00001],respiratory rectification time [WMD=1.22,95%（-2.11,-0.33）,P=0.007] and pathogenesis [WMD=1.38,95%（-2.65,-0.11）,P=0.03].Conclusions The limited evidence indicates that naloxone cannot improve the efficacy of viral encephalitis treatment,but it is useful for symptom improvement.More RCTs are required to verify these conclusions owing to the limitations of the present study.
出处
《华西医学》
CAS
2013年第6期853-858,共6页
West China Medical Journal
关键词
纳洛酮
病毒性脑炎
对照试验
系统评价
Naloxone
Viral encephalitis
Controlled trials
Systematic review
