期刊
LANCET
卷 374, 期 9695, 页码 1067-1073出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(09)61115-6
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资金
- Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship
- Medical Research Council [G0001237, G9439390, G0600986] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10327] Funding Source: researchfish
- MRC [G0001237, G9439390, G0600986] Funding Source: UKRI
Background Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes. Methods We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294). Findings Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups. Interpretation Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months. Funding Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).
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