Analysis Of Surgical Effects And Prognostic Factors Of Hypertensive Thalamic Hemorrhage Breaking Into Ventricles

Objective:To analyze the surgical effects and the the relevant factors related to the prognosis of hematoma puncture and drainage(HPD)vs minimally invasive(small bone window)craniotomy for patients with hypertensive thalamic hemorrhage breaking into ventricles(HTHBIV),so as to provide relevant reference for the clinical diagnosis and treatment of patients with HTHBIV.Methods:Following the criteria for inclusion and exclusion strictly,a retrospective analysis was performed on the patients admitted to the neurosurgery department of our hospital from January 2014 to January2018.A total of 63 cases were collected and divided into two groups:the HPD group(33 cases)and the craniotomy group(30 cases).The data of gender,age,height and weight,history of hypertension and diabetes,volume of thalamic hematoma,preoperative GCS score,surgical timing,surgical methods and postoperative complications of the patients were collected.The database was created using Microsoft Excel 2010 and the questionnaire was designed.The collected case data was coded,logged,verified and reviewed,respectively.The ADLBarthel index score and GOS score of six months of postoperative follow-up were used as indicators to evaluate the prognosis of patients,and SPSS25.0 statistical software package was used for statistical data analysis.The measurement data were expressed as?x±s and t test was used;?~2 test was used for counting data.Univariate analysis and binary Logistic regression were used to test the risk factors,and P<0.05 was considered to be statistically significant.Results:1.The results showed that there was no significant correlation with surgical timing and surgical method on surgical prognosis(P>0.05).In terms of postoperative rebleeding,there were 2cases of rebleeding in HPD group(6.1%)and 3 cases in the craniotomy group(10.0%).Fisher's accurate probability test showed no significant difference in the rebleeding rate between the two surgical methods(P>0.05).In terms of mortality,there were 4 deaths(12.1%)in the HPD group and 5 deaths(16.7%)in the craniotomy group during hospitalization.Fisher's accurate probability test showed no significant difference between the two surgical methods(P>0.05).After 6 months of follow-up,7 patients died in the HPD group(21.2%),and 9 patients died in the craniotomy group(30.0%).2.Other prognostic factors influencing the prognosis:on the basis of ADL scores,univariate analysis showed that body mass index(BMI),smoking,drinking,preoperative GCS score,volume of thalamic hematoma,postoperative complications have significant correlation with the prognosis of patients with HTHBIV(P<0.05),while the age,gender,history of hypertension,diabetes history,operation timing,operation method have no obvious correlation with the prognosis(P>0.05).Logistic regression analysis showed that overweight patients had an increased risk of poor prognosis compared to normal weight patients(OR=11.378,95%CI:1.968~65.782).Patients with a preoperative GCS score less than 8 points had an increased risk of poor prognosis compared to those with a preoperative GCS score greater than 8 points(OR=17.404,95%CI:3.297~91.882).On the basis of GOS score,prognosis univariate analysis showed that BMI,smoking,drinking,history of diabetes mellitus,preoperative GCS score,thalamic hematoma volume have obvious correlation with the prognosis(P<0.05),while the age,gender,history of hypertension,operation timing,operation method,postoperative complications have no obvious correlation with the prognosis(P>0.05).Logistic regression analysis showed that overweight patients had an increased risk of poor prognosis compared with patients of normal weight(OR=4.761,95%CI:0.870-26.070).Patients with a preoperative GCS score less than 8 points had an increased risk of poor outcomes compared to those with a preoperative GCS score greater than8 points(OR=15.897,95%CI:2.548~99.175).Conclusions:1.There was no statistical difference in the prognosis of patients with HPD and small bone window craniotomy six months after surgery,and there was no statistical difference in the risk of rebleeding and death between the two surgical methods.2.In the treatment of patients with HTHBIV,BMI,smoking,drinking,history of diabetes mellitus,preoperative GCS score,thalamic hematoma volume,postoperative complications affected the prognosis of patients with surgery;among them,the overweight and preoperative GCS score less than eight points are the independent risk factors of poor prognosis of HTHBIV.