| Background:Hypertensive intracerebral hemorrhage is one of the commoncomplications of hypertension with a high mortality rate.The basal ganglia region has cortical spinal tract walking,cerebral hemorrhage patients with hemiplegia and other sequelae.At present,the main objective of the treatment of cerebral hemorrhage is to improve the patients’ physical activities and improve the quality of life.The treatment of cerebral hemorrhage mainly includes conservative treatment,minimally invasive puncture treatment,neuroendoscopic minimally invasive hematoma removal and traditional craniotomy hematoma removal.At present,minimally invasive puncture treatment iswidely used in the treatment of hypertensive cerebral hemorrhage.The choice of treatment is relevantwith the amount of bleeding and the location of the bleeding.At present,for patients with hematoma greater than 30 ml and clearconsciousness,whether there is difference between puncture therapy and conservative therapy is controversial.Diffusion Tensor Imaging(DTI)is a new imaging method developed on the basis of Magnetic Resonance Imaging(MRI).After obtaining the original data,DTT based on Diffusion Tensor Tractography(DTT)can be obtained through the reprocessing of computer software.The distribution and running condition of the fiber bundles can be understood through the examination of diffusion tensor fiber bundle imaging,and the damage and integrity of the fiber bundles can be known.Diffusion tensor imaging can be used to evaluate the prognosis of patients with cerebral hemorrhage.Diffusion tensor imaging is widely used in clinical practice,and there are few reports on whether diffusion tensor imaging can be used in the treatment of cerebral hemorrhage.At present,the treatment of hypertensive intracerebral hemorrhage includes traditional craniotomy,minimally invasive neuroendoscopic therapy,drilling hematoma drainage and conservative treatment.The objective of surgical treatment is to remove hematoma,reduce hematoma compression and re-injury.For patients with a small amount of bleeding and20ml< 30 ml hematoma,we generally choose conservative treatment.With the development of imaging and the improvement of surgical techniques,the surgical indications of cerebral hemorrhage are somewhat relaxed.For a small number of patients with 20 ml of hemorrhage<30ml of hematoma,many clinical neurosurgeons have performed puncture drainage.Whether surgical treatment is definitely better than conservative treatment in patients with intracerebral hemorrhage with 20ml< hematoma volume <30m remains to be determined.Diffusion tensor imaging can not only quantitatively analyze fiber bundles,but also visually display them.It is not clear whether puncture therapy and conservative therapy have different therapeutic effects in patients with bleeding of 20ml< hematoma volume <30ml,and whether diffusion tensor imaging can be used as an indicator for surgical intervention of small amount of cerebral hemorrhage.Objective:1.To explore whether minimally invasive puncture treatment combined with urokinase can be used as a treatment for hypertensive cerebral hemorrhage,and to explore the safety and effectiveness of this treatment。2.To explore whether there is a difference in the therapeutic effect between minimally invasive puncture treatment combined with postoperative urokinase therapy and conservative therapy for patients with hypertensive cerebral hemorrhage with a hematoma volume greater than 30 ml.3.To explore whether diffusion tensor imaging is related to limb movement recovery in patients with cerebral hemorrhage and whether diffusion tensor imaging can be used as an indicator for surgical intervention of small amount of cerebral hemorrhage.Methods:1.The data of patients with hypertensive intracerebral hemorrhage from August 2011 to August2017 operated in the Affiliated Hospital of Qingdao University were collected.There were 203 patientswith hypertensive intracerebral hemorrhage,threepatients bled again after minimally invasive puncture treatment and they were got rid of the study group.The main indexes to evaluate the therapeutic effect of intracerebral hemorrhage patients are the amount of intracerebral hematoma,the eye opening reaction,the speech reaction and the limb movement reaction of the patients after treatment.The amount of intracranial hematoma can be calculated by CT.Patients’ eye opening reaction,speech and limb motor response can be evaluated by GCS(Glasgow Coma Scale).The scores of the patients were high,the prognosis of the patients was good.Two hundreds of hypertensive intracerebral hemorrhage patients in this study who