论文部分内容阅读
目的:通过系统评价有关苯妥英钠预防颅脑损伤后早期癫痫的文献,评估苯妥英钠预防颅脑损伤后早期癫痫发作的有效性。方法:在Medline数据库、Pubmed数据库、Embase数据库和Cochrane Library和中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库中输入检索词检索有关苯妥英钠用于颅脑损伤后早期癫痫防治的随机对照试验(randomized controlled trials,RCTs)文献,并且筛选符合纳入标准的文献,提取文献中数据进行Meta分析。采用相对危险度(relative risk,RR)分析早期癫痫的发作率。研究间的异质性采用Q检验法检验,并采用经自由度(文献数)校正后的I2值进行定量。若异质性检验结果为P>0.01,或I2≤50%,用固定效应模型(fixed-effect model)计算合并效应;反之,采用随机效应模型(randomized-effect model)计算合并效应。结果:共纳入1 657位患者在内的8篇文献,861位患者纳入苯妥英钠试验组,796位患者纳入阴性对照组。各文献间异质性不明显(I2=8%,P=0.36),采用固定效应模型对早期癫痫防治作用进行META分析。结果显示,在颅脑损伤中苯妥英钠试验组早期癫痫发作率较对照组低,2组差异有统计学意义(RR=0.38,95%CI:0.26,0.56,P<0.000 01);在颅脑创伤中苯妥英钠试验组早期癫痫较对照组低,2组差异有统计学意义(RR=0.33,95%CI:0.19,0.59,P=0.000 2);在颅脑外科手术中苯妥英钠试验组早期癫痫发作率较对照组低,2组差异有统计学意义(RR=0.43,95%CI:0.25,0.71,P=0.001)。结论:苯妥英钠能够有效预防颅脑损伤后早期癫痫发作。
OBJECTIVE: To assess the efficacy of phenytoin in preventing early epileptic seizures after craniocerebral injury through a systematic review of the literature on the prevention of early seizures after head injury with phenytoin. Methods: Enter the search term in the Medline database, Pubmed database, Embase database, Cochrane Library and Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang database for the search of phenytoin sodium for early brain injury Randomized controlled trials (RCTs) of epilepsy prevention and control, and screened the documents that meet the inclusion criteria, and extracted the data in the literature for meta-analysis. The relative risk (RR) was used to analyze the incidence of early epilepsy. The heterogeneity between studies was tested by Q test and quantified using I2 values corrected by degrees of freedom (number of documents). If the heterogeneity test is P> 0.01, or I2≤50%, the combined effect is calculated using a fixed-effect model; otherwise, the combined effect is calculated using a randomized-effect model. RESULTS: Eight articles enrolled 1 657 patients, 861 patients in the phenytoin sodium trial group and 796 patients in the negative control group. The heterogeneity of each literature was not significant (I2 = 8%, P = 0.36). META analysis was performed on the prevention and treatment of early epilepsy using fixed effect model. The results showed that the incidence of early seizure in the experimental group was lower than that in the control group (P <0.000 01), the difference was statistically significant in the two groups (RR 0.38, 95% CI 0.26, 0.56, P 0.0001) In the PHT group, the early epilepsy in the trauma group was lower than that in the control group, with significant difference between the two groups (RR = 0.33, 95% CI: 0.19, 0.59, P = 0.0002) The seizure rate was lower than that of the control group, with significant difference between the two groups (RR = 0.43, 95% CI: 0.25, 0.71, P = 0.001). Conclusion: Phenytoin sodium can effectively prevent early seizures after craniocerebral injury.