微创血肿清除术治疗基底节区中量脑出血随机对照研究
|
摘要
目的:比较颅内血肿微创穿刺粉碎清除术和内科保守治疗两种不同方法治疗基底节区中等量(25～40ml)自发性脑出血的临床疗效。
方法:本研究是卫生部课题“微创清除技术治疗颅内血肿效果及效益再评价研究”(多中心随机对照临床研究)中的一部分。病人被随机分入内科保守治疗组(简称内科组)或颅内血肿微创穿刺粉碎清除术组(简称微创组)进行治疗。评价其治疗后第14天时斯堪的纳维亚卒中量表评分,第14与90天时改良Rankin量表评分,以及第90天时Barthel指数评分、再出血率和病死率。
结果:共29例病人入选,其中微创组15例,内科组14例。治疗后第14天时两组斯堪的纳维亚卒中量表评分和改良Rankin量表评分无显著差异(P>0.05)。治疗后第90天时改良Rankin量表评分和Barthel指数评分,微创组明显好于内科组(P<0.05);以Barthel指数评分≤60分为明显依赖生存的标准,微创组的明显依赖生存率低于内科组(0 vs.41.7%,P=0.012)。治疗后第90天时两组再出血率(6.7% vs.7.1%,P=1.000)、病死率(6.7% vs.14.3%,P=0.598)均无显著差别。
结论:与单纯内科保守治疗相比,颅内血肿微创穿刺粉碎清除术治疗基底节区中等量(25～40ml)自发性脑出血,可以明显提高患者的日常生活活动能力,降低明显依赖生存率,且不增加再出血率和病死率,是一项安全而有效的治疗方法。
Objective: To compare the clinical effect of the mini-invasive aspiration with conservative medical treatment in treating patients with 25~40ml spontaneous basal ganglia intracerebral hemorrhage.Methods: The study was a part of "the research of evaluating the clinical effect and cost of hospitalization in treating intracerebral hematoma with mini-invasive aspiration", which was a multi-center, randomized controlled research subject of Ministry of Health. Patients were randomly divided into "Aspiration group" and "Conservative group". The Scandinavian Stroke Scale (SSS) score in the 14th day, modified Rankin Scale (MRS) score in the 14~th and 90~th day, Barthel Index (BI) score, the rebleeding rate and mortality in the 90th day were used as the evaluating parameters.Results: Twenty-nine patients were involved in the study, 15 of them in Aspiration group and 14 of them in Conservative group. There was no significant difference between the two groups about the SSS score and MRS score in the 14~th day (P>0.05). In the 90th day after the therapy, the Aspiration group showed a remarkable improvement in MRS score and BI score (P<0.05). Taking the BI score < 60 as a remark of significant life dependency, the outcome of the Aspiration group were much better than that of Conservative group at the end of the study (0 vs. 41.7%, P=0.012). In the 90~th day of the study, no significant difference between the two groups in the rebleeding rate (6.7% vs.7.1%, P=1.000) and mortality (6.7% vs. 14.3%, P=0.598) was found.Conclusions: Compared with conservative therapy in treating 25~40ml spontaneous basal ganglia intracerebral hemorrhage, the mini-invasive aspiration therapy remarkably improved the patients' activities of daily life, decreased their dependency rate, indicating that the mini-invasive aspiration is a safe and effective method.
