Correlative Analysis Of Perihematomal Edema And Functional Outcomes In Basal Ganglia Intracerebral Hemorrhage

BACKGROUND AND OBJECTIVEIntracerebral hemorrhage(ICH),also known as hemorrhagic stroke,is an acute cerebrovascular disease with high morbidity,mortality and morbidity.It is divided into primary cerebral hemorrhage(Primary ICH)and secondary cerebral hemorrhage(Secondary ICH).The Primary ICH or spontaneous intracerebral hemorrhage(SICH)is often referred in medical literature.The most common bleeding site of ICH is basal ganglia,accounting for about 40%of SICH.There is no effective treatment nowadays.Therefore,finding indicators of prognosis of ICH and starting a reasonable and effective treatment,plays an important role to improve the functional outcome.Researchers all over the world generally agree that the neuronal damage induced by hematoma is irreversible,whereas PHE is reversible,which makes the latter to be a potential therapeutic target.The research on the correlation between PHE and prognosis is little and the result controversial.In particular,the correlation is more limited between Perihermatomal edema absolute volume(PHEAV),relative Perihermatomal edema volume(rPHE)and functional outcome in basal ganglia ICH.Patients with basal ganglia cerebral hemorrhage were selected as subjects in the Department of Neurology of Second Hospital of Shandong University in the study.It is important to clarify the relationship between PHEAV,rPHE and prognosis and select the prognostic factors of ICH in 90 days.And the mortality and morbidity of patients can be reduced by taking appropriate treatment measures as soon as possible.METHODSAs a prospective study,the study is focused on patients with basal ganglia cerebral hemorrhage within 6 hours of onset.The clinical baseline information of patients was collected at the time of admission,including gender,age,smoking and drinking history,past history(hypertension,diabetes,hyperlipidemia,cerebrovascular disease,etc.),blood pressure,blood glucose and other indicators.The National Institutes of Health Stroke(NIHSS)score was obtained to understand neurological deficits of patients.Hematoma,PHEAV and rPHE were routinely recorded ccording to computed tomography(CT)in admission and 24-48 hours.The patients were divided into good prognosis groups(mRs<3)and poor prognosis groups(mRs≥3)according to the three-month improved Rankin scale(mRS),and the influencing factors were analyzed.RESULTSDuring the study,a total of 78 patients with basal ganglia Intracerebral hemorrhage,in which 65 patients completed CT one-stop examination at the baseline level and in 24-48 hours,and 5 patients were lost in 90 days follow-up.In final,60 cases of patients were included in the statistics,including 38 males and 22 females who aged 42 to 81 years.And 2 patients had been dead in 90d.The baseline hematoma volume is from 1.32ml to 60ml.NIHSS score(r=0.646,P<0.001)was positively correlated with hematoma volume but the relationship is not relevant between the rPHE and hematoma volume in the study.The difference between the rPHE,the hematoma volume at the baseline level and in the 24-48h and the NIHSS score was statistically significant(P<0.05)in the two groups in the univariate analysis.Thus there was no significant difference(P>0.05)in PHEAV,age,sex,smoking and drinking history,past history(hypertension,diabetes,hyperlipidemia,cerebrovascular disease,etc.),hematoma volume,baseline blood pressure and blood glucose.The rPHE was an independent protective factor[OR=0.08,95%CI=0.008-0.092,P=0.038]for poor prognosis(mRs≥3)in 90 days with basal ganglia ICH at the baseline level,whereas hematoma volume was an independent risk factor[OR=1.16,95%CI=1.028-1.308,P=0.016]in the Logistic regression analysis.And in 24-48 hours,the above conclusion is still valid.CONCLUSIONSThe rPHE and hematoma volume at the baseline level and in the 24-48h and NIHSS score can be used as a predictor of the prognosis in 90 days of patients with basal ganglia ICH.And the rPHE and hematoma volume can be used as independent predictors.The larger the rPHE was,the better the prognosis of patients in 90d.While the larger the hematoma volume was,the worse the prognosis of the patient.There was no significant correlation between the PHEAV,age,sex,smoking and drinking history,past history(hypertension,diabetes,hyperlipidemia,cerebrovascular disease),hematoma volume,blood pressure,blood glucose and the prognosis of patients.