吡拉西坦治疗颅内肿瘤术后颅内高压的有效性及安全性Meta分析被引量：1

A Meta-analysis on efficacy and safety of piracetam in reducing intracranial hypertension after intracranial tumor surgery

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摘要目的评价吡拉西坦治疗颅内肿瘤术后颅内高压的有效性及安全性。方法检索PubMed、the Cochrane Library、Embase、中国知网、万方和维普数据库,收集吡拉西坦(试验组)对比甘露醇(对照组)治疗颅内肿瘤术后颅内高压疗效和安全性的随机对照试验(RCT),提取符合纳入标准的临床研究资料,采用RevMan 5.2统计软件进行Meta分析。结果共纳入18项RCT,包括1675例患者(试验组840例,对照组835例)。Meta分析结果显示,吡拉西坦治疗颅内肿瘤术后颅内高压总有效率[RR=1.09,95%CI(1.06~1.12),P<0.01]和显效率[RR=1.30,95%CI(1.20~1.41),P<0.01]均优于甘露醇,胃肠道不良反应发生率[RR=0.32,95%CI(0.15~0.88),P<0.01]和血尿发生率[RR=0.25,95%CI(0.07~0.88),P<0.05]均低于甘露醇。两组低钾血症发生率无统计学差异[RR=0.30,95%CI(0.09~1.00),P>0.05]。结论在减轻颅内肿瘤术后颅内高压方面,吡拉西坦比甘露醇更具有效性及安全性,不良反应较少。然而本研究目前无高质量、多中心RCT研究,结论有待进一步验证。 Objective To evaluate the efficacy and safety of piracetam in the treatment of the patients with intracranial hypertension after intracranial tumor surgery.Methods The data of randomized controlled trials（RCT）relevant to the treatments for reducing intracranial hypertension after intracranial tumor surgery were collected by searching PubMed,the Cochrane Library,Embase,CNKI,Wanfang and VIP databases.The clinical research materials met with the inclusion criteria were extracted and analyzed with RevMan 5.2 statistical software.Results A total of 18 RCT involving1675 patients was selected（piracetam group 840 cases,mannitol group 835 cases）.The results of Meta-analysis indicated that compared with mannitol in the treatment of intracranial hypertension after intracranial tumor surgery,piracetam had significantly higher total effective rate[RR=1.09,95%CI（1.06-1.12）,P〈0.01]and excellent rate of clinical efficacy[RR=1.30,95%CI（1.20-1.41）,P〈0.01].The incidence rates of gastro-intestinal tract response[RR=0.32,95%CI（0.15-0.88）,P〈0.01]and hematuria[RR=0.25,95%CI（0.07-0.88）,P〈0.05]were significantly lower in piracetam group than those in mannitol group.There was no significant difference in the incidence of hypokalemia[RR=0.30,95% CI（0.09-1.00）,P〉0.05]between two groups.Conclusion For patients with intracranial hypertension after intracranial tumor surgery,the efficacy and safety of piracetam treatment are better than mannitol with less incidence of adverse responses.Limited by the quantity and quality of the studies included,more large size,multi-center,high-quality RCT are needed to verify the above conclusion.