方法:本研究是卫生部课题“微创清除技术治疗颅内血肿效果及效益再评价研究”(多中心随机对照临床研究)中的一部分。病人被随机分入内科保守治疗组(简称内科组)或颅内血肿微创穿刺粉碎清除术组(简称微创组)进行治疗。评价其治疗后第14天时斯堪的纳维亚卒中量表评分,第14与90天时改良Rankin量表评分,以及第90天时Barthel指数评分、再出血率和病死率。
结果:共29例病人入选,其中微创组15例,内科组14例。治疗后第14天时两组斯堪的纳维亚卒中量表评分和改良Rankin量表评分无显著差异(P>0.05)。治疗后第90天时改良Rankin量表评分和Barthel指数评分,微创组明显好于内科组(P<0.05);以Barthel指数评分≤60分为明显依赖生存的标准,微创组的明显依赖生存率低于内科组(0 vs.41.7%,P=0.012)。治疗后第90天时两组再出血率(6.7% vs.7.1%,P=1.000)、病死率(6.7% vs.14.3%,P=0.598)均无显著差别。
结论:与单纯内科保守治疗相比,颅内血肿微创穿刺粉碎清除术治疗基底节区中等量(25～40ml)自发性脑出血,可以明显提高患者的日常生活活动能力,降低明显依赖生存率,且不增加再出血率和病死率,是一项安全而有效的治疗方法。
Objective: To compare the clinical effect of the mini-invasive aspiration with conservative medical treatment in treating patients with 25~40ml spontaneous basal ganglia intracerebral hemorrhage.Methods: The study was a part of "the research of evaluating the clinical effect and cost of hospitalization in treating intracerebral hematoma with mini-invasive aspiration", which was a multi-center, randomized controlled research subject of Ministry of Health. Patients were randomly divided into "Aspiration group" and "Conservative group". The Scandinavian Stroke Scale (SSS) score in the 14th day, modified Rankin Scale (MRS) score in the 14~th and 90~th day, Barthel Index (BI) score, the rebleeding rate and mortality in the 90th day were used as the evaluating parameters.Results: Twenty-nine patients were involved in the study, 15 of them in Aspiration group and 14 of them in Conservative group. There was no significant difference between the two groups about the SSS score and MRS score in the 14~th day (P>0.05). In the 90th day after the therapy, the Aspiration group showed a remarkable improvement in MRS score and BI score (P<0.05). Taking the BI score < 60 as a remark of significant life dependency, the outcome of the Aspiration group were much better than that of Conservative group at the end of the study (0 vs. 41.7%, P=0.012). In the 90~th day of the study, no significant difference between the two groups in the rebleeding rate (6.7% vs.7.1%, P=1.000) and mortality (6.7% vs. 14.3%, P=0.598) was found.Conclusions: Compared with conservative therapy in treating 25~40ml spontaneous basal ganglia intracerebral hemorrhage, the mini-invasive aspiration therapy remarkably improved the patients' activities of daily life, decreased their dependency rate, indicating that the mini-invasive aspiration is a safe and effective method.
引文
1.杨期东,刘运海,田发发,肖剑锋.我国脑卒中发病分类亚型分布特征.中国现代医学杂志,1994,4(4):9-11.
2. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. The New England journal of medicine, 2001,344(19): 1450-1460.
3. Fayad PB, Awad IA. Surgery for intracerebral hemorrhage. Neurology, 1998, 51 (3): S69-73.
4.王文化,赵冬,吴桂贤,刘军,刘飒,秦兰萍,吴兆苏.北京市1984～1999年急性脑出血和脑血栓发病率变化趋势分析.中华流行病学杂志,2002,23(5):352-355.
5. Zhang LF, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, Huang YN, Chen J, Wu YF. Proportion of different subtypes of stroke in China. Stroke, 2003, 34(9): 2091-2096.
6.史玉泉,周孝达,吕传真,周良辅.实用神经病学(第三版).上海:上海科技出版社,2004,834-839.
7. Backlund EO, von Hoist H. Controlled subtotal evacuation of intracerebral haematomas by stereotactic technique. Surgical neurology, 1978, 9(2): 99-101.
8.陈牺光.高血压脑出血立体定向穿刺吸引术.大连医学院学报,1991,13(2):56-59.
9. Niizuma H, Otsuki T, Johkura H, Nakazato N, Suzuki J. CT-guided stereotactic aspiration of intracerebral hematoma--result of a hematoma-lysis method using urokinase. Applied neurophysiology. 1985, 48(1): 427-430.
10. Auer LM, Ascher PW, Heppner F, Ladurner G, Bone G, Lechner H, Tolly E. Does acute endoscopic evacuation improve the outcome of patients with spontaneous intracerebral hemorrhage? European neurology, 1985, 24(4): 254-261.
11. Hondo H, Uno M, Sasaki K, Ebisudani D, Shichijo F, Toth Z, Matsumoto K. Computed tomography controlled aspiration surgery for hypertensive intracerebral hemorrhage. Experience of more than 400 cases. Stereotactic and functional neurosurgery, 1990, 54-55: 432-437.
12. Ito H, Muka H, Kitamura A. Stereotactic aqua stream and aspirator for removal of intracerebral hematoma. Stereotactic and functional neurosurgery, 1990, 54-55: 457-460.
13. Nguyen JP, Decq P, Brugieres P, Yepes C, Melon E, Gaston A, Keravel Y. A technique for stereotactic aspiration of deep intracerebral hematomas under computed tomographic control using a new device. Neurosurgery, 1992, 31(2): 330-335.
14.贾保祥,蒋盘宏,顾征,徐屹,孙永权,王虹,刘人伟.经针穿刺治疗颅内血肿.中华外科杂志,1996,34(2):104-106.
15.贾保祥,孙仁泉,顾征,徐屹,孙永权.穿刺射流及液化技术治疗高血压脑出血的初步报告.中国神经精神疾病杂志,1996,22(4):233-235.
