摘要
目的评价阿托伐他汀辅助手术治疗慢性硬膜下血肿(CSDH)的临床疗效。方法计算机检索the Cochrane Library、PubMed、EMBase、中国知网(CNKI)、维普网及万方数据知识服务平台等数据库,检索时间为2009年3月—2019年3月,检索有关阿托伐他汀辅助手术治疗CSDH的随机对照试验(RCT)、回顾性研究及队列研究。对照组患者单纯采用手术治疗,阿托伐他汀组患者于术后给予阿托伐他汀辅助治疗,采用RavMan5.3软件进行Meta分析。比较两组患者有效率、治疗后日常生活活动能力(ADL)评分、治疗后血肿量及术后并发症发生率、复发率。结果最终纳入13篇文献,共包括1 246例患者。Meta分析结果显示,阿托伐他汀组患者有效率〔RR=0.87,95%CI(0.78,0.96)〕和治疗后ADL评分〔MD=10.14,95%CI(4.71,15.58)〕高于对照组,治疗后血肿量少于对照组〔MD=-6.42,95%CI(-9.87,-2.98)〕,术后并发症发生率〔RR=0.42,95%CI(0.21,0.84)〕、术后复发率〔RR=0.16,95%CI(0.09,0.28)〕低于对照组(P<0.05)。绘制报道术后复发率文献发表偏倚的倒漏斗图显示,分布于直线两侧的散点不对称,提示可能存在发表偏倚。结论现有文献证据表明,与单纯手术治疗相比,阿托伐他汀辅助手术治疗能有效提高CSDH患者有效率,改善患者ADL,促进血肿吸收,降低术后并发症发生率及复发率。
Objective To evaluate the clinical effect of atorvastatin-assisted surgery in treating chronic subdural hematoma(CSDH).Methods Databases such as the Cochrane Library,PubMed,EMBase,CNKI,VIP and Wanfang Data were searched to retrieve randomized controlled trials(RCT),retrospective studies and cohort studies about atorvastatinassisted surgery in treating CSDH that reported from March 2009 to March 2019.Patients in control group were treated by surgery only,while the patients in atorvastatin group were treated with atorvastatin after surgery.Meta-analysis was performed by using RavMan 5.3 software.Effective rate,activity of daily living(ADL)score after treatment,hematoma volume after treatment,incidence of postoperative complications and postoperative recurrence rate were compared between the two groups.Results A total of 13 literatures were enrolled,including 1,246 patients.Meta-analysis results showed that,effective rate〔RR=0.87,95%CI(0.78,0.96)〕and ADL score after treatment〔MD=10.14,95%CI(4.71,15.58)〕in atorvastatin group were statistically significantly higher than those in control group,hematoma volume after treatment in atorvastatin group was statistically significantly less than that in control group〔MD=-6.42,95%CI(-9.87,-2.98)〕,incidence of postoperative complications〔RR=0.42,95%CI(0.21,0.84)〕and postoperative recurrence rate〔RR=0.16,95%CI(0.09,0.28)〕in atorvastatin group were statistically significantly lower than those in control group(P<0.05).Inverted funnel plot for publication bias of literatures reported postoperative recurrence rate showed that,the scattered points were not complete symmetrical,thus publication bias may exist.Conclusion Existing literature evidence suggests that,compared with surgery only,atorvastatinassisted surgery can effectively improve the effective rate and ADL in patients with CSDH,promote the absorption of hematoma,reduce the incidence of postoperative complications and postoperative recurrence rate.
作者
秦晓雅
万力源
赵晓平
范小璇
王凯
杨永锋
马思田
王欢
QIN Xiaoya;WAN Liyuan;ZHAO Xiaoping;FAN Xiaoxuan;WANG Kai;YANG Yongfeng;MA Sitian;WANG Huan(The First Clinical Medical College,Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China;Department of Brain Surgery,the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine(Shaanxi Provincial Traditional Chinese Medicine Brain Disease Clinical Medical Research Center),Xianyang 712000,China)
出处
《实用心脑肺血管病杂志》
2019年第8期26-30,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
国家自然科学基金资助项目（81873288）
陕西省重点研发计划项目（2018SF-311）
陕西省中医脑病临床医学研究中心建设项目（201704）
陕西中医药大学学科创新团队建设项目（2019-YL15）
关键词
硬膜下血肿
慢性
阿托伐他汀
外科手术
辅助治疗
治疗结果
META分析
Subdural hematoma,chronic
Atorvastatin
Surgical procedures,operative
Adjuvant therapy
Treatment outcome
Meta-analysis