were treated by minimally invasive puncture or by minimally invasive puncture and monitoring of intracranial pressure from August 2011 to August 2017 were studied.The amount of hematoma in the brain was calculated by CT before and after operation,the preoperative and postoperative GCS scores were calculated according to the electronic medical records of the patients.The amount of intracerebral hematoma,GCS scores were compared before and after minimally invasive puncture treatment,and whether the changes were statistically significant.We randomly choose 20 patients from 140 patients whose blood mass was more than 30 ml as study group.We randomly chose20 patients of hypertensive intracerebral hemorrhage as the control group.The GCS scores of 1 week later、one month later and the blood mass were recorded and statistically analyzed and the difference between the two groups was or was not statistically significant.2.There were 60 patients of hypertensive intracerebral hemorrhage in the two hundreds patents from August 2011 to August 2017.The blood mass of the patients were less than30 ml and they had the diffusion tensor imaging before the minimally invasive puncture treatment.The number of patients of CST grade 1,grade 2,grade 3 was 21,31 and 8respectively.We randomly choose 20 patients of CST grade 1 as operational group A and 20 patients of CST grade 2 or 3 as operational group B.We randomly chose 20 patients of hypertensive intracerebral hemorrhage as the control group.We recorded the NIHSS scores of every group and FA of operational group A and operational group B.Then the data of the three groups were analyzed and compared statistically.Operational group A and operational group B patients’ preoperative hematoma volume was calculated according to CT.The difference of preoperative hematoma volume between the two groups was or was not statistically significant.Operational group A and operational group B patients’ hematoma volume of the first day of postoperativewas or was not statistically significant.Operational group A and operational group B patients’ preoperative hematoma volume was or was not statistically significant with the control group.The NIHSS limb motion scores were recorded before operation,1 week after operation and 1 month after operation in the surgical treatment group and the conservative treatment group.The NIHSS scores of preoperative,1 week after operation and 1 month after operation of group A and group B were statistically analyzed and the difference between the two groups was or was not statistically significant.The NIHSS scores of preoperative,1 week after operation and 1month after operation of group A and the control group were statistically analyzed and the difference between the two groups was or was not statistically significant.The NIHSS scores of preoperative,1 week after operation and 1 month after operation of group B and the control group were statistically analyzed and the difference between the two groups was or was not statistically significant.The operational group patients had the diffusion tensor imaging and recorded the FA before the minimally invasive puncture treatment and 1 month after operation.The FA of preoperative and 1 month after operation of group A and group B were statistically analyzed and the difference between the two groups was or was not statistically significant.Results:There were 203 patientswith hypertensive intracerebral hemorrhage,threepatients bled again after minimally invasive puncture treatment and they were got rid of the study group.The remaining 200 cases had no death,6 cases had intracranial infection after operation,and 9 cases had pulmonary infection.The rates of intracranial infection and pulmonary infection were 3% and 4.5%.The hematoma volume and GCS score were calculated before operation,the first day of postoperativeand the fourth day of postoperative.The patients’ blood mass of preoperative,the first day of postoperative,the fourth day of postoperative were 31.45±6.33 ml,13.65±2.29 ml,6.22±1.55 ml respectively.The hematoma evacuation rate of the first day of postoperative,the fourth day of postoperative were0.56±0.05,0.79±0.07 respectively.We conducted T test for hematoma volume preoperative,the first day of postoperative and the fourth day of postoperative.There were significantly statistical difference between the blood mass of preoperative and the first day of postoperative(t=16.72,p<0.05);between the blood mass of preoperative and the fourth day of postoperative(t=17.44,p<0.05).The patients’ GCS score of preoperative,the first day of postoperative,the fourth day of postoperative