Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
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DOI：
10.1038/jcbfm.2011.7
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发表时间：
2011-06-01
影响因子：
6.3
通讯作者：
Macdonald, R. Loch
中科院分区：
文献类型：
--
作者：
Etminan, Nima;Di Vergouwen, Mervyn;Macdonald, R. Loch
由于通常认为蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）是由血管痉挛引起的，临床试验往往侧重于血管痉挛的预防，以改善临床预后。然而，血管痉挛在DCI发病机制和临床结果中的作用可能比以前认为的要小。我们对所有研究药物预防策略对SAH患者血管痉挛、DCI和临床结局影响的随机、双盲、安慰剂对照试验进行了系统回顾和荟萃分析，以进一步探讨血管痉挛和临床结局之间的关系。效应大小用合并风险比（RR）估计值和相应的95%置信区间（CI）表示。共纳入14项研究，随机纳入4235名患者。尽管血管痉挛减少（RR 0.80 (95% CI 0.70 ~ 0.92)），但对不良结局没有统计学上显著的影响（RR 0.93 (95% CI 0.85 ~ 1.03)）。DCI定义的多样性并不能证明汇集DCI数据是合理的。我们的结论是，药物治疗显著降低了血管痉挛的发生率，但没有不良的临床结果。血管痉挛和临床结果之间的分离可能是由于方法学问题、样本量、临床结果测量的不敏感性，或者是血管痉挛以外的其他机制也导致了不良结果。脑血流与代谢杂志（2011）31,1443-1451；doi: 10.1038 / jcbfm.2011.7;2011年2月2日在线发布
As it is often assumed that delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is caused by vasospasm, clinical trials often focus on prevention of vasospasm with the aim to improve clinical outcome. However, the role of vasospasm in the pathogenesis of DCI and clinical outcome is possibly smaller than previously assumed. We performed a systematic review and meta-analysis on all randomized, double-blind, placebo-controlled trials that studied the effect of pharmaceutical preventive strategies on vasospasm, DCI, and clinical outcome in SAH patients to further investigate the relationship between vasospasm and clinical outcome. Effect sizes were expressed in pooled risk ratio (RR) estimates with corresponding 95% confidence intervals (CI). A total of 14 studies randomizing 4,235 patients were included. Despite a reduction of vasospasm (RR 0.80 (95% CI 0.70 to 0.92)), no statistically significant effect on poor outcome was observed (RR 0.93 (95% CI 0.85 to 1.03)). The variety of DCI definitions did not justify pooling the DCI data. We conclude that pharmaceutical treatments have significantly decreased the incidence of vasospasm, but not of poor clinical outcome. This dissociation between vasospasm and clinical outcome could result from methodological problems, sample size, insensitivity of clinical outcome measures, or from mechanisms other than vasospasm that also contribute to poor outcome. Journal of Cerebral Blood Flow & Metabolism (2011) 31, 1443-1451; doi:10.1038/jcbfm.2011.7; published online 2 February 2011