| Background and ObjectiveHypertensive intracerebral hemorrhage (HICH), accounting for20%to%of stroke, is a common disease with the characteristics of high incidence of disability, death rate and recurrence. HICH is serious harm to human health. On the one hand, due to the pressure of hematoma on the around brain tissue, causing cerebral edema, increasing intracranial pressure, brain herniation or secondary causing brain stem hemorrhage and necrosis; on the other hand, the longer compression time of hematoma, the more severe edema of surrounding brain, thus leading to the majority of HICH patients died at acute phase. Previous studies suggest that the pathological basis of HICH is closely related with blood pressure and arterial atherosclerosis (AS). The mechanisms of intracerebral hemorrhage after secondary injury are complex, such as occupying effect of hematoma, decreased regional cerebral blood flow, the toxic effects of thrombin and hemoglobin, acidosis, inflammatory and immune response. These mechanisms interact with each and synergistically promote the progress of brain damage. Conservative treatment used for dehydration and preventing complications of HICH, but have no significant effect on the formation of the occupying effect of hematoma, increased intracranial pressure and brain herniation. Therefore, early removing the hematoma, getting rid of the hematoma compression effect, and breaking the intracerebral the vicious cycle of secondary injury after hemorrhage, not only can reduce the mortality of HICH, but also improve the prognosis of HICH.Intracranial hematoma microinvasive craniopuncture scavenging technique (MPST), a new technology for treating HICH which invented by Jia Baoxiang in1994, has lower trauma, strong closing, low-cost, simple operation, quick recovering as well as short course. MPST can quickly remove most of the hematomas, reduce direct compression injury and secondary damage caused by hematomas, and thus can effectively improve the survival rate and reduce disability and death rate, and has been gotten wide application in primary hospital.At present, MPST is limited to30ml-50ml of supratentorial hemorrhage in patients with HICH. However, little known about the treatment effect of<30ml of supratentorial hemorrhage in patients with HICH. For depth investigated whether MPST can be used in a small amount of hematomas in patients with HICH treatment, following study were carried out:collecting HICH patients with20ml-30ml of supratentorial hematoma, treatment with MPST, observing the rebleeding rate, absorption time of intracerebral hematoma, and nerve function. We may get to know whether MPST can be used in treating20to30ml of supratentorial hematomas in patients with HICH from above study.1ObjectiveTo investigate the treatment effect of MPST on supratentorial hematoma (20ml-30ml) in patients with HICH under CT positioning. 2Materials and Methods2.1Object of study85patients with HICH (supratentorial hematoma volume was20ml to30ml) were enrolled in this study, and were randomly divided into MPST group (Minimally Invasive group) and conservative treatment group (control group).2.2Inclusion criteria:①Meeting the diagnostic criteria of HICH developed by the Chinese Academy of Neurology in1997.②Supratentorial hemorrhage confirmed by CT or MRI.③Hematoma volume between20ml and30ml.④Informed consent for surgery programs and signed surgical informed consent to family members of patients.2.3Exclusion criteria:①Blood clotting disorders.②Suffering from serious illness, and surgery contraindications.③Cerebral hemorrhage was possibly or definitely caused by non-hypertensive intracerebral hemorrhage, such as traumatic brain injury, aneurysm, cerebral vascular malformations, brain tumors, and stroke.2.4therapeutic methodMPST were taken into treatment for minimally invasive group, and conservative method for control group.2.5Evaluation index①Rebleeding rate and absorption time of intracranial hematomas;②Barthel ADL score for Daily living ability evaluation;③Neurological impairment evaluation;④Efficient rate; ④Hospital fees.2.6Statistical analysisAll Statistical data were analyzed by SPSS16.0statistical software. All experimental results are expressed by mean±standard deviation (x±s) or percentage (%). Gender, bleeding site, patients with different time surgery were analyzed by χ2test. Independent sample t-test were used to compare between the two groups. P<0.05was considered statistically significant.3Results3.1General characteristics.The two groups have no significant statistical difference in age, gender, amount of bleeding, and the bleeding site.(P>0.05).3.2Comparison of the absorption time of intracranial hematoma, rebleeding rate, daily living ability, neurological deficits, efficient rate and hospital fees.The absorption time of intracranial hematoma in minimally invasive group and control group are (10.238±2.970) days and (26.581±4.707) days, respectively. The absorption time of intracranial hematoma in minimally invasive group was less than in control group (P<0.001). The rebleeding rate in minimally invasive group and control group are2.38%and2.33%, respectively. This two group have no obvious statistical difference (P>0.05). The daily living ability score in minimally invasive group and control group are84.976±7.062and64.884±10.990in3months, and87.143±5.308and69.326±8.320in9months, respectively. The daily living ability score was higher in minimally invasive group than in control group (P<0.05). The neurological deficits score in minimally invasive group and control group are9.691±2.290and18.349±4.029in3months, and8.310±1.703and16.326±3.006, respectively. The neurological deficits score was less in minimally invasive group than in control group (P<0.05). The efficient rate in minimally invasive group and control group are85.72%and62.79%, respectively. The efficient rate was higher in minimally invasive group than in control group (P<0.05). The hospital fees in minimally invasive group and control group are (8417.3±2033.5) yuan and (14335.0±4008.2) yuan, respectively. The hospital fees was less in minimally invasive group than in control group (P<0.05)4ConclusionMPST can reduce the absorption time of intracranial hematoma, raising the daily living ability, improve the neurological function, enhance the therapeutic efficiency. It could be used to treat patients with HICH (supratentorial hematoma volume ia20ml to30ml). MPST can effectively improve the prognosis of HICH patients, and reduce the economic burden on patients. |
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