脑出血:化繁为简。

Intracerebral Hemorrhage: Keep It Simple.

机构信息

Department of Neurology, BIOS Clinical Trial Coordinating Center, Trial Innovation Center, Johns Hopkins University School of Medicine, Baltimore, MD (D.F.H., W.C.Z., N.A.M.).

TIRR Memorial Hermann, Houston, TX (F.S.V.).

出版信息

Stroke. 2024 Dec;55(12):2942-2945. doi: 10.1161/STROKEAHA.124.048533. Epub 2024 Oct 30.

Abstract

The quotation, attributed to Confucius many centuries ago, in our opinion, applies to the evolving story of defining a primary surgical treatment for spontaneous intracerebral hemorrhage. The precise quote is: "Keep it simple and focus on what matters. Don't let yourself be overwhelmed." The evidence from multiple trials on intracerebral hemorrhage regarding mortality benefit and potential functional benefit directs us toward the simple task of evacuating the clot, similar to our prime focus on opening the artery in ischemic stroke. We need not be overwhelmed by questions about adjustments to patient selection, comparative techniques, and precision timing, for which we do not have conclusive data. We review the consensus results from the recent MISTIE trial (Minimally Invasive Surgery Plus Alteplase in ICH Evacuation) and ENRICH trial (Early Minimally Invasive Removal of Intracerebral Hemorrhage) and articulate remaining questions where further evidence is needed to challenge equipoise and define future practice.

摘要

几百年前,孔子的一句名言恰当地描述了自发性脑出血主要治疗方法的演变过程。这句话是:“保持简单,专注于重要的事情。不要让自己不知所措。”大量脑出血临床试验的证据表明,清除血肿可以提高患者的生存率和改善其功能,这与我们专注于开通缺血性脑卒中患者的动脉非常相似。我们不必为患者选择、比较技术和精准时机等问题而不知所措,因为这些问题目前尚无定论。我们回顾了最近的 MISTIE 试验(脑出血微创手术加阿替普酶治疗)和 ENRICH 试验(早期微创清除脑出血)的共识结果,并阐述了需要进一步研究来挑战平衡状态和确定未来治疗方法的遗留问题。

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