16. Wagner KR, Xi G, Hua Y, Kleinholz M, de Courten-Myers GM, Myers RE, Broderick JP, Brott TG.Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. Stroke, 1996, 27(3): 490-497.
17. Wagner KR, Xi G, Hua Y, Kleinholz M, de Courten-Myers GM, Myers RE. Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage.Journal of neurosurgery, 1998, 88(6): 1058-1065.
18. Xi G, Hua Y, Bhasin RR, Ennis SR, Keep RF, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of extravasated red blood cells on blood flow and blood-brain barrier integrity. Stroke, 2001, 32(12): 2932-2938.
19. Huang FP, Xi G, Keep RF, Hua Y, Nemoianu A, Hoff JT. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. Journal of neurosurgery, 2002, 96(2): 287-293.
20.张新江,易黎,常丽英,殷小平,徐广润,张苏明,方思羽,卢广,刘买力.凝血酶神经毒性作用的在体MRI观察.中国急救医学,2004,24(1):7-9.
21. Peeling J, Del Bigio MR, Corbett D, Green AR, Jackson DM. Efficacy of disodium 4-[(tert-butylimino)methyl]benzene-1,3-disulfonate N-oxide(NXY-059), a free radical trapping agent, in a rat model of hemorrhagic stroke. Neuropharmacology, 2001 40(3): 433-439.
22. Hua Y, Xi G, Keep RF, Hoff JT. Complement activation in the brain after experimental intracerebral hemorrhage. Journal of neurosurgery, 2000, 92(6): 1016-1022.
23. Matz PG, Massa SM, Weinstein PR, Turner C, Panter SS, Sharp FR. Focal hyperexpression of hemeoxygenase-1 protein and messenger RNA in rat brain caused by cellular stress following subarachnoid injections of lysed blood. Journal of neurosurgery, 1996, 85(5): 892-900.
24. Qureshi AI, Suri MF, Ostrow PT, Kim SH, Ali Z, Shatla AA, Guterman LR, Hopkins LN. Apoptosis as a form of cell death in intracerebral hemorrhage. Neurosurgery, 2003, 52(5): 1041-1048.
25. Kitaoka T, Hua Y, Xi G, Hoff JT, Keep RF. Delayed argatroban treatment reduces edema in a rat model of intracerebral hemorrhage. Stroke, 2002, 33(12): 3012-3018.
26. Yonezawa T, Hashimoto H, Sakaki T. Serial change of cerebral blood flow after collagenase induced intracerebral hemorrhage in rats. No shinkei geka(Neurological surgery), 1999, 27(5): 419-425.
27. Siddique MS, Fernandes HM, Wooldridge TD, Fenwick JD, Slomka P, Mendelow AD. Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study. Journal of neurosurgery, 2002, 96(4): 736-741.
28.董强,丁宏岩,史朗峰,韩翔,傅建辉,吕传真.急性脑出血患者颅内血肿周边局部脑血流量的氙-CT研究.中华医学杂志,2004,84(10):822-825.
29. Zazulia AR, Diringer MN, Videen TO, Adams RE, Yundt K, Aiyagari V, Grubb RL Jr, Powers WJ.Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. Journal of cerebral blood flow and metabolism. 2001, 21(7): 804-810.
30. Yague L, Garcia-March G, Paniagua C, Sanchez-Ledesma MJ, Diaz P, Ludena D, Maillo A, Broseta J. Stereotactic evacuation and local administration in intracerebral haematomas: A comparative study.Acta neurochirurgica, 1987, 39: 45-48.
31. Wagner KR, Xi G, Hua Y, Zuccarello M, de Courten-Myers GM, Broderick JP, Brott TG. Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model intracerebral hemorrhage:edema reduction and blood-brain barrier protection. Journal of neurosurgery,1999, 90(3): 491-498.
32. Rohde V, Rohde I, Thiex R, Ince A, Jung A, Duckers G, Groschel K, Rottger C, Kuker W, Muller HD,Gilsbach JM. Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. Journal of neurosurgery, 2002,97(4): 954-962.
33. Deinsberger W, Volgel J, Fuchs C, Auer LM, Kuschinsky W, Boker DK. Fibrinolysis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurological research, 1999, 21(5): 517-523.
34.刘剑立,王立辉,王耀山,何祥,刘际清,韩晓娟.高血压脑出血部位与临床表现分析.中国实用内科杂志,2004,24(6):352-353.
35. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score:a simple,reliable grading scale for intracerebral hemorrhage. Stroke, 2001, 32(4): 891-897.
