| BackgroundHypertensive intracerebral hemorrhage(HICH)is one of the common emergencies in neurosurgery,with high rates of mortality and disability.There are many treatment plans for HICH,but there is no unified treatment guidance standard at present.Various factors such as the amount of bleeding,the location of bleeding,and the timing of treatment will have a great impact on its prognosis.Therefore,we designed this retrospective study to clarify the clinical features of HICH and its risk factors,and to analyze the prognosis of HICH;on the other hand,we compared the characteristics of patients with different treatment methods and the treatment effect,in order to provide a certain basis in the clinical treatment decision-making and to strengthen the follow-up management of patients after surgery in order to improve the prognosis of HICH.MethodsFrom January 2016 to December 2016,patients diagnosed as hypertensive intracerebral hemorrhage at the Second Affiliated Hospital of Zhejiang University School of Medicine and who had not been treated in other hospitals before coming to hospital according to whether they were treated surgically or not,were divided in two groups,conservative treatment group and surgical group,the latter according to different surgical methods were divided into craniotomy group,and stereotactic puncture group.The clinical baseline data,imaging data,operation status,discharge status,and long-term follow-up data were recorded.Multivariate logistic regression analysis was used to screen independent risk factors for HICH.Kaplan-Meier method was used to draw the survival curve of patients in each treatment group and to compare the survival curve of each group.Then the Cox regression model was used to study the effects of different treatment methods and other factors on self-recovery at 6-month.ResultsA total of 97 patients with hypertensive intracerebral hemorrhage were included.Among them,77 patients underwent surgical treatment and 20 patients underwent conservative medical treatment.The average age of hypertensive intracerebral hemorrhage patients was 57.44±12.10 years old,and the old rate was 28.90%.Male patients were predominant.The median GCS score at admission was 10 points.The main manifestations were unclear consciousness(54.60%)and physical fatigue(52.60%).The hemorrhage site was mainly located in the basal ganglia region(67.0%),and 48.5%of patients had bleeding into the ventricles.The median length of hospital stay for all patients was 15 days.High GCS scores(OR = 0.802,95%CI(0.693,0.929),p = 0.003)were independent protective factors of poor prognosis,hospital stay(OR =1.096,95%CI(1.017,1.1180),p = 0.016),Older age(OR = 5721,95%CI(1.720,19.032)(p = 0.004),ruptured ventricles(OR = 3.503,95%CI(1.113,11.025)(p =0.032)was an independent risk factor for poor prognosis.Whether or not surgery,blood loss,and bleeding sites were also potential risk factors for poor prognosis.Cox regression analysis found that the elderly(HR = 0.475,95%CI:0.249-0.905,p = 0.024),and the amount of bleeding(HR = 0.563,95%CI;0.319-0.992,p = 0.047),smoking history(HR = 0.529,95%Cl:0.287-0.975,p = 0.041)were independent predictors of self-care recovery after discharge in all patients.Treatment and surgical treatment had no significant difference in prognosis and self-care recovery after discharge.However,in patients undergoing surgical treatment,the prognosis of patients treated with stereotactic aspiration and craniotomy hematoma removal was better than that of patients undergoing cerebral ventricular drainage.There was no significant difference in self-care after recovery.ConclusionThis study verified the characteristics of HICH,and found that advanced age,bleeding into the ventricles,and total length of hospital stay were independent risk factors for poor prognosis of HICH,and high GCS score was an independent protective factor for poor prognosis of HICH.Among patients who had a GCS score of>12 on admission,there was no significant difference in the effect of medical treatment and surgical treatment,and there was no significant difference in self-care recovery rate and self-care recovery time after discharge.Among patients who chose surgical treatment,patients with stereotactic aspiration had better therapeutic outcomes than patients with a craniotomy hematoma removal,and patients with stereotactic aspiration had a higher rate of self-care recovery and a faster recovery rate. |
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