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目的采用meta分析的方法系统比较7.5%高渗氯化钠溶液(hypertonic saline,HS)和甘露醇降低颅内压(intracranial pressure,ICP)的效果,以期为临床应用提供依据。方法检索自建库至2016年1月Cochrane Library、Pub Med、Embase、中国生物医学文献数据库、中国知网、维普和万方数据库文献中关于7.5%HS与甘露醇降低颅内高压的随机对照试验的相关文献,同时追索纳入文献的参考文献,根据纳入与排除标准进行文献筛选、质量评价和数据提取后,应用Revman 5.3软件对各项指标进行Meta分析。结果最终纳入10篇文献共447例患者,其中,应用7.5%HS患者226例(HS组),应用甘露醇患者221例(甘露醇组)。Meta分析结果显示:7.5%HS在降低ICP效果方面较甘露醇更佳(P=0.020),且7.5%HS降低ICP维持时间更长(P=0.004)。干预后CVP水平、血浆渗透压以及血清钠水平与甘露醇差异均无统计学意义。干预后MAP水平HS组低于甘露醇(P<0.001)。结论 7.5%HS和甘露醇均能有效地降低颅内高压且持续时间更长,但维持平均动脉压的效果不如甘露醇。
Objective To compare the effects of 7.5% hypertonic saline (HS) and mannitol on intracranial pressure (ICP) by meta-analysis, in order to provide a basis for clinical application. Methods A randomized controlled trial of 7.5% HS and mannitol for reducing intracranial hypertension was retrieved from the self-constructed database to the January 2016 Cochrane Library, Pub Med, Embase, China Biomedical Literature Database, CNKI, VIP and Wanfang Database The related literatures were retrieved at the same time. References included in the literature were recalled. After screening, quality evaluation and data extraction according to inclusion and exclusion criteria, Meta-analysis was performed on each index using Revman 5.3 software. Results A total of 447 patients were enrolled in 10 articles, including 226 patients (HS group) with 7.5% HS and 221 patients (mannitol group) with mannitol. Meta-analysis showed that 7.5% HS was better than mannitol in reducing ICP (P = 0.020), and 7.5% HS reduced ICP longer (P = 0.004). CVP level after intervention, plasma osmolality and serum sodium levels and mannitol differences were not statistically significant. The level of MAP in HS group was lower than that of mannitol after intervention (P <0.001). Conclusion 7.5% HS and mannitol can effectively reduce intracranial hypertension and last longer, but the effect of maintaining mean arterial pressure is not as good as that of mannitol.