摘要
目的系统评价立体定向软通道颅内血肿清除术治疗高血压性脑出血的效果。〈br〉方法计算机检索国内外数据库中关于立体定向软通道颅内血肿清除术与内科保守治疗高血压性脑出血的随机对照试验（randomizedcontroledtrial，RCT），同时追索纳入文献的参考文献。检索时限均从建库至2012年12月。根据卫生系统中证据推荐分级的评估、制订与评价（gradingofrecommendationsassessment，developmentandevaluation，GRADE）系统推荐分级方法，对纳入研究的质量进行严格评价和资料提取，对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan5.2软件和GRADEprofiler4.0.3软件。〈br〉结果共纳入11个RCT。Meta分析主要结局结果显示，定向软通道颅内血肿清除术治疗高血压性脑出血3个月内的临床疗效、病死率、发生感染、发生再出血四个方面，与传统的内科保守治疗方法相比，其差异有显著性，优势比（oddsratio，OR）和95%可信区间（confidenceinterval，CI）分别为3.34（2.13～5.22）、0.42（0.29～0.60）、0.42（0.27～0.64）、0.47（0.28～0.77）。每个结局的GRADE系统推荐分级均为低等级。〈br〉结论现有研究显示立体定向软通道颅内血肿清除术治疗高血压性脑出血疗效确切，3个月病死率、发生感染及再出血并发症较传统内科保守治疗更低，临床医师在治疗高血压性脑出血时，可以把立体定向软通道颅内血肿清除术作为一般推荐。
Objective To evaluate stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage. 〈br〉 Methods Cochrane database of systematic review （CENTRAL）, MEDLINE, Excerpta Medica Database （EMbase）, Physiotherapy Evidence Database, Open System for Information on Grey Literature in Europe （OpenSIGLE）, National Technical Information Service （NTIS）, China National Knowledge Infrastructure （CNKI）, VIP, Wanfang data, and China Biology Medicine disc （CBMdisc） were searched for the randomized controlled trials （RCTs） of stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage from the data of establishment of the databases to December 2012. The bibliographies of included studies were searched, too. Two researchers evaluated the included studies using grading of recommendations assessment, development and evaluation （GRADE）. The extract data were analyzed by RevMan 5.2 and GRADE proifler 4.0.3. 〈br〉 Results A total of 11 trials were discovered. Meta-analysis showed that there were significant differences in clinical beneift, fatality rate, infection, and rebleeding in stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage compared with initial conservative treatment （odds ratio [OR] 3.34, 95%conifdence interval [CI] 2.13 to 5.22;OR 0.42, 95%CI 0.29 to 0.60;OR 0.42, 95%CI 0.27 to 0.64;and OR 0.47, 95%CI 0.28 to 0.77）. The four outcomes were all of low quality in the GRADE system. 〈br〉 Conclusion The current evidence shows stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage was effective whereas reduction in the numbers of fatality rate, infection and rebleeding and increase at clinical benefit at the end of 3 months, compared with initial conservative treatment. The clinician should recommend it for its simplicity, low input costs, low operating costs and fewer side effects. Due to the limitations of the included studies, more large-sample, high-quality RCTs are required.
出处
《中国卒中杂志》
2014年第2期106-116,共11页
Chinese Journal of Stroke
关键词
高血压性脑出血
立体定向血肿清除术
疗效
感染
再出血
病死率
META分析
Hypertensive intracerebral hemorrhage
Stereotactic aspiration
Efifcacy
Infection
Rebleeding
Fatality rate
Meta-analysis
