| ObjectivesSpontaneous intracranial hemorrhage is also called the bleeding in the brain (Intracerebral Hemorrhage, ICH), which refers to the traumatic parenchymal hemorrhage caused by vascular rupture. In China, the incidence rate of ICH is higher due to large number of patients with hypertension and many of them combined with hypertension and cerebral arteriosclerosis. The state of illness among patients with ICH is usually emergent and develop worse rapidly. And moreover, most of the patients with ICH also have serious complications. So the fatality rate and disability rate of ICH is higher. It is the key point to improve the prognosis of patients with ICH by adopting corresponding treatment according to the disease progression of the patients.Patients with ICH from neurosurgery of Henan Zhoukou central hospital were invited to the present study. The cases of ICH patients were collected during January2012to December2013. We analyze the vital signs, laboratory examination and imaging examination, the influencing factors and prognosis condition, so as to take a more active and effective treatment methods, and provide reference basis to reduce the fatality rate of ICH.Study objects and methods According to the diagnostic criteria of ICH, inclusion criteria and exclusion criteria,389patients with ICH from neurosurgery of Henan Zhoukou central hospital were chosen from January2012to December2013. Using the retrospective method, we collect basic information on admission to hospital, laboratory and imaging examination results, vital signs and laboratory and radiographic findings, discharge imaging examination results of24hours after admission and the3rd,7th and14th days after treatment and the laboratory test results and prognosis.Analysis of variance for repeated measurements was used to compare the difference of vital signs and laboratory examination before and after treatment. Two-independent samples rank sum test or k-independent samples rank sum test was used to compare the difference of prognosis. Binary logistic regression model was used to do multivariate analysis of prognosis. The significant level was0.05.Results1The research object in general:The proportion of the youth (>18years), middle-aged (from45years to60years) and the elderly patients (≥60years) was17.2%,38.3%and44.5%. The elderly was the main crowd of ICH. The number of male patients with ICH was1.42times of female patients.2The cause of intracerebral hemorrhage:Hypertension (307,78.9%) was the major cause of cerebral hemorrhage, followed by cerebral arteriosclerosis (33,8.5%)3Vital signs change in ICH patients of different degree of bleeding:The heart rate of the ICH patients was not different with different degree of bleeding, F=0.517, P=0.597. The breathing rate of patients with different degree of bleeding showed no difference, F=0.007,P=0.993. There was no difference in pupil size among patients with different degree of bleeding (left:F=0.626,P=0.627, right: F=0.028,P=0.972). The bleeding patients with large pupils scattered ones were more. Different degree of bleeding had no different systolic blood pressure levels, F=0.174, P=0.840. Consciousness of the3rd,7th and14th days of research objects before and after treatment was different, x2=964.918, P<0.001. The consciousness of the research objects improve gradually after treatment.4. The blood routine changes of different degree of bleeding:Different degree of bleeding had influence on the average level of haemoglobin, F=0.075, P=0.047. The white blood cells levels of different degree of bleeding showed no difference, F=1.858,P=0.158. On admission, white blood cells levels of all patients were higher than the medical reference range, while more than90%of patients’white blood cell returned to normal medical reference range after treatment.5Imaging examination changes before and after treatment:CT results showed there was a significant reduction in bleeding after treatment, Z=16.122, P<0.001.6. The prognosis and influence factors:After treatment, the number of recovery, improving, invalid and death was53,243,50and43respectively. The fatality rate was significantly different among patients of different degree of bleeding, x2=71.775, P<0.001. The patients bleeding larger than60ml had higher fatality rate. One-way analysis showed that the amount of bleeding had influence on the prognosis, x2=112.733, P<0.001. The worst prognosis condition belongs to basal ganglia hemorrhage patients, followed by patients with intraventricular hemorrhage, x2=17.193, P=0.002. The age, gender, the reason of bleeding and consciousness state before treatment had no influence on the prognosis of ICH patients. Binary logistic regression showed that the prognosis is worse among patients with loss of blood more than60ml or coma in moderate depth, OR and95%CI was10.470(3.609-30.376),3.990(1.731-9.195)。Conclusions1The elderly and men are high-risk population of ICH and also the important population of ICH.2. In the process of clinical treatment of ICH patients, as long as patient’s vital signs and the blood routine examinations are monitored dynamically and the individualized treatment is adopted, the vital signs, white blood cell count and consciousness state of the patients will improve markedly or return to the normal medical reference range after treatment for7days.3The early clinical treatment to the ICH patients with massive bleeding patients, coma patients in moderate depth, basal ganglia hemorrhage patients should be strengthened so as to reduce the disability rate and fatality rate of ICH. |
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