ABSTRACT
To systematically review the efficacy and safety of acupuncture combined with minimally invasive surgery or basic the-rapy in treating hypertensive intracerebral hemorrhage(HICH) patients compared with minimally invasive surgery or basic treatment. In this study, the four Chinese databases, the four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, all above were systematically and comprehensively retrieved from the time of database establishment to September 10, 2020. Rando-mized controlled trials(RCTs) were screened out according to inclusion criteria and exclusion criteria established in advanced. The methodological quality of included studies was evaluated by the tool named "Cochrane bias risk assessment 6.1". Meta-analysis of the included studies was performed using RevMan 5.4, and the quality of outcome indicators was evaluated by the GRADE system. Finally, 17 studies were included, involving 1 852 patients with HICH, and the overall quality of the included studies was not high. According to Meta-analysis,(1)CSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-3.50,95%CI[-4.39,-2.61],P<0.000 01);(2)NIHSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.78,95%CI[-5.55,-4.00],P<0.000 01);(3)the cerebral hematoma volume of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.44,95%CI[-5.83,-3.04],P<0.000 01);(4)ADL score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=20.81,95%CI[17.25,24.37],P<0.000 01);(5)the GCS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=2.41,95%CI[1.90,2.91],P<0.000 01). The GRADE system showed an extremely low level of evidence for the above outcome indicators. Adverse reactions were mentioned only in two literatures, with no adverse reactions reported. The available evidence showed that acupuncture combined with minimally invasive surgery or basic therapy had a certain efficacy in patients of HICH compared with minimally invasive surgery or basic therapy. However, due to the high risk of bias in the included studies, its true efficacy needs to be verified by more high-quality studies in the future.
Subject(s)
Humans , Acupuncture Therapy , Intracranial Hemorrhage, Hypertensive/therapy , Treatment OutcomeABSTRACT
PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48h may be a good way in treating hypertensive hemorrhage of basal ganglia region.
OBJETIVO: Comparar o efeito curativo de diferentes tratamentos da hemorragia hipertensiva cerebral de 25 a 35ml. MÉTODOS: Foram analisados 595 casos agrupados segundo tratamento conservador e evacuação com técnica de punção transcraniana dentro de 6h ou de 6 às 48h do início do quadro clínico. RESULTADOS: O seguimento após três meses e avaliado pelo Escore de Atividade de Vida Diário, indicou que não houve diferenças significantes entre os tratamentos conservador e cirúrgico (p>0.05) O tratamento cirúrgico mostrou vantagem com hospitalização mais curta e redução de custos. CONCLUSÃO: A técnica de punção transcraniana para drenagem de hematoma dos núcleos da base pode ser uma boa alternativa de tratamento.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Basal Ganglia Hemorrhage/therapy , Basal Ganglia/surgery , Intracranial Hemorrhage, Hypertensive/therapy , Neurosurgical Procedures/methods , Basal Ganglia Hemorrhage/pathology , Basal Ganglia/pathology , Chi-Square Distribution , Hematoma/surgery , Length of Stay , Punctures/methods , Time Factors , Treatment OutcomeABSTRACT
The assessment of outcome in admitted patients with hypertensive intracerebral hemorrhage in a tertiary care hospital on the basis of GCS and CT scan.The cases of hypertensive intracerebral hemorrhage admitted to neurosurgery department of a tertiary care hospital during the year 2004 were included in the study. Those with cerebral infarction, recurrent hematoma, or hemorrhage due to non-hypertensive causes were excluded. The parameters assessed included age and sex of the patient, associated comorbids like DM and IHD, GCS on admission, CT scan findings, management and outcome. A total of 84 cases with hypertensive bleed were analyzed, of which 52 [62%] were between 30-60 years and 32 [38%] were more than 60 years of age with equal sex distribution. Statistically significant association was observed between co-morbidity and outcome of patients [p 0.00 1], between CT scan findings and management [p 0.006], between management and outcome [p=0.02]. Management and outcome of hypertensive ICH is dependent on multiple factors like age of the patient, co-morbidity, CT scan findings and GCS. These are some of the direct predictors of assessing ICH. The aim should be to prevent such incidents secondary to hypertension
Subject(s)
Humans , Male , Female , Intracranial Hemorrhage, Hypertensive/therapy , Intracranial Hemorrhage, Hypertensive/prevention & control , Glasgow Coma Scale , Tomography, X-Ray Computed , Myocardial Ischemia , Metabolic Diseases , Comorbidity , Outcome Assessment, Health CareABSTRACT
Los hematomas intracraneanos hipertensivos constituyen el 20 por ciento del total de los accidentes vasculares encefálicos. Tienen una incidencia de aproximadamente 100 casos cada 100.000 habitantes y una mortalidad global de casi el 50 por ciento. En nuestro país, la relación entre la hipertensión arterial mal controlada y mal tratada, con una hemorragia encefálica espontánea en el adulto, es significativa. Tomando en cuenta lo anterior y la gama de posibilidades terapéuticas y diagnósticas con que se cuenta actualmente, es que los autores realizan una valoración actualizada de la indicación quirúrgica en los hematomas de origen hipertensivo. Es así que en un período de 9 meses se reunió un total de 145 pacientes con hematomas hipertensivos, de los cuales 69 fueron operados y 76 no; se efectuó un análisis de ambos grupos por separado, comparándolos posteriormente. El objetivo del trabajo es tener una idea de la evolución de los pacientes operados y los no operados, según los criterios generales tomados en nuestro medio