Kirkman M A, Mahattanakul W, Gregson B A, Mendelow A D
Department of Neurosurgery, Regional Neurosciences Centre, Newcastle General Hospital, The Medical School, Newcastle University, Newcastle upon Tyne, UK.
Br J Neurosurg. 2008 Dec;22(6):739-46; discussion 747. doi: 10.1080/02688690802346091.
Recently, the Surgical Trial in IntraCerebral Haemorrhage (STICH) was unable to show an overall benefit from 'early surgery' compared with a policy of 'initial conservative treatment'. Here, we evaluated the impact of the STICH results on the management of spontaneous supratentorial intracerebral haemorrhage (ICH) in the Newcastle upon Tyne Hospitals. The STICH results were released to the Neurosurgery Department at Newcastle General Hospital in November 2003; using ICD-10 data, we analysed ICH admissions before (2002) and after (2004, 2006, 2007) this. We assessed numbers of Neurosurgery and Stroke Unit admissions, numbers of clot evacuation procedures, and 30-day mortality rate (Neurosurgery vs. Stroke Unit admissions). Subarachnoid haemorrhage (SAH) admissions data were also collected to corroborate our findings. There were 478 spontaneous supratentorial ICH admissions in total; 156 in 2002, 120 in 2004, 106 in 2006 and 96 in 2007. SAH admissions remained remarkably constant over this period. Neurosurgery admissions decreased significantly across the four time periods, from 71% of total ICH admissions (n = 156) in 2002 to 55% (n = 96) in 2007, and Stroke Unit admissions increased significantly from 8% (n = 156) in 2002 to 30% (n = 96) in 2007 (chi(2) = 20.968, p < 0.001, df = 3). Clot evacuation procedures also decreased significantly from 32% (n = 111) of Neurosurgery admissions in 2002 to 17% (n = 53) in 2007 (chi(2) = 11.919, p = 0.008, df = 3). 30-day mortality increased in Neurosurgery from 14% of Neurosurgery admissions (n = 111) in 2002 to 26% (n = 53) in 2007, and decreased in the Stroke Unit, from 42% of Stroke Unit admissions (n = 12) in 2002 to 17% (n = 29) in 2007. The STICH results have significantly impacted ICH management in Newcastle, with a trend towards fewer Neurosurgery admissions and clot evacuations, and increased Stroke Unit admissions. The role of surgery for ICH remains controversial, and randomization continues in STICH II for patients with superficial lobar ICH.
最近，脑出血手术试验（STICH）未能显示出与“初始保守治疗”策略相比，“早期手术”具有总体益处。在此，我们评估了STICH结果对泰恩河畔纽卡斯尔医院自发性幕上脑出血（ICH）管理的影响。STICH结果于2003年11月发布给纽卡斯尔总医院神经外科；利用国际疾病分类第十版（ICD - 10）数据，我们分析了在此之前（2002年）和之后（2004年、2006年、2007年）的ICH入院情况。我们评估了神经外科和卒中单元的入院人数、血肿清除手术数量以及30天死亡率（神经外科与卒中单元入院情况）。还收集了蛛网膜下腔出血（SAH）入院数据以证实我们的发现。总共478例自发性幕上ICH入院病例；2002年有156例，2004年有120例，2006年有106例，2007年有96例。在此期间SAH入院人数保持显著稳定。在这四个时间段内，神经外科入院人数显著下降，从2002年占ICH入院总数的71%（n = 156）降至2007年的55%（n = 96），而卒中单元入院人数从2002年的8%（n = 156）显著增加至2007年的30%（n = 96）（卡方值 = 20.968，p < 0.001，自由度 = 3）。血肿清除手术也从2002年占神经外科入院人数的32%（n = 111）显著下降至2007年的17%（n = 53）（卡方值 = 11.919，p = 0.008，自由度 = 3）。神经外科的30天死亡率从2002年占神经外科入院人数的14%（n = 111）升至2007年的26%（n = 53），而卒中单元的死亡率从2002年占卒中单元入院人数的42%（n = 12）降至2007年的17%（n = 29）。STICH结果显著影响了纽卡斯尔的ICH管理，呈现出神经外科入院人数和血肿清除手术减少、卒中单元入院人数增加的趋势。ICH手术的作用仍存在争议，STICH II针对浅表脑叶ICH患者的随机试验仍在继续。