were 6.95±1.19,10.80±0.83,12.00±0.86 respectively.We conducted T test for GCS scorepreoperative,the first day of postoperative and the fourth day of postoperative.There were significantly statistical difference between the GCS of preoperative and the first day of postoperative(t=15.15,p<0.05);between the GCS of preoperative and the forth day of postoperative(t=16.65,p<0.05).The age of study group and control group were 50.3 ± 4.6 and4 9.5 ± 4.9respectively.The blood mass of study group and control group were 37.5±2.8ml and37.3±3.6mlrespectively.The GCS scores of study group of attack、 1 week later、one month later were 6.35±1.18、8.45±1.15 and 10.45±1.23 respectively.The GCS scores of control group of attack、1 week later、one month later were 6.10±1.41、6.10±1.41 and 9.25±0.89 respectively.We conducted T test for GCS scores of 1 week later of study group and control group.There were significant statistical difference in GCS scores of study group and control group(t=8.9,p<0.05).We conducted T test for GCS scores of one month later of study group and control group.There were significant statistical difference in GCS scores of study group and control group(t=4.8,p<0.05).The age of group A,group B and conservative treatment group were 50.8±4.5,49.5±3.5 and 50.0 ± 3.2 respectively.The preoperative blood mass of group A,group B and conservative treatment group were 24.8±3.9ml,24.7±3.5ml and 24.0±2.9ml respectively.The preoperative NIHSS scores of group A,group B and conservative treatment group were4.80±0.89,4.65±0.81 and 4.60±0.88 respectively.The NIHSS scores of group A,group B and conservative treatment group were3.65±0.88,4.20±0.70 and 4.30±0.73 respectively 1week after operation.The NIHSS scores of group A,group B and conservative treatment group were2.65±0.67,3.15±0.75 and 3.35±0.88 respectively one month after operation.Theblood mass of group A and group B were 13.75±2.94 ml,12.65±1.79 ml afterthe first day of postoperative respectively.The FA of preoperative and 1 month after operation of group A and group B was 0.32±0.05,0.24±0.05,0.37±0.04,0.27±0.06 respectively.The age,blood loss and NIHSS score of group A,group B and conservative treatment group were statistically analyzed.We conducted T test for age,preoperative blood mass and the NIHSS scores of group A,group B and conservative treatment group.There were no significant statistical difference in age,blood loss and the NIHSS score of group A and group B(t=1.08,0.09,0.72,p>0.05).There were no significant statistical difference in age,blood loss and the NIHSS score of group A and conservative treatment group(t=0.69,0.63,0.68,p>0.05).There were no significant statistical difference in age,blood loss and NIHSS score of group B and conservative treatment group(t=0.48,0.65,0.19,p>0.05).Each group has homogeneity and can be compared and statistical analysis.There were significant statistical difference in FA of group A and group B(t=4.35,p<0.05).There were significant statistical difference in FA of group A and group B(t=t=4.8,p<0.05)one month after operation.The FA of group A was higher than group B.There were significant difference in the number of FA(p<0.05)and no significant difference in the blood mass of the first day of postoperative(p>0.05).There were significant statistical differencein the NIHSS scores between operational group A and the control group.(p<0.05)There were significant statistical difference in the NIHSS scores between operational group A and operational group B.(p<0.05)There were no significant statistical difference in the NIHSS scores between operational group B and the control group.(p>0.05)There were significant statistical difference in the number of FA between operational group A and operational group B.(p<0.05)Conclusion:1.Minimally invasive puncture treatment combined with urokinase can eliminate hematoma effectively and is a feasible and effective treatment for hypertensive cerebral hemorrhage.2.Minimally invasive puncture treatment combined with postoperative urokinase therapy was better than conservative treatment for patients with hypertensive intracerebral hemorrhage with hematoma volume greater than 30 ml.3.For the patients of hypertensive cerebral hemorrhage who there are a little blood mass(20-30ml),we advise minimally invasive puncture treatment that can improve the prognosis if the diffusion tensor imaging of the patients are only oppressed by the blood or partial fracture;The minimally invasive puncture treatment can not improve the prognosis if all or most of the diffusion tensor imaging of the patients are fracture;... |
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