立体定向软通道颅内血肿清除术与内科保 守治疗高血压性脑出血疗效的Meta分析

目的 系统评价立体定向软通道颅内血肿清除术治疗高血压性脑出血的效果。
方法 计算机检索国内外数据库中关于立体定向软通道颅内血肿清除术与内科保守治疗高血压
性脑出血的随机对照试验（randomized controlled trial，RCT），同时追索纳入文献的参考文献。检
索时限均从建库至2012年12月。根据卫生系统中证据推荐分级的评估、制订与评价（grading of
recommendations assessment，development and evaluation，GRADE）系统推荐分级方法，对纳入研究的质
量进行严格评价和资料提取，对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan 5.2软件
和GRADE profiler 4.0.3软件。
结果 共纳入11个RCT。Meta分析主要结局结果显示，定向软通道颅内血肿清除术治疗高血压性
脑出血3个月内的临床疗效、病死率、发生感染、发生再出血四个方面，与传统的内科保守治疗方法
相比，其差异有显著性，优势比（odds ratio，OR）和95%可信区间（confidence interval，CI）分别为3.34
（2.13～5.22）、0.42（0.29～0.60）、0.42（0.27～0.64）、0.47（0.28～0.77）。每个结局的GRADE系统
推荐分级均为低等级。
结论 现有研究显示立体定向软通道颅内血肿清除术治疗高血压性脑出血疗效确切，3个月病死率、
发生感染及再出血并发症较传统内科保守治疗更低，临床医师在治疗高血压性脑出血时，可以把立
体定向软通道颅内血肿清除术作为一般推荐。

Efficacy of Stereotactic Catheter Indwelt Hematoma Aspiration in Patients with Hypertensive Intracerebral Hemorrhage:Meta-analysis

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.