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针对自发性上门门内脑内出血的手术

Floor Nh Wilting¹, Lotte Sondag^1,2, Floris Hbm Schreuder¹

¹Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.

The Cochrane database of systematic reviews

|July 17, 2025

概括

针对自发性上门内脑出血 (ICH) 的手术可以改善功能结果并降低死亡率. 最少侵入性手术 (MIS) 是有前途的,而切可能会降低死亡率,尽管对功能结果的证据仍然不确定. 需要进一步的研究.

科学领域:

神经外科神经外科
神经学神经学
关键护理医学关键护理医学

背景情况:

针对自发性上内脑出血 (ICH) 的外科手术的疗效仍然不确定.
之前的审查没有最终确定不同手术技术对ICH的益处和危害.

研究的目的:

评估手术干预加上标准医疗管理的益处和危害,以及对自发性 supratentorial ICH.
为了比较不同手术技术的有效性,包括切除术,微创手术 (MIS) 和解压切除术.

主要方法:

包括24项随机对照试验 (RCT),涉及4597名参与者.
使用随机效应模型的元分析来评估功能性结果,全因死亡率和30天病例死亡率等结果.
使用GRADE框架评估证据确定性.

主要成果:

进行血栓切除手术可以改善功能结果,降低死亡率和30天病例死亡率 (低确定性证据).
最少侵入性手术 (MIS) 可能会改善功能结果,并降低死亡率和30天病例死亡率 (中度确定性证据).
切除可能会降低死亡率 (中度确定性证据),但对功能结果有不确定的影响.
减压性脑切除显示不准确的估计,可能有益处或危害.

结论:

手术,特别是MIS,可能为自发性 supratentorial ICH 患者提供好处,改善功能结果并降低死亡率.
对切割和解压切割的有效性的证据不太确定,这凸显了需要高质量的研究.
需要进一步进行足够强大的研究来最终指导临床实践并确认观察到的益处.

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