HICH Database Established And Hypertensive Intracerebral Hemorrhage Of Non-thalamus Type Feasibility Study On The Sequencing Treatment

Objective: To establish clinical HICH databases preliminary and discussthe feasibility of sequencing treatment based on the cases of database, whichown to hypertensive intracerebral hemorrhage of non-thalamus type.Methods:1Cases source: the retrospective analysis was collected fromNovember2011to October2012in the second Hospital of HeBei MedicalUniversity,151patients involved in. Patient’s gender, age, live area, length ofhospital stay, hospital cost, symptom, GCS score, GOS score, mRS score,history of diabetes, smoking history, drinking history, family history, durationfrom onset to attendance, cerebral hemorrhage part, blood loss, broken into theventricle or not, secondary hemorrhage or hematoma expanded, operationmodes, operation time, complications and so on, these clinical characteristics,risk factors and treatments of disease were made into the registration formthrough Access database, to establish the HICH clinical information database.2The hypertensive cerebral hemorrhage cases were choose into HICHdatabase within72h to admission, all patients were diagnosed by CT,confirmed by the diagnostic criteria made on the fourth nationalcerebrovascular disease conference in1995.110cases were included in thisstudy. Exclusion criteria:(1) Intracranial aneurysms, arteriovenousmalformation (AVM), tumor, trauma, or bleeding was caused by systemicdiseases such as blood diseases.(2) Bleeding after cerebral infarction.(3) Withserious diseases of heart, liver, kidney, lung or functional failure.(4) Ipsilateralstroke history, and left limb dysfunction.(5) The pre-hospital medical historydata was unknown.(6) Patients who automatic left hospital without treatmentor dead as time as admission.(7) Exclusion of intraventricular hemorrhage,thalamus, and the curtain of cerebral hemorrhage.(8) Patients who failed to return or lost contact.3The methods of non-thalamus supratentorial cerebral hemorrhagetreatment program: for the patients with onset within24hours andconsciousness below shallow coma, controlled blood pressure and bleeding bydrug treatment, forbidden to dehydration drugs and closely observeconsciousness change;For onset within24hours, consciousness of shallowcoma or above, half amount of20%mannitol are available to light coma, formoderate coma or above, full amount or combined with other dehydrationdrugs is needed, by the time of giving the above drug treatment, we shouldclosely observe patients consciousness change, continue to the treatment ifconsciousness improved, hematoma puncture drainage should beperformed;if there is no improvement or even deepen consciousness,consciousness improved for6hours after operation, by injection ofurokinase drainage tube head (2-30000units) could be injected through thedrainage tube, usually once every6~8hours (occlusion for3hours, open for3~5hours),and pull out the tube within72hours; emergency surgicaloperations were given if the consciousness of postoperative patients were notimproved or more serious. For patients with onset time exceeded24hours, theconsciousness under light coma, while the bleeding dose<20ml, gave thedrug conservative treatment to stop bleeding, regulate the blood pressure andprotect nerves; while the bleeding dose>20ml, hematoma puncture drainagewas feasible, the postoperative treatment was same with onset in24hours.4Data description and statistic, measurement data used mean±standarddeviation, median (interquartile spacing), the count data were expressed asfrequency and percentage (%); measurement data comparison was analyzed byt test or nonparametric test, count data was analyzed by the chi-square test orFisher’s exact probability method, all data were analyzed by SPSS13.0software, inspection level α=0.05.Results:1There was no statistically significant difference of hospitalstay between the two groups of patients (nonparametric rank and inspection Z=0.021, P=0.983). 2The comparison of hospital cost between the two groups has nostatistically significant difference (nonparametric rank and inspection Z=1.302, P=0.193).3Curative effect comparison3.1The one month mortality of two groups: in110cases of cerebralhemorrhage patients, the total death cases were11(20.4%), while in theprocedural treatment group, death number was2(4.65%) and41cases alive(95.35%), in non-procedural treatment group,9patients dead (13.43%),survival cases were58cases (86.57%), the mortality between two groups hadno statistical significance (P=0.196with the Fisher’s exact probabilitymethod).3.2The life activity (mRS) score of two groups’survivors after onset onemonth: procedural treatment groups: mRS score, there was1case got0points,5cases got1piont,6cases got2points,4cases got3points,20cases got4points, and5points in5cases; Non-procedural treatment groups: mRS score,0point appeared in1case,1point in4cases,2points in3cases,3points in2cases,4points and5points were both in24cases. Prognosis of two groups ofmRS score is statistically significant (chi-square=12.025, P=0.034).3.3Mortality incidence after three months (including the death toll in amonth): there were2death cases (4.65%) and41survival cases (95.35%) inthe procedural treatment group, in non-programmed group,12cases dead(17.91%),55cases (82.09%) alive, the difference of mortality between twogroups was statistically significant (P=0.046, with the Fisher’s exactprobability method).3.4The life activity (mRS) score of two groups’survivors after onsetthree months: mRS score in procedural treatment groups: there were3casesgot0point,5cases got1point,12cases got2points,3points got16cases,4points got4cases and1case got5points; in non-procedural treatment group:0points appeared in4cases,1points in6cases,2points in9cases,3points in11cases,4points in17cases and5points in8cases. Prognosis of twogroups of mRS score is statistically significant (χ~2=13.322, P=0.021). 4The incidence of lung infection (via image diagnosis, routine blood,sputum culture and lung signs confirmed): in procedural treatment group,7cases (16.30%) with lung infection,36cases (83.70%) without lung infection;in non-programmed processing group,23cases with pulmonary infection(35.40%),42cases (64.60%) without lung infection; the difference wasstatistically significant (chi-square=4.709, P=0.030).Conclusions:1The established HICH databases of hypertensive cerebralhemorrhage has the vital significance for clinical research.2The procedural treatment of non-thalamus supratentorial cerebralhemorrhage can reduce mortality, improve prognosis, decrease complicationssuch as pulmonary infection, and has promotion value.