The Lancet· 2013
Lobar Beyin Kanamalarında Erken Cerrahi, Konservatif Tedaviye Üstün Değil
Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial
- 1.409atıf
- 2013yıl
Kısa özet
Spontan supratentorial lobar intrakraniyal hematomların (10-100 mL) erken cerrahi ile boşaltılması, başlangıçta konservatif tedaviye kıyasla 6. ayda sonuçları iyileştirmedi; cerrahi grubundaki hastaların %59'unda, konservatif gruptaki %62'ye karşılık olumsuz sonuç görüldü.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Ana noktalar
- Lobar intrakraniyal kanamalar (10-100 mL) için erken cerrahi (12 saat içinde) konservatif tedaviye kıyasla 6 aylık sonuçları anlamlı derecede iyileştirmedi.
- Erken cerrahi grubundaki hastaların %59'unda olumsuz sonuç (Genişletilmiş Glasgow Sonuç Ölçeği) görülürken, konservatif grupta bu oran %62 idi.
- Deneye 27 ülkede 78 merkezden 601 hasta dahil edildi ve niyet-tedavi prensibine göre analiz edildi.
- Erken cerrahi, 6. ayda ölüm veya sakatlık oranını artırmadı.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Özet (abstract)
BACKGROUND: The balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10-100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients. METHODS: In this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1:1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967. FINDINGS: 307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3·7% [95% CI -4·3 to 11·6], odds ratio 0·86 [0·62 to 1·20]; p=0·367). INTERPRETATION: The STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage. FUNDING: UK Medical Research Council.
Yazarların özeti; kaynağından alınmıştır. The Lancet, 2013 · DOI ↗
Ücretsiz hesapla devam et
Makaleye Sor ile bu makaleye günde 3 soru ücretsiz; makaleyi kaydet, kaynakçasını al, ilgi alanına göre her gün yeni özetler. Çıkarımlar Premium.
Web'de ücretsiz devam etGoogle ya da Apple hesabınla giriş; kart istemez. Bu makaleye geri dönersin.
Telefonda:
Alan: Nöroloji (Tıp)
NeurologyMedicine