Samprón N, Mendia A, Azkarate B, Alberdi F, Arrazola M, Urculo E
Hospital Donostia, San Sebastián, España.
Neurocirugia (Astur). 2010 Apr;21(2):93-8. doi: 10.1016/s1130-1473(10)70063-4.
Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival.
Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU.
During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS subgroups. Maximal benefit was observed in patient with admission GCS of 4-8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases.
Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages.
自发性幕上脑出血是一种严重、常见且了解甚少的病症。尽管已发表了12项关于该主题的随机对照试验，但手术的作用仍存在争议，且尚无治疗方法被证明有效。我们报告一项基于特定人群的十年前瞻性队列研究，这些人群接受了手术或未接受手术治疗，并报告了他们的早期生存结果。
基于人群的十年前瞻性观察性研究，针对一家三级中心重症监护病房（ICU）连续收治的自发性幕上脑出血患者。根据入院时的格拉斯哥昏迷评分（GCS）将患者分为五组。出血分为深部或浅表性。所有患者均接受标准医疗护理，如有值班神经外科医生指示，还会接受手术治疗。主要终点是早期死亡率，定义为在ICU住院期间因任何原因死亡。
在十年期间，1485例患者因原发性脑出血入住我们中心。其中，376例入住重症监护病房，285例发生幕上出血。低GCS是早期死亡的有力预测指标。尽管接受手术清除血肿的患者血肿体积更大，但在所有GCS亚组中，手术与较低的早期死亡率相关。入院GCS为4 - 8的患者获益最大。浅表血肿的手术治疗更为频繁，且与死亡率低于深部血肿的患者相关。
我们的研究结果表明，开颅血肿清除术可能降低原发性幕上脑出血患者的早期死亡率。手术似乎对入院GCS在4至8之间的患者以及浅表出血患者特别有用。
