关键词: 高血压性脑出血; 立体定向血肿清除术; 疗效; 感染; 再出血; 病死率; Meta分析

Abstract:

Objective To evaluate stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage. Methods Cochrane database of systematic review (CENTRAL), MEDLINE, Excerpta Medica Database (EMbase), Physiotherapy Evidence Database, Open System for Information on Grey Literature in Europe (OpenSIGLE), National Technical Information Service (NTIS), China National Knowledge Infrastructure (CNKI), VIP, Wanfang data, and China Biology Medicine disc (CBMdisc) were searched for the randomized controlled trials (RCTs) of stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage from the data of establishment of the databases to December 2012. The bibliographies of included studies were searched, too. Two researchers evaluated the included studies using grading of recommendations assessment, development and evaluation (GRADE). The extract data were analyzed by RevMan 5.2 and GRADE profiler 4.0.3. Results A total of 11 trials were discovered. Meta-analysis showed that there were significant differences in clinical benefit, fatality rate, infection, and rebleeding in stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage compared with initial conservative treatment (odds ratio [OR] 3.34, 95% confidence interval [CI] 2.13 to 5.22; OR 0.42, 95%CI 0.29 to 0.60; OR 0.42, 95%CI 0.27 to 0.64; and OR 0.47, 95%CI 0.28 to 0.77). The four outcomes were all of low quality in the GRADE system.

Conclusion The current evidence shows stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage was effective whereas reduction in the numbers of fatality rate, infection and rebleeding and increase at clinical benefit at the end of 3 months, compared with initial conservative treatment. The clinician should recommend it for its simplicity, low input costs, low operating costs and fewer side effects. Due to the limitations of the included studies, more large-sample, high-quality RCTs are required.

Key words: Hypertensive intracerebral hemorrhage; Stereotactic aspiration; Efficacy; Infection;
Rebleeding; Fatality rate; Meta-analysis