Influence Factors Analysis Of Early Brain Edema Following Hypertensive Intracerebral Hemorrhage Surgery

Objective: To investigate the risk factors affecting postoperative early brain edema in patients with hypertensive intracerebral hemorrhage.Methods: From september 2016 to february 2019,105 patients that admitted in the Department of Neurosurgery,the Second Affiliated Hospital of Fujian Medical University were enrolled in the study.They all suffered from hypertensive cerebral hemorrhage,including 64 males and 41 females,aged 44-82 years,mean 61.4±9.45 years,Bleeding site: 46 cases of basal ganglia,28 cases of thalamus,10 cases of cerebral lobe,and 21 cases of others.They were treated with brain surgery.According to the postoperative CT findings,the patients were divided into two groups,including 43 patients with moderate to severe cerebral edema and 62 patients with mild cerebral edema.The clinical data of these groups were retrospectively analyzed,including gender,age,history of smoking,history of alcohol abuse,history of diabetes,duration of hypertension,time from onset to surgery,volume of bleeding,location of bleeding,systolic blood pressure at admission,and diastolic blood pressure at admission,Random blood glucose at admission,preoperative Glasgow score,fibrinogen,preoperative pupillary changes,surgical procedures,etc.Results: There were no significant differences in gender,age,history of smoking,history of alcoholism,history of diabetes,bleeding site,random blood glucose at admission,and fibrinogen between two groups(P>0.05).The presurgical time,bleeding volume,systolic blood pressure at admission,diastolic blood pressure at admission,GCS score,surgical procedure,and preoperative pupillary changes were statistically significant(P<0.05).The results of binary logistic regression analysis of the eight factors showed that the time from onset to surgery [more than 6h,OR=4.163,95% CI(1.084,15.996)],traditional non-microsurgery [OR=4.158,95%CI(1.078,16.035)],lower preoperative GCS score[OR=2.859,95% CI(1.006,8.129)],preoperative pupillary changes [OR=4.096,95% CI(1.030,16.291)],volume of hematoma [OR = 1.100,95% CI(1.006,1.203)] and a longer course of hypertension [OR = 1.134,95% CI(1.010,1.273)] were the Risk factors of early cerebral edema following hypertensive intracerebral hemorrhage(P < 0.05).Conclusion: 1.Long duration of hypertension,large volume of hematoma,preoperative pupillary changes,long presurgical time,low preoperative GCS score,and traditional nonmicrosurgical surgery were the risk factors of brain edema following hypertensive cerebral hemorrhage.It should be highly noted during clinical diagnosis and treatment.2.Clinically,the course of hypertension,volume of hematoma,preoperative pupillary changes,preoperative GCS score,time of surgery,and surgical procedure can be used as indicators for early postoperative brain edema in patients with hypertensive intracerebral hemorrhage.3.It can help surgeons to decide the time of surgery for patients with hypertensive cerebral hemorrhage and the methods of brain surgery.