七叶皂苷钠联合甘露醇治疗脑出血有效性 和安全性的Meta 分析

Meta analysis of efficacy and safety of sodium aescinate in combined treatment of cerebral hemorrhage

摘要:

目的 采用Meta 分析评价七叶皂苷钠联合甘露醇治疗脑出血的有效性及安全性。方法 通过检 索Embase、PubMed、CNKI、维普及万方数据库公开发表的七叶皂苷钠联合甘露醇治疗脑出血的随机对照 研究，检索期限截至2019 年10 月。由2 位研究人员独立对纳入研究进行文献筛选、资料提取和质量评价后， 采用Rev Man 5.3 软件进行Meta 分析。结果 共纳入19 项研究，其中包括1 829 例患者。Meta 分析结果显示， 试验组的临床有效率高于对照组[Rl ^ R=1.27（95% CI ：1.22，1.33），P =0.000] ；试验组治疗后神经功能缺损改 善情况优于对照组[WMD=6.98（95% CI ：6.34，7.62），P =0.000] ；试验组经治疗后脑血肿吸收情况优于对照 组[WMD=4.38（95% CI ：3.45，5.31），P =0.000] ；试验组治疗过程中不良反应发生率低于对照组[Rl ^ R=0.40 （95% CI ：0.24，0.65），P =0.000]。结论 与单用甘露醇相比，七叶皂苷钠联合甘露醇治疗脑出血能显著提高 临床有效率，改善神经功能缺损状况，促进脑血肿吸收，且不良反应发生率也显著降低。

Abstract:

Objective To systematically review the efficacy and safety of aescinate combined with mannitol in the treatment of cerebral hemorrhage, by the access of meta analysis and on the basis of current clinical research. Methods Retrieved from PubMed, Embase, CNKI, Wanfang database and VIP, randomized controlled trials about therapeutic efficacy of aescinate combined with mannitol in the treatment of cerebral hemorrhage were collected from base-building to Oct.2019. After two reviewers independently screening literature, extracting data and evaluating the quality of included studies, meta-analysis was conducted by using Rev Man5.3. Results A total of 19 RCTs involving 1829 participants were included. Meta analysis showed that the clinical efficacy of aescinate combined with mannitol in the treatment of cerebral hemorrhage was better than that of control group [Rl ^ R=1.27 (95% CI: 1.22, 1.33), P = 0.000); but the risk of adverse reactions was significantly lower than control group [Rl ^ R=0.40 (95% CI: 0.24, 0.65), P = 0.000]; the neurological deficit scores after treatment [WMD=6.98 (95% CI: 6.34, 7.62), P = 0.000] and the absorption of brain edema [WMD=4.38 (95% CI: 3.45, 5.31), P = 0.000] were better than that of control group. Conclusion The current evidence indicates that the aescinate combined with mannitol can significantly promoted the absorption of brain edema,improve the clinical efficacies and neurological deficits, and significantly decreased the risk of adverse reactions. However, due to limited quality of the included studies, it is still necessary to use more foresight, multicenter, large scale well-designed and high quality studies to verify the above conclusion.