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目的系统评价糖皮质激素联合高压氧对急性一氧化碳中毒迟发性脑病的防治疗效与安全性。方法计算机检索Pub Med、EMbase、Web of Science、the Cochrane Library、CBM、CNKI、VIP和Wan Fang Data数据库,检索时间均从建库至2015年9月30日。采用End Note X6、Rev Man5.3和Stata软件进行Meta分析。结果共纳入12个随机对照试验,共1 415名研究对象。Meta分析结果显示:1与采用高压氧治疗的对照组相比,采用糖皮质激素联合高压氧的试验组在预防DEACMP的发生[RR=0.23,95%CI(0.14,0.38),P<0.001]、提高治愈率[RR=1.52,95%CI(1.17,1.98),P=0.002]、提高总有效率[RR=1.36,95%CI(1.22,1.51),P<0.001]、减少无效率[RR=0.24,95%CI(0.15,0.40),P<0.001]方面效果更佳,其差异均有统计学意义。2在病死率方面,试验组与对照组差异无统计学意义(P=0.38)。3试验组存在少量的不良反应(1.6%)。结论糖皮质激素联合高压氧治疗虽有少量不良反应,但对急性一氧化碳中毒迟发性脑病的防治效果好于常规高压氧治疗。
Objective To evaluate the efficacy and safety of glucocorticoid combined with hyperbaric oxygen in the prevention and treatment of delayed encephalopathy after acute carbon monoxide poisoning. Methods The databases of Pub Med, EMbase, Web of Science, the Cochrane Library, CBM, CNKI, VIP and Wan Fang Data were searched by computer. The search time was from the database to September 30, 2015. Meta analysis was performed using End Note X6, Rev Man5.3, and Stata software. Results A total of 12 randomized controlled trials were included and a total of 1 415 subjects were included. Meta-analysis showed that: 1 Compared with the control group treated with hyperbaric oxygen, the experimental group with glucocorticoid combined with hyperbaric oxygen prevented the occurrence of DEACMP [RR = 0.23, 95% CI (0.14, 0.38), P <0.001] (RR = 1.52, 95% CI 1.17, 1.98, P = 0.002) and increased total effective rate (RR = 1.36, 95% CI 1.22, 1.51, P 0.001) RR = 0.24, 95% CI (0.15,0.40), P <0.001], the difference was statistically significant. 2 In case fatality rate, there was no significant difference between experimental group and control group (P = 0.38). 3 test group there is a small amount of adverse reactions (1.6%). Conclusion Although glucocorticoid combined with hyperbaric oxygen therapy has a few side effects, its prevention and treatment of delayed encephalopathy after acute carbon monoxide poisoning is better than conventional hyperbaric oxygen therapy.