| Objective:Hypertensive intracerebral hemorrhage(HICH)is the most common type of spontaneous intracerebral hemorrhage(sICH).It is a critical and severe disease with high morbidity,high mortality and high disability rate.As the prognosis of the disease is affected by a variety of complex risk factors,how to reduce the adverse results caused by these risk factors plays an important role in improving the prognosis of patients.In this study,the clinical data of patients with supratentorial hypertensive intracerebral hemorrhage treated by Department of Neurosurgery of Qujing Hospital Affiliated to Kunming Medical University were collected,and the relevant risk factors affecting short-term prognosis were further discussed through statistical analysis.At the same time,combined with the relevant literature in recent years,the risk factors affecting prognosis were analyzed.The purpose of this study is to provide a certain reference basis for standardized and individual clinical diagnosis,treatment and prognosis evaluation of HICH patients in the future so as to improve the prognosis of patients and improve their quality of l ife.Methods:In this subject,we consult the literature related to hypertensive intracerebral hemorrhage at home and abroad to understand the current research status,trends and research results.Combined with the diagnosis and treatment of the disease in the neurosurgery department of our hospital,statistics were made on 205 patients who were diagnosed as hypertensive intracerebral hemorrhage and underwent surgical treatment in our department from August 2018 to January 2020,who met the inclusion and exclusion criteria of this study.Combined with the focus of controversy and discussion,through the screening of clinical data,the following factors that may affect the prognosis of patients are selected as independent variables:personal data(age,sex),past history(history of hypertension,diabetes,smoking,drinking),preoperative CT imaging data(location,shape(?)and volume of hematoma,blood accumulated in the ventricle and the midline shifted or not).Preoperative general condition(preoperative systolic blood pressure,preoperative diastolic blood pressure,preoperative pulse pressure difference,preoperative GCS score),laboratory data(preoperative blood glucose,total cholesterol,homocysteine),time from onset to operation,mode of operation,intraoperative tracheotomy,postoperative complications(pulmonary infection,gastrointestinal bleeding,postoperative rebleeding,whether occurred intracranial infection or deep vein thrombosis of the lower extremity),NICU hospitalization days.The neurological function and prognosis of the patients in one month were evaluated by modified Rankin scale(Modified Rankin Scale)and activities of daily living scale(Barthel Index).According to the score,the patients were divided into two groups:(1)good prognosis group:the patients were able to walk independently,the mRS score was within 0,1,2,3,-or the ADL score was≥75;(2)poor prognosis group:the patients could not walk independently,the mRS score was within 4,5 and 6,-or the ADL score was less than 75.Chi-square test was used for univariate analysis of all possible risk factors and P<0.05 represents statistical significance.Then statistically significant factors were introduced into multivariate Logistic regression model analysis to further screen out independent risk factors affecting the prognosis of patients.Results:1.Among the 205 patients in this study,there were 113 male patients(55.1%).The average age of the patients was(59.01±12.003)years.The average preoperative systolic blood pressure was(174.24±27.298)mmHg and the preoperative diastolic blood pressure was(96.67±17.649)mmHg.There are 110 patients with the preoperative GCS score was 3～8(53.7%).The statistics of imaging data,showed that the most bleeding site was in the basal ganglia(62.0%),the average hematoma volume was(41.64 ± 15.861)ml,and the hematoma volume was more than 50ml in 49 cases(23.9%),the midline was obviously shifted to≥ 5mm in 98 cases(47.7%),the shape of hematoma was irregular in 46 cases(22.4%),and the hematoma broke into the ventricle in 91 cases(55.6%).Large bone flap craniotomy was performed in 55 cases(26.8%),minimally invasive small bone window craniotomy in 66 cases(32.2%),and skull drilling and drainage in 84 cases(41.0%).There were 82 patients(40.0%)who underwent tracheotomy,112 patients(59.5%)with pulmonary infection,52 patients(25.4%)with postoperative rebleeding,82 patients(40.0%)with gastrointestinal bleeding,13 patients(6.3%)with intracranial infection and 15 patients(7.3%)with deep venous thrombosis of lower extremities.The hospitalization days of NICU were more than seven days in 136 patients(66.3%).-The follow-up results of one month after operation,showed that 97 cases(47.3%)had good prognosis evaluated using mRS score,108 cases(52.7%)had poor prognosis,84 cases(41.0%)had good prognosis and 121 cases(59.0%)had poor prognosis showed by ADL score.2.Univariate analysis was conducted on 27 influencing factors according to mRS score and ADL score,respectively.The results showed that there were significant differences in the following 15 factors(P<0.05):preoperative systolic blood pressure,preoperative GCS score,hematoma volume,midline displacement,NICU days,operation time,hematoma shape,hematoma location,operation method,whether the hematoma broke into the ventricle,tracheotomy,postoperative rebleeding,pulmonary infection,gastrointestinal bleeding,intracranial infection.Multivariate Logistic regression analysis was introduced,and the results based on mRS score showed that preoperative GCS score(95%CI(0.000,0.125),OR=0.007,P=0.001),hematoma volume(95%CI(0.000,0.332),OR=0.001,P=0.004),midline shift(95%CI(0.002,0.249),OR=0.021,P=0.002),NICU days(95%CI(0.001,0.151),OR=0.013,P=0.001),surgical methods(95%CI(0.001,0.332),OR=0.001,P=0.008),whether the hematoma broke into the ventricle(95%CI(0.020,0.987),OR=0.142,P=0.048)and postoperative rebleeding(95%CI(0.004,0.269),OR=0.033,P=0.001),There were significant differences in seven factors mentioned above,which were the key factors affecting the prognosis of the patients.The results based on ADL score showed:preoperative GCS score(95%CI(0.015,0.337),OR=0.072,P=0.001),hematoma volume(95%CI(0.000,0.800),OR=0.016,P=0.038),NICU days(95%CI(0.008,0.201),OR=0.040,P=0.000),surgical methods(95%CI(0.008,0.678),OR=0.073,P=0.021),whether the hematoma broke into the ventricle(95%CI(0.042,0.914),OR=0.196,P=0.038)(?)and postoperative rebleeding 95%CI(0.024,0.896),OR=0.147,P=0.038)(?).There were significant differences in six factors mentioned above,which were the key factors affecting the prognosis of the patients.Conclusion:The early prognosis of patients with supratentorial hypertensive intracerebral hemorrhage treated by surgery is affected by many complex factors.The study showed that preoperative GCS score,hematoma volume,degree of midline displacement,NICU days,mode of operation,whether the hematoma broke into the ventricle and postoperative rebleeding were the key risk factors affecting the prognosis of the patients.Therefore,paying attention to these influencing factors and choosing individualized and standardized treatment programs for patients with different conditions in the treatment of hypertensive intracerebral hemorrhage is the key to improve the treatment rate of patients.It plays a positive role in improving the prognosis of patients,improving the survival rate and reducing the social and family economic burden. |
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