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脑内出血的微创手术前后出血扩张率:MISTIE II/III的后期分析
Wendy C Ziai1,2, Shervin Badihian2,3, Natalie Ullman4
1Division of Neurosciences Critical Care Department of Neurology Johns Hopkins University School of Medicine Baltimore MD.
Stroke (Hoboken, N.J.)
|January 26, 2026
概括
大型脑内和心室内出血的出血扩张通常在24小时内稳定. 这一发现表明,早期的手术干预,如立体性血栓溶解,对于这些患者来说可能是可行的.
科学领域:
- 神经外科 神经外科
- 放射学 放射学是一门学科.
- 神经学 神经学
背景情况:
- 针对大脑内出血 (ICH) 和心室内出血 (IVH) 的立体性血栓溶解需要进行手术前的出血稳定.
- 调查出血扩张 (HE) 对于确定手术干预的最佳时间至关重要.
研究的目的:
- 为了研究手术候选人的内出血扩张 (HE).
- 为了确定ICH和IVH患者的出血稳定性的时间进程.
- 为了确定与出血扩张相关的危险因素.
主要方法:
- 来自MISTIE II/ICES中的141名患者和MISTIE III中的499名患者的顺序CT扫描的前性评估.
- 主要结局:ICH>6mL和IVH>5mL的预随机化HE.
- 二次结果:后随机化HE;稳定性定义为时间到没有进一步的HE观察.
主要成果:
- 前随机化HE>6mL发生在33.8%的受试者中;中位稳定时间为7小时.
- 在6.3%的受试者中,IVH扩张>5mL发生;中位稳定时间为6.9小时.
- 在24小时内,检测到91%的ICH和IVH扩张事件;36%的ICH和33%的IVH扩张事件在12小时内仍在进行.
结论:
- 大型ICH和IVH中的出血扩张通常在24小时内稳定.
- 立体性血栓溶解的早期时间窗口可能是可行的.
- ICH扩张的独立风险因素包括年龄,性别,种族,抗凝剂,ICH体积,位置,IVH存在以及诊断CT的时间.
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