36. Gebel JM Jr, Jauch EC, Brott TG, Khoury J, Sauerbeck L, Salisbury S, Spilker J, Tomsick TA, Duldner J, Broderick JP. Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke, 2002, 33(11): 2636-2641.
37. Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke, 1996, 27(10): 1783-1787.
38. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke, 1997, 28(12): 2370-2375.
39.褚晓凡,曲松滨,石峰,王海涛.高血压脑出血问题继续研究.中风与神经疾病杂志,1998,15(1):25-27.
40. Fujii Y, Takeuchi S, Harada A, Abe H, Sasaki O, Tanaka R. Hemostatic activation in spontaneous intracerebral hemorrhage. Stroke, 2001, 32(4): 883-890.
41. Mayer SA. Ultra-early hemostatic therapy for intracerebral hemorrhage. Stroke, 2003, 34(1): 224-229.
42. Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke, 2005, 36(1): 74-79.
43. Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Recombinant activated factor Ⅶ for acute intracerebral hemorrhage. The New England journal of medicine, 2005,352(8):777-785.
44. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology, 2001, 56(10):1294-1299.
45. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, Kase C, Krieger D, Mayberg M, Tilley B, Zabramski JM, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage:A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke, 1999, 30(4): 905-915.
46. Huang CF, Tsai ZP, Li CS, Wang KL, Wang YC. Surgical improvement of brain edema related to hypertensive intracerebral hemorrhage. Zhonghua Yi Xue Za Zhi (Taipei), 2002, 65(6): 241-246.
47.杜建新,凌锋,谌燕飞,赵瑞林,徐庚,李萌,陈革,单永治,陈文劲,张鹏.小骨窗开颅术和钻孔引流术治疗脑出血疗效的对比研究.中国脑血管病杂志,2004,1(7):292—294.
48. McKissock W, Richardson A, Taylor J. Primary intracerebral haemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet, 1961, 2(4): 222-226.
49.陈衔城,杨涵铭,陈振平.高血压脑出血的内外科治疗疗效的比较.上海医科大学学报,1992,19(3):237-240.
50.陈衔城,吴劲松,周晓平,张义,王知秋,秦智勇,庞力.高血压脑出血内外科规范化 治疗的疗效比较一多中心随机对照前瞻性研究.中国临床神经科学,2001,9(4):365-368.
51. Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. Journal of neurosurgery, 1989, 70(5): 755-758.
52. Batjer HH, Reisch JS, Allen BC,Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Archives of neurology. 1990, 47(10): 1103-1106.
53. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology, 1998, 51(5): 1359-1363.
54. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, Van Loveren H, Yeh HS, Tomsick T, Pancioli A, Khoury J, Broderick J. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke, 1999, 30(9): 1833-1839.
55. Tan SH, Ng PY, Yeo TT, Wong SH, Ong PL, Venketasubramanian N. Hypertensive basal ganglia hemorrhage: a prospective study comparing surgical and nonsurgical management. Surgical neurology, 2001, 56(5): 287-293.
56. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage(STICH):a randomised trial. Lancet, 2005, 365(9457): 387-397.
57. Hankey G J, Hon C. Surgery for primary intracerebral hemorrhage: is it safe and effective? A systemic review of case series and randomized trials. Stroke, 1997, 28(11): 2126-2132.
58. Prasad K, Browman G, Shrivastava A, Menon G. Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials. Acta neurologica Scandinavica, 1997, 95(2):103-110.
59. Saver JL. Surgery for primary intracerebral hemorrhage: meta-analysis of CT-era studies. Stroke, 1998, 29(7): 1477-1478.
60. Fernandes HM, Gregson B, Siddique S, Mendelow AD. Surgery in intracerebral hemorrhage. the uncertainty continues. Stroke, 2000, 31 (10): 2511-2516.
61. Bernays RL, Kollias SS, Romanowski B, Valavanis A, Yonekawa Y. Near-real-time guidance using intraoperative magnetic resonance imaging for radical evacuation of hypertensive hematomas in the basal ganglia. Neurosurgery, 2000, 47(5): 1081-1090.
62. Nakano T, Ohkuma H, Ebina K, Suzuki S. Neuroendoscopic surgery for Intracerebral hemorrhage—comparison with traditional therapies. Minimally invasive neurosurgery. 2003, 46(5): 278-283.
63.颅内血肿微创清除技术全国研究与推广协作组.颅内血肿微创清除技术临床应用培训教材.北京,2003,2-3,83-102.
