Prospective Study Of Appointed Programmed Treatment For Supratentorial Non-thalamus Hypertensive Intracerebral Hemorrhage

Objective: This study is performed to verify the clinical generalization ofappointed programmed treatment for supratentorial non-thalamus Hypert-ensive Intracerebral Hemorrhage(HICH).Methods:1General data: we retrospectively studied165cases suffered HICH,54cases treated with programmed protocol in Second Hospital of Hebei MedicalUniversity from Feb2013to Nov2013, and111cases with non-programmedtreatment from ICH data base. We create the database of Access whichregistered relative factors as below: gender, age, vocation, birth place, chiefcomplaint, symptom, GCS on admission, Modified Rankin Score (mRS) whendischarge from hospital, Medical history of diabetes mellitus, smoking andalcoholism, family history, length of hospitalization, cost of hospitalization,time from stroke to admission, location and volume of ICH, whether it hadbreak into ventricle or not, rebleeding or hematoma expanded, surgery, timingof surgery and complication.2All cases were confirmed HICH by computed tomography (CT) within72hours, meet with The Fourth National Conference on The Diagnosis ofCerebrovascular Disease Academic. Exclusion criteria:(1) ICH caused byIntracranial aneurysm, arteriovenous malformation (AVM), tumor, trauma,and systemic disease such as coagulation disorders.(2) ICH after cerebralinfarction.(3) ICH accompany with serious diseases such as heart, lung, liver,kidney damage or failure.(4) Ipsilateral stroke history with limbs disturbance.(5) Medical history was faulty before admission.(6) Ventricular, thalamus andinfratentorial ICH.(7) Dead or without treatment in hospital.(8) Failure tofollow up. 3Procedures of programmed treatment for supratentorial non-thalamusHICH:(1) Consecutive treatment with Hemostatic and blood pressure-lowering drugs for patients within24hours not achieved the light comaaccording to the GOS score. Give a close observation without dehydrated drug.(2) For cases within24hours after onset,20%mannitol at0.5g/kg admin-istration for the mild coma, and1g/kg or combining with other dehydratingdugs for the midrange coma or higher confusion. Continuing conservativetreatment as before when getting better, in addition, close observation to theconsciousness should attend before surgical intervention. Micro-invasivesurgery of hematoma puncture proceed when deterioration of consciousness.Take urokinase injection (20k~30k units, Q6H) to the hematoma along thedrain6hs after surgery, recanalization3hs after3hs blocking. Our target is:90%of the hematoma flow out within48~72hours. Mandatory craniotomyshould be done when consciousness get worse or drain invalid.(3)Conservative treatment with hemostatic, blood pressure-lowering andneurotrophic drugs for cases over24hours after onset which not achievedmild coma. Hematoma puncture were performed when the volume>20ml, thepostoperative managements are the same to the cases within24hours.4Statistics: Statistical analysis was carried out using SPSS version16.0for Windows software (SPSS Cop., USA). Continuous variables with a normaldistribution are expressed as mean±SEM and median. Median and interq-uartile range were reported for normal distribution data, Rank test used forcomparing with two groups and chi-square test used for ratio comparison,Graded data compared with Rank test. A ‘P’ value<0.05was consideredsignificant.Result:1There was no statistically significant difference in terms of hospital-lization between two groups (nonparametric Rank test, Z=-1.182, P=0.237).2There was no statistically significant difference in terms of expenditurebetween the programmed treatment group and the non-programmed treatmentgroup (nonparametric Rank test, Z=-0.681, P=0.389). 3Compare of clinical effects between programmed and non-programmedtreatment groups.Comparison of Modified Rankin Score (mRS) when discharge fromhospital between programmed and non-programmed treatment groups: Amongthe165cases, in programmed treatment group, the number of54cases getting0to6point are3,4,6,4,13,22,2cases and0,9,14,9,41,36,2cases innon-programmed treatment group respectively. There was no statisticallysignificant difference in terms of mRS when discharge from hospital betweenthe two groups (nonparametric Rank test Z=-0.476, P=0.634).4Compare of incidence of pulmonary infection (diagnosed by lungimaging, sputum culture, blood test and physical signs of lung) after HICHbetween programmed and non-programmed treatment group: there are6(11.1%) cases with pulmonary infection in programmed treatment group,whereas in the non-programmed treatment group, there are31(27.9%) caseswith pulmonary infection. The programmed treatment group has a lowerincidence of pulmonary infection, which shows statistically significantdifference(χ2=5.906, P=0.015).Conclusions:This prospective study shows that our programmed treatment has greatvalue of clinical generalization. It can reduce the incidence of pulmonaryinfection. There was no statistically significant difference in terms of mRSwhen discharge from hospital between the two groups.