蛛网膜下腔出血后迟发性脑缺血风险的时间趋势：一项随机对照试验的荟萃分析

Time trends in the risk of delayed cerebral ischemia after subarachnoid hemorrhage: a meta-analysis of randomized controlled trials.

作者信息

Rigante Luigi, van Lieshout Jasper Hans, Vergouwen Mervyn D I, van Griensven Carlijn H S, Vart Priya, van der Loo Lars, de Vries Joost, Vinke Ruben Saman, Etminan Nima, Aquarius Rene, Gruber Andreas, Mocco J, Welch Babu G, Menovsky Tomas, Klijn Catharina J M, Bartels Ronald H M A, Germans Menno R, Hänggi Daniel, Boogaarts Hieronymus D

机构信息

1Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands.

2Department of Neurosurgery, Henrich-Heine-University Düsseldorf, Germany.

出版信息

Neurosurg Focus. 2022 Mar;52(3):E2. doi: 10.3171/2021.12.FOCUS21473.

DOI:10.3171/2021.12.FOCUS21473

PMID:35231892

Abstract

OBJECTIVE

Delayed cerebral ischemia (DCI) contributes to morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in the management of these patients, such as neurocritical care and aneurysm repair, may decrease the prevalence of DCI. In this study, the authors aimed to investigate potential time trends in the prevalence of DCI in clinical studies of DCI within the last 20 years.

METHODS

PubMed, Embase, and the Cochrane library were searched from 2000 to 2020. Randomized controlled trials that reported clinical (and radiological) DCI in patients with aSAH who were randomized to a control group receiving standard care were included. DCI prevalence was estimated by means of random-effects meta-analysis, and subgroup analyses were performed for the DCI sum score, Fisher grade, clinical grade on admission, and aneurysm treatment method. Time trends were evaluated by meta-regression.

RESULTS

The search strategy yielded 5931 records, of which 58 randomized controlled trials were included. A total of 4424 patients in the control arm were included. The overall prevalence of DCI was 0.29 (95% CI 0.26-0.32). The event rate for prevalence of DCI among the high-quality studies was 0.30 (95% CI 0.25-0.34) and did not decrease over time (0.25% decline per year; 95% CI -2.49% to 1.99%, p = 0.819). DCI prevalence was higher in studies that included only higher clinical or Fisher grades, and in studies that included only clipping as the treatment modality.

CONCLUSIONS

Overall DCI prevalence in patients with aSAH was 0.29 (95% CI 0.26-0.32) and did not decrease over time in the control groups of the included randomized controlled trials.

摘要

目的

迟发性脑缺血（DCI）是导致动脉瘤性蛛网膜下腔出血（aSAH）患者发病和死亡的原因之一。对这些患者治疗管理的不断改进，如神经重症监护和动脉瘤修复，可能会降低DCI的发生率。在本研究中，作者旨在调查过去20年中DCI临床研究中DCI发生率的潜在时间趋势。

方法

检索2000年至2020年的PubMed、Embase和Cochrane图书馆。纳入将aSAH患者随机分为接受标准治疗的对照组，并报告临床（和影像学）DCI的随机对照试验。通过随机效应荟萃分析估计DCI发生率，并对DCI总分、Fisher分级、入院时临床分级和动脉瘤治疗方法进行亚组分析。通过Meta回归评估时间趋势。

结果

检索策略共获得5931条记录，其中纳入58项随机对照试验。对照组共纳入4424例患者。DCI的总体发生率为0.29（95%CI 0.26-0.32）。高质量研究中DCI发生率的事件率为0.30（95%CI 0.25-0.34），且未随时间下降（每年下降0.25%；95%CI -2.49%至1.99%，p = 0.819）。仅纳入较高临床或Fisher分级患者的研究以及仅将夹闭作为治疗方式的研究中，DCI发生率更高。