降低收缩压对蛛网膜下腔出血动脉瘤再出血的影响：系统回顾和荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-10 DOI:10.1016/j.jstrokecerebrovasdis.2024.108084

Mohammad Aladawi MD , Mohamed Elfil MD , Sherief Ghozy MD , Zaid R. Najdawi MD , Hazem Ghaith MD , Mohammad Alzayadneh MD , Alejandro A. Rabinstein MD , Maximiliano A. Hawkes MD

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引用次数: 0

摘要

背景：预防动脉瘤早期再出血是动脉瘤性蛛网膜下腔出血（SAH）治疗的关键。降低收缩压（SBP）被认为是一种潜在的策略，但目前尚无定论。本系统综述和荟萃分析旨在确定特定的收缩压目标是否能在治疗前降低动脉瘤再出血的风险：系统检索电子数据库，比较手术治疗前有动脉瘤再出血和无动脉瘤再出血的 SAH 患者的 SBP。提取了有关SBP值、患者特征和再出血事件的数据。对不同SBP临界值下再出血的平均SBP差异和几率比（ORs）进行汇总，并进行Meta分析：系统综述共纳入十项研究。纳入研究的汇总数据显示，再出血组的平均 SBP 较高（平均差值为 5.89，95 % CI 为 1.94 至 9.85）。SBP≤160 mmHg 与较低的再出血风险相关（OR 0.30，95 % CI 0.14 至 0.65）。然而，研究设计和定义存在很大的异质性和局限性：这项荟萃分析表明，SAH 再出血患者的 SBP 可能较高。然而，由于研究的局限性，应谨慎解读研究结果。未来需要开展具有标准化定义和全面数据收集的前瞻性研究，以阐明血压动态变化与 SAH 再出血风险之间的复杂关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The impact of systolic blood pressure reduction on aneurysm re-bleeding in subarachnoid hemorrhage: A systematic review and meta-analysis

Background

Preventing early aneurysm rebleeding is crucial in the management of aneurysmal subarachnoid hemorrhage (SAH). Lowering systolic blood pressure (SBP) has been proposed as a potential strategy, but the evidence remains inconclusive. This systematic review and meta-analysis aimed to determine if a specific SBP target could reduce the risk of aneurysm rebleeding prior to treatment.

Methods

Electronic databases were systematically searched for studies comparing SBP between SAH patients with and without aneurysm rebleeding before surgical treatment. Data on SBP values, patient characteristics, and rebleeding events were extracted. Meta-analyses were performed to pool mean SBP differences and odds ratios (ORs) for rebleeding at different SBP cut-offs.

Results

Ten studies were included in the systematic review. Pooled data from the included studies showed that the mean SBP was higher in the rebleeding group (mean difference 5.89, 95 % CI 1.94 to 9.85). SBP ≤160 mmHg was associated with lower rebleeding risk (OR 0.30, 95 % CI 0.14 to 0.65). However, substantial heterogeneity and limitations in study designs and definitions were noted.

Conclusions

This meta-analysis suggests that SAH patients with rebleeding may present with higher SBP. However, the findings should be interpreted cautiously due to study limitations. Future prospective studies with standardized definitions and comprehensive data collection are needed to elucidate the complex relationship between blood pressure dynamics and rebleeding risk in SAH.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.