64. Deinsberger W, Lang C, Hornig C, Boeker DK. Stereotactic aspiration and fibrinolysis of spontaneous supratentorial intracerebral hematomas versus conservative treatment: a matched-pair study. Zentralblatt fur Neurochirurgie, 2003, 64(4): 145-150.
65. Marquardt G, Wolff R, Sager A, Janzen RW, Seifert V. Subacute stereotactic aspiration of haematomas within the basal ganglia reduces occurrence of complications in the course of haemorrhagic stroke in non-comatose patients. Cerebrovascular diseases, 2003, 15(4): 252-257.
66. Marquardt G, Wolff R, Janzen RW, Seifert V. Basal ganglia haematomas in non-comatose patients:subacute stereotactic aspiration improves long-term outcome in comparison to purely medical treatment. Neurosurgical review, 2005,28(1), 64-69.
67. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R,Schneider G, Holzer P, Bone G, Mokry M, Korner E. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. Journal of neurosurgery, 1989, 70(4): 530-535.
68. Hosseini H, Leguerinel C, Hariz M, Melon E, Palfi S, Deck P, Gaston A, Cesaro P, Nguyen JP. Stereotactic aspiration of deep intracerebral hematomas under computed tomographic control. A multicentric prospective randomized trial. 12th European Stroke Conference, 2003, Valencia, Spain: 57.
69.关俊文,刘茂健,吴华超,招康东.颅内血肿微创清除术治疗高血压脑出血104例的随机对照研究.广东医学院学报,2004,22(2):133-134,143.
70. Teernstra OP, Evers SM, Lodder J, Leffers P, Franke CL, Blaauw G. Stereotactic treatment of intracerebral hematoma by means of plasminogen activator: a multicentre randomized controlled trial(SICHPA). Stroke, 2003, 34(4): 968-974.
71.李伟,刘鸣.锥颅穿刺血肿抽吸术治疗脑出血临床研究证据的系统评价.中国循证医学杂志,2004,4(1):42-45.
72.杨前进,微创清除术治疗高血压性脑出血(基底节区)的手术指征探讨:[硕士学位论文].广州:广州暨南大学第一临床医学院,2004.
73.中华神经科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29(6):379～380.
74. Barberl M, Faill M, Shieldsl M, Stottl DJ, Langhornel P. Validity and reliability of estimating the Scandinavian stroke scale score from medical records. Cerebrovascular Diseases, 2004, 17(2): 224.
75. Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke, 1999, 30(8):1538-1541.
76.蒋开夫,刘毅,王东,何芸,金泉伟,叶方博,王宁.基底节区脑出血早期微创血肿清除的疗效及再出血的分析.中风与神经疾病杂志,2004,21(3):259-260.
77. Montes JM, Wong JH, Fayad PB, Awad IA. Stereotaetic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke, 2000, 31 (4):834-840.
78.胡长林,吕海涛,李志超.颅内血肿微创清除技术规范化治疗指南.北京:中国协和医科大学出版社,2003:19—21,76—77,91,94—97.
79.王爱平,张小林,朱遂强,张苏明.超早期高血压脑出血微创术治疗的临床研究.内科急危重症杂志,2003,9(4):185-187.
80.殷小平,张苏明,张新江,姜亚平,王苇,夏黎明,方思羽.急性期血肿抽吸引流术对脑起保护作用的机制研究.中风与神经疾病杂志,2002,19(6):360-362.
2. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. The New England journal of medicine, 2001,344(19): 1450-1460.
3. Fayad PB, Awad IA. Surgery for intracerebral hemorrhage. Neurology, 1998, 51 (3): S69-73.
4.王文化,赵冬,吴桂贤,刘军,刘飒,秦兰萍,吴兆苏.北京市1984～1999年急性脑出血和脑血栓发病率变化趋势分析.中华流行病学杂志,2002,23(5):352-355.
5. Zhang LF, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, Huang YN, Chen J, Wu YF. Proportion of different subtypes of stroke in China. Stroke, 2003, 34(9): 2091-2096.
6.史玉泉,周孝达,吕传真,周良辅.实用神经病学(第三版).上海:上海科技出版社,2004,834-839.
7. Backlund EO, von Hoist H. Controlled subtotal evacuation of intracerebral haematomas by stereotactic technique. Surgical neurology, 1978, 9(2): 99-101.
8.陈牺光.高血压脑出血立体定向穿刺吸引术.大连医学院学报,1991,13(2):56-59.
9. Niizuma H, Otsuki T, Johkura H, Nakazato N, Suzuki J. CT-guided stereotactic aspiration of intracerebral hematoma--result of a hematoma-lysis method using urokinase. Applied neurophysiology. 1985, 48(1): 427-430.
