安装在螺栓上的外部心室排水与道上的外部心室排水的安全性和有效性:系统性审查,元分析和试验顺序分析
Shaan Patel1, Shiva A Nischal2, Ayush Sinha2
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
概括
螺栓式外腔室排水器 (EVD) 与道式EVD相比,提供更高的精度和机械可靠性,CSF泄漏较少. 然而,需要更多的研究来确认重新运行率的差异.
科学领域:
- 神经外科和神经临床护理
- 医疗器械技术 医疗器械技术
- 基于证据的医学基于证据的医学.
背景情况:
- 外腔室排水管 (EVDs) 在神经临床护理中至关重要,但固定方法 (螺栓式与道式) 缺乏明确的比较数据.
- 现有的证据是相互矛盾的,主要来自观察性研究,需要严格评估不同的EVD固定技术.
研究的目的:
- 系统地比较螺栓式和道式EVDs关于导管精度,重新操作率和安全结果.
- 利用元分析和试验序列分析,提供关于EVD固定方法的强有力的证据.
主要方法:
- 系统性审查和随机和观察性研究的元分析,比较螺栓式和道式EVD,遵循PRISMA指南.
- 包括2008年患者的10项研究;主要结果:最佳的导管安置和重新操作;次要结果:ICH,感染,脑脊液泄漏,阻塞,停药和排水时间.
- 进行了随机效应元分析和试验序列分析,以评估证据确定性和所需信息大小.
主要成果:
- 安装在螺栓上的EVD显示出显著更高的最佳导管精度 (RR 1.27) 和降低了CSF泄漏 (RR 0.13) 和导管阻塞 (RR 0.46) 的风险.
- 用螺栓装备的EVD的重新运行率在数值上较低 (RR 0.51),但试验序列分析表明没有足够的证据来得出最终的结论.
- 两种方法之间在阳性ICH,CSF感染,意外停药或排水持续时间方面没有发现显著差异.
结论:
- 安装在螺栓上的EVD显示出卓越的准确性,减少了CSF泄漏,并且在不增加感染或出血风险的情况下具有更好的机械可靠性.
- 虽然可能减少重新操作,但目前对螺栓式EVD的证据不足,需要进一步调查.
- 这些发现挑战了传统观点,并支持在神经临床护理中选择特定于环境的EVD固定方法.
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