Neurosurgery Department, Guangzhou Overseas Chinese Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Neurosurgery Department, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Neurosurg Rev. 2022 Aug;45(4):2733-2744. doi: 10.1007/s10143-022-01785-5. Epub 2022 Apr 19.
Spontaneous intracerebral hemorrhage (ICH) is a commonly occurring disease in neurosurgery, yet its surgical treatment is controversial. This paper pertains to the study of the effects of different treatment regimens on the outcome of ICH population. Based on a globally shared third-party MIMIC-III database, the researchers firstly described the dissimilarities in survival probability, mortality, and neurological recovery among mainstream treatments for ICH; secondly, patient classification was determined by important clinical features; and outcome variations among treatment groups were compared. The 28-day, 90-day, and in-hospital mortality in the craniotomy group were significantly lower than minimally invasive surgery (MIS) and non-surgical group patients; and, the medium/long-term mortality in MIS group was significantly lower than the non-surgical group. The craniotomy group positively correlated with short-term GCS recovery compared with the MIS group; no difference existed between the non-surgical and MIS groups. The craniotomy group 90-day survival probability and short-term GCS recovery were superior to the other two treatments in the subgroups of first GCS 3-12; this tendency also presented in the MIS group over non-surgical group. For milder patients (first GCS > 12), the three treatment regimens had a minimal effect on patient survival, but the non-surgical group showed an advantage in short-term GCS recovery. Craniotomy patients have a lower mortality and a better short-term neurological recovery in an ICH population, especially in short-to-medium term mortality and short-term neurological recovery over MIS patients. In addition, surgical treatment is recommendable for patients with a GCS ≤ 12.
自发性脑出血（ICH）是神经外科中常见的疾病，但手术治疗存在争议。本文研究了不同治疗方案对 ICH 患者结局的影响。基于全球共享的第三方 MIMIC-III 数据库，研究人员首先描述了 ICH 主流治疗方法的生存概率、死亡率和神经恢复的差异；其次，根据重要的临床特征对患者进行分类；并比较了治疗组之间的结局差异。开颅组的 28 天、90 天和住院死亡率明显低于微创手术（MIS）和非手术组患者；MIS 组的中/长期死亡率明显低于非手术组。与 MIS 组相比，开颅组与短期 GCS 恢复呈正相关；非手术组与 MIS 组之间无差异。在初次 GCS 为 3-12 的亚组中，开颅组 90 天生存率和短期 GCS 恢复优于其他两种治疗方法；在 MIS 组中也表现出优于非手术组的趋势。对于轻症患者（初次 GCS>12），三种治疗方案对患者生存率的影响较小，但非手术组在短期 GCS 恢复方面有优势。ICH 患者中，开颅手术治疗可降低死亡率和改善短期神经功能恢复，尤其是在中短期死亡率和短期神经功能恢复方面优于 MIS 患者。此外，对于 GCS≤12 的患者，推荐进行手术治疗。