10. Auer LM, Ascher PW, Heppner F, Ladurner G, Bone G, Lechner H, Tolly E. Does acute endoscopic evacuation improve the outcome of patients with spontaneous intracerebral hemorrhage? European neurology, 1985, 24(4): 254-261.
11. Hondo H, Uno M, Sasaki K, Ebisudani D, Shichijo F, Toth Z, Matsumoto K. Computed tomography controlled aspiration surgery for hypertensive intracerebral hemorrhage. Experience of more than 400 cases. Stereotactic and functional neurosurgery, 1990, 54-55: 432-437.
12. Ito H, Muka H, Kitamura A. Stereotactic aqua stream and aspirator for removal of intracerebral hematoma. Stereotactic and functional neurosurgery, 1990, 54-55: 457-460.
13. Nguyen JP, Decq P, Brugieres P, Yepes C, Melon E, Gaston A, Keravel Y. A technique for stereotactic aspiration of deep intracerebral hematomas under computed tomographic control using a new device. Neurosurgery, 1992, 31(2): 330-335.
14.贾保祥,蒋盘宏,顾征,徐屹,孙永权,王虹,刘人伟.经针穿刺治疗颅内血肿.中华外科杂志,1996,34(2):104-106.
15.贾保祥,孙仁泉,顾征,徐屹,孙永权.穿刺射流及液化技术治疗高血压脑出血的初步报告.中国神经精神疾病杂志,1996,22(4):233-235.
16. Wagner KR, Xi G, Hua Y, Kleinholz M, de Courten-Myers GM, Myers RE, Broderick JP, Brott TG.Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. Stroke, 1996, 27(3): 490-497.
17. Wagner KR, Xi G, Hua Y, Kleinholz M, de Courten-Myers GM, Myers RE. Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage.Journal of neurosurgery, 1998, 88(6): 1058-1065.
18. Xi G, Hua Y, Bhasin RR, Ennis SR, Keep RF, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of extravasated red blood cells on blood flow and blood-brain barrier integrity. Stroke, 2001, 32(12): 2932-2938.
19. Huang FP, Xi G, Keep RF, Hua Y, Nemoianu A, Hoff JT. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. Journal of neurosurgery, 2002, 96(2): 287-293.
20.张新江,易黎,常丽英,殷小平,徐广润,张苏明,方思羽,卢广,刘买力.凝血酶神经毒性作用的在体MRI观察.中国急救医学,2004,24(1):7-9.
21. Peeling J, Del Bigio MR, Corbett D, Green AR, Jackson DM. Efficacy of disodium 4-[(tert-butylimino)methyl]benzene-1,3-disulfonate N-oxide(NXY-059), a free radical trapping agent, in a rat model of hemorrhagic stroke. Neuropharmacology, 2001 40(3): 433-439.
22. Hua Y, Xi G, Keep RF, Hoff JT. Complement activation in the brain after experimental intracerebral hemorrhage. Journal of neurosurgery, 2000, 92(6): 1016-1022.
23. Matz PG, Massa SM, Weinstein PR, Turner C, Panter SS, Sharp FR. Focal hyperexpression of hemeoxygenase-1 protein and messenger RNA in rat brain caused by cellular stress following subarachnoid injections of lysed blood. Journal of neurosurgery, 1996, 85(5): 892-900.
24. Qureshi AI, Suri MF, Ostrow PT, Kim SH, Ali Z, Shatla AA, Guterman LR, Hopkins LN. Apoptosis as a form of cell death in intracerebral hemorrhage. Neurosurgery, 2003, 52(5): 1041-1048.
25. Kitaoka T, Hua Y, Xi G, Hoff JT, Keep RF. Delayed argatroban treatment reduces edema in a rat model of intracerebral hemorrhage. Stroke, 2002, 33(12): 3012-3018.
26. Yonezawa T, Hashimoto H, Sakaki T. Serial change of cerebral blood flow after collagenase induced intracerebral hemorrhage in rats. No shinkei geka(Neurological surgery), 1999, 27(5): 419-425.
27. Siddique MS, Fernandes HM, Wooldridge TD, Fenwick JD, Slomka P, Mendelow AD. Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study. Journal of neurosurgery, 2002, 96(4): 736-741.
28.董强,丁宏岩,史朗峰,韩翔,傅建辉,吕传真.急性脑出血患者颅内血肿周边局部脑血流量的氙-CT研究.中华医学杂志,2004,84(10):822-825.
29. Zazulia AR, Diringer MN, Videen TO, Adams RE, Yundt K, Aiyagari V, Grubb RL Jr, Powers WJ.Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. Journal of cerebral blood flow and metabolism. 2001, 21(7): 804-810.
