脑出血血肿抽吸术临床疗效的综合文献分析  

Clinical efficacy of clot aspiration in the treatment of intracerebral hemorrhage by reviewing papers

作　　者：石元洪[1,2] 唐洲平[1] 徐金枝[1] 张苏明[1] 曾文高[1] 

机构地区：[1]华中科技大学同济医学院同济医院神经内科,武汉430030 [2]江西九江学院附属医院神经内科

出　　处：《中华医学杂志》2010年第19期1333-1336,共4页National Medical Journal of China

基　　金：国家自然科学基金（30770751）;湖北省卫生厅重点项目（JX4A04）

摘　　要：目的 通过分析文献资料,了解我国血肿抽吸术治疗脑出血的临床疗效.方法 通过检索我国主要4个医学文献数据库获取所有脑出血血肿抽吸术的文献,根据手术方法不同分为硬通道抽吸术（HTAC）组和软通道抽吸术（STAC）组,描述性分析其临床疗效.结果 共1205篇合格文献入选（72 855例）,HTAC和STAC分别以80%～89%（34.0%）和50%～69%（37.7%）的血肿清除率的研究最多.HTAC和STAC的病死率和再出血率分别为14.0%vs 14.5%和7.2%vs 7.6%（均P＞0.05）.HTAC和STAC与保守治疗的患者病死率和再出血发生率分别是13.4%vs 36.0%和14.3%vs36.1%（均P＜0.001）;9.3%vs 10.6%和12.2%vs 16.1%（均P＞0.05）.HTAC和STAC与开颅术患者的病死率和再出血发生率分别是14.4%vs 24.1%和16.7%vs 24.8%（均P＜0.01）;9.1%vs 13.9%（P＞0.05）和7.1%vs 14.7%（P＜0.01）.结论 血肿抽吸术可以有效清除血肿,降低病死率,并不增加再出血风险;硬通道与软通道血肿抽吸术临床疗效接近,可能有更好的血肿清除率.Objective To investigate the clinical efficacy of clot aspiration in the treatment of intracerebral hemorrhage （ICH） by reviewing literatures. Methods All studies assigned into two groups of hard or soft tunnel aspiration of clots （ HTAC or STAC） on the basis of surgical approaches were obtained by searching four major Chinese medical databases.And the surgical outcomes were descriptively analyzed. Results A total of 1205 reports （72 855 patients） met the eligibility criteria.The trials （34. 0% ） with 80%-89% of clot removal ratio were the most in all HTAC papers and those （37.7%） with 50%-69% of clot removal ratio were the most in all STAC papers. The mortality and re-bleediag rate in HTAC and STAC group were 14. 0% vs 14. 5% and 7. 2% vs 7. 6% respectively （ P〉 0. 05 ）. As compared with the conventional medical group, the mortalities in HTAC and STAC groups were 13. 4% vs 36. 0% and 14. 3% vs 36. 1% （P 〈0. 001 ） and the re-bleeding rates 9. 3% vs 10. 6% and 12. 2% vs 16. 1% （P 〉0. 05） respectively. As compared with the eraniotomy group, the mortalities in HTAC and STAC groups were 14.4% vs24. 1% and 16.7% vs 24.8% （P〈0.01 ） and the re-bleeding rates 9. 1% vs 13.9% （P〉0.05） and 7. 1% vs 14.7% （P〈0.01） respectively. Conclusion Aspiration of clots can effectively remove hematoma and reduce the mortality. But it does not increase the risk of re-bleeding. The outcome of HTAC is similar to that of STAC. HTAC has the advantage of clot removal over STAC.

关 键 词：脑出血 外科手术 文献 疗效评价 

分 类 号：R651.1[医药卫生—外科学]