Zhang Zhehao, Yang Wensong, Li Zuoqiao, Shen Yiqing, Lv Xinni, Wang Zijie, Hu Xiao, Yang Tiannan, Yin Hao, Xie Peng, Li Qi
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
World Neurosurg. 2025 Jun;198:123971. doi: 10.1016/j.wneu.2025.123971. Epub 2025 Apr 10.
The management of acute intracerebral hemorrhage (ICH) primarily involves medical treatment and surgical intervention. However, current evidence regarding the effectiveness and safety of surgical treatment remains controversial. Thus, we conducted a real-world investigation, aimed to explore the actual situation of spontaneous ICH patients receiving different treatment and compare the impact on the prognosis.
The study consecutively collected spontaneous supratentorial ICH patients aged 18 to 80 years within 72 hours of symptom onset from 2019 to 2022. Propensity score matching was employed to ensure the comparability of baseline characteristics, and a subgroup analysis was performed according to hematoma volume. The primary outcome was defined as 3-month functional status.
A total of 568 patients met the inclusion criteria. Of these, 401 received conservative medical treatment, while 167 underwent surgical intervention. After propensity score matching, 76 patients were included in each group. The surgical group demonstrated a reduced mortality rate (P = 0.047) but had a lower incidence of achieving functional independence (P = 0.006) and higher incidence of moderate disability (P = 0.047). Subgroup analysis revealed that minimally invasive surgical treatment was associated with a decreased mortality in patients with hematomas of 30-100 mL.
While surgical intervention can reduce mortality, it may have a negative impact on functional independence. Minimally invasive surgical treatment for patients with large-size hematoma (30-100 mL) may be beneficial. Personalized treatment strategies are essential to identify patients who may benefit most from surgical intervention.
急性脑出血（ICH）的治疗主要包括药物治疗和手术干预。然而，目前关于手术治疗有效性和安全性的证据仍存在争议。因此，我们进行了一项真实世界研究，旨在探讨自发性ICH患者接受不同治疗的实际情况，并比较其对预后的影响。
本研究连续收集了2019年至2022年症状发作72小时内年龄在18至80岁的自发性幕上ICH患者。采用倾向评分匹配法确保基线特征的可比性，并根据血肿体积进行亚组分析。主要结局定义为3个月时的功能状态。
共有568例患者符合纳入标准。其中，401例接受了保守药物治疗，167例接受了手术干预。经过倾向评分匹配后，每组纳入76例患者。手术组死亡率降低（P = 0.047），但功能独立发生率较低（P = 0.006），中度残疾发生率较高（P = 0.047）。亚组分析显示，微创外科治疗与血肿量为30 - 100 mL患者的死亡率降低相关。
虽然手术干预可降低死亡率，但可能对功能独立产生负面影响。对于大血肿（30 - 100 mL）患者，微创外科治疗可能有益。个性化治疗策略对于确定可能从手术干预中获益最大的患者至关重要。
