脑血管痉挛防治策略PPT课件.ppt

1996年Barker FG 等人就关于尼莫地平预防蛛网膜下腔出血后的脑血管痉挛的试验进行荟萃分析，共纳入7项随机对照试验，结果表明预防性应用尼莫地平可以显著改善SAH患者的预后，包括总体的病死率和病残率以及总体的预后，P值分别为0.004和0.0007，NNT（需要治疗的数量）分别为7和10。 Good outcome versus all other grades: 1.86 (99% CI: 1.07, 3. 25, p=0.004; p(Q)=0.11). Good or fair outcome versus all other grades: 1.67 (99% CI: 1. 13, 2.46, p=0.0007; p(Q)=0.43). Overall mortality: 0.73 (99% CI: 0.42, 1. 25, p=0.1; p(Q)=0.22). Deficit or mortality attributed to vasospasm or DID: 0.46 (99% CI: 0.31, 0.68, p0.00001; p(Q)=0.64). Mortality attributed to vasospasm or DID: 0.50 (99% CI: 0.26, 0.97, p=0.007; p(Q)=0.55). 预防性应用尼莫地平显著减少由于血管痉挛引起的延迟性缺血损伤以及与血管痉挛相关的死亡，P值分别为0.00001和0.007,NNT分别为8和22。 2005年 Cochrane 循证医学中心对钙离子拮抗剂防治脑血管痉挛进行荟萃分析，其中包括12项试验，共计2844例SAH患者，其中尼莫地平试验8项，1574例患者，尼卡地平2项，954例患者，AT8771项，276例患者，Magnesium1项，40例患者。 荟萃分析显示，钙拮抗剂能够显著减少SAH后继发的缺血症状。其中的一个终点事件为继发性缺血事件，治疗组与对照组发生率分别为27%和40%，绝对风险下降33%，NNT为8，即每治疗8例患者可以预防1例缺血神经损害的发生。另一终点事件为CT证实的脑梗死，治疗组与对照组发生率分别为37%和47%，绝对风险下降20%，NNT为10，即每治疗10例患者可以预防1例CT证实的脑梗死发生。 Overall, clinical signs of secondary ischaemia were observed in 288 of 1063 patients (27%) allocated to the treatment group, against 452 of 1124 patients (40%) allocated to the control group (RR 0.67, 95% CI 0.60 to 0.76). CT-confirmed cerebral infarction was found in 303 of 821 patients (37%) allocated to the treatment group, and in 407 of 857 patients (47%) allocated to the control group (RR 0.80; 95% CI 0.71 to 0.89). The corresponding numbers needed to treat are 8 (6 to 11) patients for preventing a clinical episode of ischaemia-related deficit, and 10 patients (7 to 20) to prevent a CT-confirmed infarct. Also in the worst-case scenario analyses the risk reduction of clinical signs of secondary ischaemia was statistically significant (RR 0.77; 95% CI 0.69 to 0.86). For nimodipine separately, the relative risk for a clinical episode of ischaemic deficit was 0.65 (95% CI 0.51 to 0.82) and that for a CT confirmed infarct 0.70 (95% CI 0.58 to 0.85). Analyses by route of administration of nimodipine sh