有创颅内压监测对自发性颅内出血的临床益处：一项系统评价和荟萃分析。
Clinical benefits of invasive intracranial pressure monitoring for spontaneous intracranial hemorrhage: a systematic review and meta-analysis.
作者信息
Shen Dan, Shen Lailai, Du Xinjian, Deng Dongyuan, Zhang Wanting, Zhong Christina, Su Gui
机构信息
Department of Clinical Research and Medical Science, Medtronic China, 19Th Floor, Building B, The New Bund World Trade Center Phase I, No. 5 Lane 255 Dongyu Road, Pudong New District, Shanghai, 200126, China.
Department of Clinical Research and Medical Science, Medtronic China, 3Rd Floor, Room C06-C12, Unit 301, No. 9 Dongdaqiao Road, Chaoyang District, Beijing, 100020, China.
出版信息
J Neurol. 2025 Apr 3;272(4):310. doi: 10.1007/s00415-025-13057-5.
BACKGROUND
This meta-analysis evaluated the clinical benefits of invasive intracranial pressure (ICP) monitoring for spontaneous intracranial hemorrhage with specific focuses on the hypertensive intracerebral hemorrhage (ICH) subgroup and the outcomes when combined with minimally invasive surgery (MIS).
METHODS
PubMed and Embase were searched to identify studies comparing the clinical outcomes from ICP monitoring vs. non-ICP monitoring. Primary outcomes included in-hospital and 6-month mortality rates. Secondary outcomes were hospital length of stay (LOS), proportion of patients with poor 6-month functional outcomes, and central nervous system (CNS) infection rates. Subgroup analyses were performed on hypertensive ICH subgroup and on MIS vs. non-MIS subgroups. This study was registered in PROSPERO (CRD42024587974).
RESULTS
Thirteen studies involving 4,027 patients with spontaneous intracranial hemorrhage were included. Compared with non-ICP monitoring, ICP monitoring significantly reduced the 6-month mortality rate (43.33% vs. 28.67%, P < 0.00001), the proportion of patients with poor 6-month functional outcomes (70.49% vs. 56.71%, P = 0.0003), and hospital LOS (19.71 vs. 18.15 days, P = 0.001) but increased CNS infection rate (1.56% vs.7.49%, P < 0.00001). The hypertensive ICH subgroup analysis revealed that ICP monitoring significantly reduced in-hospital mortality rate (8.57% vs. 2.78%, P = 0.02), LOS (18.42 vs.14.54 days, P < 0.00001), and the proportion of patients with poor 6-month functional outcomes (60.00% vs. 38.77%, P = 0.001). When used with MIS, ICP monitoring significantly reduced the LOS (16.98 vs. 12.45 days, P < 0.00001) and the proportion of patients with poor 6-month functional outcomes (66.89% vs. 36.22%, P < 0.00001).
CONCLUSION
ICP monitoring improves short- and long-term outcomes in patients with spontaneous intracranial hemorrhage, particularly when combined with MIS therapy.
背景
本荟萃分析评估了有创颅内压（ICP）监测对自发性颅内出血的临床益处，特别关注高血压性脑出血（ICH）亚组以及与微创手术（MIS）联合使用时的结果。
方法
检索PubMed和Embase以确定比较ICP监测与非ICP监测临床结果的研究。主要结局包括住院期间和6个月死亡率。次要结局为住院时间（LOS）、6个月功能结局不良患者的比例以及中枢神经系统（CNS）感染率。对高血压性ICH亚组以及MIS与非MIS亚组进行亚组分析。本研究已在PROSPERO（CRD42024587974）注册。
结果
纳入了13项涉及4027例自发性颅内出血患者的研究。与非ICP监测相比，ICP监测显著降低了6个月死亡率（43.33%对28.67%，P < 0.00001）、6个月功能结局不良患者的比例（70.49%对56.71%，P = 0.0003）以及住院LOS（19.71天对18.15天，P = 0.001），但增加了CNS感染率（1.56%对7.49%，P < 0.00001）。高血压性ICH亚组分析显示，ICP监测显著降低了住院死亡率（8.57%对2.78%，P = 0.02）、LOS（18.42天对14.54天，P < 0.00001）以及6个月功能结局不良患者的比例（60.00%对38.77%，P = 0.001）。与MIS联合使用时，ICP监测显著降低了LOS（16.98天对12.45天，P < 0.00001）以及6个月功能结局不良患者的比例（66.89%对36.22%，P < 0.00001）。
结论
ICP监测可改善自发性颅内出血患者的短期和长期结局，特别是与MIS治疗联合使用时。
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