30. Yague L, Garcia-March G, Paniagua C, Sanchez-Ledesma MJ, Diaz P, Ludena D, Maillo A, Broseta J. Stereotactic evacuation and local administration in intracerebral haematomas: A comparative study.Acta neurochirurgica, 1987, 39: 45-48.
31. Wagner KR, Xi G, Hua Y, Zuccarello M, de Courten-Myers GM, Broderick JP, Brott TG. Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model intracerebral hemorrhage:edema reduction and blood-brain barrier protection. Journal of neurosurgery,1999, 90(3): 491-498.
32. Rohde V, Rohde I, Thiex R, Ince A, Jung A, Duckers G, Groschel K, Rottger C, Kuker W, Muller HD,Gilsbach JM. Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. Journal of neurosurgery, 2002,97(4): 954-962.
33. Deinsberger W, Volgel J, Fuchs C, Auer LM, Kuschinsky W, Boker DK. Fibrinolysis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurological research, 1999, 21(5): 517-523.
34.刘剑立,王立辉,王耀山,何祥,刘际清,韩晓娟.高血压脑出血部位与临床表现分析.中国实用内科杂志,2004,24(6):352-353.
35. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score:a simple,reliable grading scale for intracerebral hemorrhage. Stroke, 2001, 32(4): 891-897.
36. Gebel JM Jr, Jauch EC, Brott TG, Khoury J, Sauerbeck L, Salisbury S, Spilker J, Tomsick TA, Duldner J, Broderick JP. Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke, 2002, 33(11): 2636-2641.
37. Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke, 1996, 27(10): 1783-1787.
38. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke, 1997, 28(12): 2370-2375.
39.褚晓凡,曲松滨,石峰,王海涛.高血压脑出血问题继续研究.中风与神经疾病杂志,1998,15(1):25-27.
40. Fujii Y, Takeuchi S, Harada A, Abe H, Sasaki O, Tanaka R. Hemostatic activation in spontaneous intracerebral hemorrhage. Stroke, 2001, 32(4): 883-890.
41. Mayer SA. Ultra-early hemostatic therapy for intracerebral hemorrhage. Stroke, 2003, 34(1): 224-229.
42. Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke, 2005, 36(1): 74-79.
43. Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Recombinant activated factor Ⅶ for acute intracerebral hemorrhage. The New England journal of medicine, 2005,352(8):777-785.
44. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology, 2001, 56(10):1294-1299.
45. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, Kase C, Krieger D, Mayberg M, Tilley B, Zabramski JM, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage:A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke, 1999, 30(4): 905-915.
46. Huang CF, Tsai ZP, Li CS, Wang KL, Wang YC. Surgical improvement of brain edema related to hypertensive intracerebral hemorrhage. Zhonghua Yi Xue Za Zhi (Taipei), 2002, 65(6): 241-246.
47.杜建新,凌锋,谌燕飞,赵瑞林,徐庚,李萌,陈革,单永治,陈文劲,张鹏.小骨窗开颅术和钻孔引流术治疗脑出血疗效的对比研究.中国脑血管病杂志,2004,1(7):292—294.
48. McKissock W, Richardson A, Taylor J. Primary intracerebral haemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet, 1961, 2(4): 222-226.
49.陈衔城,杨涵铭,陈振平.高血压脑出血的内外科治疗疗效的比较.上海医科大学学报,1992,19(3):237-240.
50.陈衔城,吴劲松,周晓平,张义,王知秋,秦智勇,庞力.高血压脑出血内外科规范化 治疗的疗效比较一多中心随机对照前瞻性研究.中国临床神经科学,2001,9(4):365-368.
51. Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. Journal of neurosurgery, 1989, 70(5): 755-758.
52. Batjer HH, Reisch JS, Allen BC,Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Archives of neurology. 1990, 47(10): 1103-1106.
53. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology, 1998, 51(5): 1359-1363.
54. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, Van Loveren H, Yeh HS, Tomsick T, Pancioli A, Khoury J, Broderick J. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke, 1999, 30(9): 1833-1839.
55. Tan SH, Ng PY, Yeo TT, Wong SH, Ong PL, Venketasubramanian N. Hypertensive basal ganglia hemorrhage: a prospective study comparing surgical and nonsurgical management. Surgical neurology, 2001, 56(5): 287-293.
56. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage(STICH):a randomised trial. Lancet, 2005, 365(9457): 387-397.
57. Hankey G J, Hon C. Surgery for primary intracerebral hemorrhage: is it safe and effective? A systemic review of case series and randomized trials. Stroke, 1997, 28(11): 2126-2132.
