摘要
评估近年来关于高血压脑出血(hypertensive intracerebral hemorrhage,HICH)微创治疗的临床效果及卫生经济学研究成果。系统比较三种微创术式——小骨窗显微手术、神经内镜手术和立体定向穿刺引流术的临床疗效与经济学价值。基于2019—2024年PubMed、EMBASE等数据库的12篇随机对照试验(randomized controlled trial,RCT)、7篇队列研究和8篇经济学研究,采用成本效益分析(cost-effectiveness analysis,CEA)、成本效用分析(cost-utility analysis,CUA)等方法评估其资源消耗与健康产出。微创手术整体优于传统开颅术,其中立体定向术住院周期最短、直接成本最低;神经内镜术显著提升生活质量(质量调整生命年,quality-adjusted life year,QALY);小骨窗手术术后稳定性最佳。建议结合患者个体特征选择术式,并通过医保支付改革、技术推广优化卫生资源配置。
This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Costeffectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs));and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.
作者
袁庆震
徐兴华
干智超
曾宇枭
靳海涛
张家墅
陈晓雷
YUAN Qingzhen;XU Xinghua;GAN Zhichao;ZENG Yuxiao;JIN Haitao;ZHANG Jiashu;CHEN Xiaolei(Department of Neurosurgery,The First Medical Center of Chinese PLA General Hospital,28 Fuxing Road,Haidian District,Beijing 100853,China)
出处
《中国神经精神疾病杂志》
北大核心
2025年第7期385-390,共6页
Chinese Journal of Nervous and Mental Diseases
基金
国家自然科学基金项目(编号:82272134)。
关键词
高血压脑出血
微创外科
卫生经济学
成本效益分析
医保支付优化
Hypertensive intracerebral hemorrhage
Minimally invasive surgery
Health economics
Costeffectiveness analysis
Insurance policy reform
