| ObjectiveHypertensive intracerebral hemorrhage(HICH)is the most common spontaneous intracerebral hemorrhage.It has a dangerous onset,rapid changes in the condition,a high disability rate,a high mortality rate,and a poor prognosis.More than 70% of cerebral hemorrhage occurred in the basal ganglia area.CT real-time neuronavigation-assisted hematoma drainagein has now become one of the widely recognized surgical methods.This study attempts to analyze the various clinical factors and the prognosis of the patients' clinical function at 6 months after surgery to explore the factors that affect the clinical outcome of patients after surgery.Treatment options for blood pressure and cerebral hemorrhage or clinicians provide reference opinions on the prediction of patients' clinical outcome.MethodsThis study retrospectively analyzed the clinical data of patients discharged from the neurosurgery department of the second affiliated hospital of guangzhou medical university from January 2014 to September 2019.In this study to collect the patient's age,gender,operation time,operation time,preoperative GCS score,hematoma side position,degree of midline shift,hematoma volume,whether hematoma broken into the ventricle,systolic blood pressure on admission,diastolic blood pressure on admission,serum creatinine,blood sugar,uric acid,aspartate amino amino aminotransferase,alanine aminotransferase,total cholesterol,high-density lipoprotein cholesterol,blood fat,low density lipoprotein cholesterol,triglycerides,and whether the residual amount of hematoma,clearance of hematoma,postoperative bleeding,intracranial infection,gastrointestinal bleeding again,pulmonary infection,secondary epilepsy,etc.Six months after the conventional operation,the patient was followed up by outpatient service,hospitalization or telephone,and the patient or his/her family was asked for information.The evaluation criteria for the patient's quality of life were as follows: the Modified RANKIN Scale(mRS),with a score of 0-3 indicating good prognosis and a score of 4-6 indicating poor prognosis.All data were input into the computer,and the data were processed and analyzed by SPSS 24.0 statistical software.Univariate analysis: the data of continuous numerical variables were expressed as mean ± standard deviation(mean ±SD),and t test was used for comparison between the two groups.The enumeration data were expressed as(%),and test was used for the enumeration data.P?0.05 was used as the determination criterion for significant difference.Multiple factors analysis: by single factor analysis of variables difference was statistically significant(P < = 0.05),the influencing factors as independent variables,main outcome in patients 6 months(= 1 good prognosis and bad prognosis = 0)as dependent variable,the binary Logistic regression analysis step forward(LR)method for model,analysis the factors influencing prognosis,with P < 0.05 for the difference was statistically significant,calculating odds ratio(OR)and 95% confidence interval.ResultsIn this study,62 patients with spontaneous hypertensive intracerebral hemorrhage in basal ganglia region were included.Among them,there were 34 male patients(54.8%)and 28 female patients(45.2%),aged from 33 to 81 years old,with an average age of 57.08±13.48 years old.Preoperative GCS score ranged from 3 to 15 points,with an average of 10.40±2.68 points.Preoperative blood glucose values ranged from 3.47 to 15.18mmol/L,with an average of 7.82±2.35 mmol/L,uric acid 143-666mmol/L,with an average of 364.05±128.26 mmol/L,total cholesterol between 2.06 and 6.08mmol/L,with an average of 3.98±0.90 mmol/L,alanine aminotransferase between 4 and 99mmol/L,with an average of 23.58±16.01 mmol/L,and aspartic aminotransferase between 10 and 87mmol/L.The mean(27.31±16.22)mmol/L,the mean(1.25±0.61)mmol/L,the average(2.75±0.67)mmol/L,the average(1.14±0.63)mmol/L,the average(27.31±16.22)mmol/L,the average(1.25±0.61)mmol/L,the average(2.01 ± 4.20)mmol/L,the average(2.75±0.67)mmol/L,the average(1.14±0.63)mmol/L,and the serum creatinine(46.0-392.8)mmol/LThe average value was(99.21±50.60)mmol/L.37 patients with bleeding in the left basal ganglia region(59.7%),bleeding in patients with right basal ganglia region 25 cases(40.3%),hematoma volume between 18 ml-124.9 ml,average(44.84 + 21.12)for ml,hematoma long axis between 38.0 mm to 111.5 mm,the average(59.82 + 10.98)mm,hematoma axis between 19.3 mm to 59.20 mm wide,the average(31.60 + 7.25)mm,hematoma longitudinal axis 6-14 layer(5 mm/layer),average(9.21 + 1.77)layer,There were 39 cases(62.9%)with midline displacement greater than 5mm,23 cases(37.1%)with midline displacement less than 5mm,and 18 cases(29.0%)with intracerebral hemorrhage.The hematoma clearance rate ranged from 13-88%,with an average of(53.20±19.25)%.The operation time ranged from 3 to 62 hours,with an average of(18.48±15.96)hours,and the operation time ranged from an average of 25 to 150 min,with an average of(86.98±40.74)min.8 patients(12.9%)underwent external ventricular puncture drainage,and the hematoma clearance rate ranged from 13 to 88%,with an average of(53.20±19.25)%.There were 6 cases of postoperative rebleeding(9.7%),3 cases of intracranial infection(4.8%),8 cases of gastrointestinal bleeding(12.9%),34 cases of pulmonary infection(54.8%),and 1 case of secondary epilepsy(1.6%).There were 32 patients(51.6%)with good prognosis(m RS score 0-3 points),30 patients(48.4%)with poor prognosis(mRS score 4-6 points),and 6 patients(mRS score 6 points)with death rate of 9.6%.1.Single factor analysisUnivariate analysis showed that: age(P = 0.005),degree of median displacement(P = 0.03),hematoma volume(P = 0.032),number of longitudinal axis layers(P = 0.015),preoperative GCS score(P = 0.004))And the clearance rate of hematoma(P = 0.037),compared with the clinical function prognosis of patients 6 months after operation,the difference has significant statistical significance(P <0.05),which affects the clinical prognosis of patients 6 months after operation The main factor.2.Multi-factor analysisThe factors with statistical significance(P <0.05)in the univariate analysis were included in the binary logistics regression analysis model.The forward LR method was used for multivariate analysis.The results showed that age,preoperative GCS score and degree of median displacement were the factors Independent risk factors for clinical prognosis of patients 6 months after surgery(P <0.05).Older patients have an increased risk of poor prognosis at 6 months after surgery compared to younger patients(OR = 0.945,95% CI: 0.899-0.992,P=0.023);patients with low preoperative GCS scores have higher risk than those with preoperative GCS scores In patients,the risk of poor prognosis increased 6 months after surgery(OR = 1.372,95% CI: 1.002-1.757,P=0.049);patients with a median displacement greater than 5 mm compared to patients with a median displacement less than 5 mm,6 months after surgery The risk of poor prognosis increased(OR = 0.235,95% CI: 0.065-0.847,P=0.027).Conclusion 1.Age,preoperative GCS score and midline shift are independent risk factors affecting the prognosis after CT real-time neuronavigation-assisted hematoma drainagein in patients with HICH in basal ganglia region.2.The amount of hematoma,the number of vertical axis layers of hematoma and the rate of hematoma clearance have an influence on the prognosis after CT real-time neuronavigation-assisted hematoma drainagein in patients with HICH in basal ganglia region. |
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