Systematic Review For Efficacy And Safety Of Surgical Or Conservative Treatment In Intracerebral Hemorrhage

Objective:To evaluate the effectiveness and safety of surgical or conservative treatment in intracerebral hemorrhage.Methods:MEDLINE,EMBASE,The Cochrane Library,CNKI were searched from 1960 to Dec.2008.And we identified randomized controlled trials of intracerebral hemorrhage.The quality of included trials was evaluated by two estimators.And meta-analysis was conducted on homogeneous studies.Results:Fourteen(3617 patients) were included.All included studies were graded in term of randomization,allocation concealment,and blinding.Ten studies were graded B and the other four were graded C.Meta-analysis based on included studies shows surgical treatment or medical treatment in intracerebral hemorrhage that patients mortality OR(95%CI) values were 0.73(0.48,1.13),0.71(0.50,1.02),0.83(0.67,1.03),0.67(0.41,1.10) at the end of 1,3,6,12 months respectively,patients survival of the two group difference had no significance statistically,p value＞0.05;patients independence OR(95%CI) values were 0.66(0.39,1.11), 1.07(0.79,1.43) at the end of 3,6 months respectively,patients independence of the two groups difference had no significance statistically,p value＞0.05;only at 12 month the difference of two groups had significance statistically,p value＜0.05.Basal ganglia intracerebral patients mortality OR(95%CI) value was 0.55(0.37,0.82),the two groups had significance statistically,p value＜0.05.Lobar and thalamic intracerebral patients mortality OR(95%CI) value were 0.66 (0.41,1.06),0.40(0.03,5.15) respectively,patients survival of the two group difference had no significance statistically,p value＞0.05;Hematoma volume＞50 ml patients mortality OR(95%CI) value was 0.71(0.21,2.36),patients survival of the two group difference had no significance statistically,p value＞0.05;GCS 3-8 score,GCS 9-12 score,GCS 13-15 score patients mortality OR(95%CI) value were 1.93(0.78,4.75),0.72(0.44,1.16),0.88(0.58,1.34), patients survival of the two group difference had no significance statistically,p value＞0.05.Conclusions:Our study shows that surgical treatment make no statistical difference to survival in intracerebral hemorrhage patients compared with conservative treatment.Surgical treatment make no statistical difference to improve the ability of living in intracerebral hemorrhage patients compared with conservative treatment at 3,6 months,but surgical treatment patients have better ability of living at 12 month after onset.And surgical treatment make no statistical difference to survival in lobar or thalamic region cerebral hemorrhage patients,but surgical treatment group had low mortality compared with medical treatment group in patients of ganglia region cerebral hemorrhage,minimally operative way may elevate the survival of intracerebral hemorrhage patients.And surgery make no statistical difference to survival to hematoma volume＞50 ml patients compared with conservative treatment.And there is no statistical difference to survival in intracerebral hemorrhage patients of surgical group or medical group with equal consciousness.Owing to high possibility of selection bias in included studies,there must be a negative impact on evidence intensity of our results.We expect high quality evidences provided by high quality double blind randomized controlled trials.