58. Prasad K, Browman G, Shrivastava A, Menon G. Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials. Acta neurologica Scandinavica, 1997, 95(2):103-110.
59. Saver JL. Surgery for primary intracerebral hemorrhage: meta-analysis of CT-era studies. Stroke, 1998, 29(7): 1477-1478.
60. Fernandes HM, Gregson B, Siddique S, Mendelow AD. Surgery in intracerebral hemorrhage. the uncertainty continues. Stroke, 2000, 31 (10): 2511-2516.
61. Bernays RL, Kollias SS, Romanowski B, Valavanis A, Yonekawa Y. Near-real-time guidance using intraoperative magnetic resonance imaging for radical evacuation of hypertensive hematomas in the basal ganglia. Neurosurgery, 2000, 47(5): 1081-1090.
62. Nakano T, Ohkuma H, Ebina K, Suzuki S. Neuroendoscopic surgery for Intracerebral hemorrhage—comparison with traditional therapies. Minimally invasive neurosurgery. 2003, 46(5): 278-283.
63.颅内血肿微创清除技术全国研究与推广协作组.颅内血肿微创清除技术临床应用培训教材.北京,2003,2-3,83-102.
64. Deinsberger W, Lang C, Hornig C, Boeker DK. Stereotactic aspiration and fibrinolysis of spontaneous supratentorial intracerebral hematomas versus conservative treatment: a matched-pair study. Zentralblatt fur Neurochirurgie, 2003, 64(4): 145-150.
65. Marquardt G, Wolff R, Sager A, Janzen RW, Seifert V. Subacute stereotactic aspiration of haematomas within the basal ganglia reduces occurrence of complications in the course of haemorrhagic stroke in non-comatose patients. Cerebrovascular diseases, 2003, 15(4): 252-257.
66. Marquardt G, Wolff R, Janzen RW, Seifert V. Basal ganglia haematomas in non-comatose patients:subacute stereotactic aspiration improves long-term outcome in comparison to purely medical treatment. Neurosurgical review, 2005,28(1), 64-69.
67. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R,Schneider G, Holzer P, Bone G, Mokry M, Korner E. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. Journal of neurosurgery, 1989, 70(4): 530-535.
68. Hosseini H, Leguerinel C, Hariz M, Melon E, Palfi S, Deck P, Gaston A, Cesaro P, Nguyen JP. Stereotactic aspiration of deep intracerebral hematomas under computed tomographic control. A multicentric prospective randomized trial. 12th European Stroke Conference, 2003, Valencia, Spain: 57.
69.关俊文,刘茂健,吴华超,招康东.颅内血肿微创清除术治疗高血压脑出血104例的随机对照研究.广东医学院学报,2004,22(2):133-134,143.
70. Teernstra OP, Evers SM, Lodder J, Leffers P, Franke CL, Blaauw G. Stereotactic treatment of intracerebral hematoma by means of plasminogen activator: a multicentre randomized controlled trial(SICHPA). Stroke, 2003, 34(4): 968-974.
71.李伟,刘鸣.锥颅穿刺血肿抽吸术治疗脑出血临床研究证据的系统评价.中国循证医学杂志,2004,4(1):42-45.
72.杨前进,微创清除术治疗高血压性脑出血(基底节区)的手术指征探讨:[硕士学位论文].广州:广州暨南大学第一临床医学院,2004.
73.中华神经科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29(6):379～380.
74. Barberl M, Faill M, Shieldsl M, Stottl DJ, Langhornel P. Validity and reliability of estimating the Scandinavian stroke scale score from medical records. Cerebrovascular Diseases, 2004, 17(2): 224.
75. Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke, 1999, 30(8):1538-1541.
76.蒋开夫,刘毅,王东,何芸,金泉伟,叶方博,王宁.基底节区脑出血早期微创血肿清除的疗效及再出血的分析.中风与神经疾病杂志,2004,21(3):259-260.
77. Montes JM, Wong JH, Fayad PB, Awad IA. Stereotaetic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke, 2000, 31 (4):834-840.
78.胡长林,吕海涛,李志超.颅内血肿微创清除技术规范化治疗指南.北京:中国协和医科大学出版社,2003:19—21,76—77,91,94—97.
79.王爱平,张小林,朱遂强,张苏明.超早期高血压脑出血微创术治疗的临床研究.内科急危重症杂志,2003,9(4):185-187.
80.殷小平,张苏明,张新江,姜亚平,王苇,夏黎明,方思羽.急性期血肿抽吸引流术对脑起保护作用的机制研究.中风与神经疾病杂志,2002,19(6):360-362.