Analysis Of The Prognosis And Factors Influencing The Prognosis Of Different Treatment Methods For Primary Brainstem Hemorrhage

Background: Primary brainstem hemorrhage(PBSH),also known as hypertensive brainstem hemorrhage(HBSH),it is the most serious subtype of hypertensive cerebral hemorrhage.At present,there are two broad categories of treatment strategies for PBSH: conservative medical treatment and surgical treatment.In the past,patients with PBSH were mostly treated conservatively,but this method did not have a significant effect on improving neurological function,and did not reduce mortality and disability.In recent years,some scholars have begun to try to use minimally invasive surgery to treat PBSH and have achieved certain results.Surgical treatment can effectively remove the bleeding focus and reduce damage to surrounding normal nerve tissue and postoperative complications.However,it is still inconclusive which method is better for the treatment of PBSH,and effective diagnosis and treatment methods and standards need to be further explored and summarized.Objective: To explore the therapeutic effects of different treatment methods on primary brainstem hemorrhage and analyze the influencing factors on the prognosis of patients with primary brainstem hemorrhage.Methods: Firstly,general clinical data of PBSH patients treated in our hospital from January2019 to September 2022 were collected.After meeting the inclusion and exclusion criteria,a total of 110 patients were selected.According to the different treatment plans,the patients were divided into four groups: Conservative management group(43 patients),craniotomy hematoma clearance group(23 patients),Lateral ventricles puncture and external drainage group(23 patients),and stereotactic brain stem hematoma puncture and Lateral ventricles puncture and external drainage group(21 patients).Subsequently,the survival status of PBSH patients at 30 days after treatment and the Glasgow Outcome Scale(GOS)at 6months were followed up by phone or outpatient visits.The patients were divided into a poor prognosis group(1-2 points)and a good prognosis group(3-5 points)based on the GOS score.Finally,the mortality rate within 30 days,GOS score after 6 months,and poor prognosis rate of four groups of PBSH patients receiving different treatment methods were compared,and univariate and multivariate logistic regression analysis was used to explore the risk factors affecting mortality and poor prognosis in PBSH patients.Results:(1)The general clinical data of the four groups of PBSH patients receiving different treatments,such as gender,age,amount of bleeding,location of bleeding,type of hematoma,whether the hematoma broke into the ventricle,and Glasgow Glasgow Coma Scale score,showed no significant difference(P>0.05).(2)The mortality of PBSH patients within 30 days was the highest in the Conservative management group(69.8%)>the Lateral ventricles puncture and external drainage group(47.8%)>the craniotomy hematoma clearance group(30.4%)>the stereotactic brain stem hematoma puncture group(23.8%).The mortality of heavy PBSH patients in the Conservative management group was significantly higher than that in the craniotomy hematoma clearance group and stereotactic group(P<0.05).(3)The GOS score of PBSH patients after 6 months of treatment,the stereotactic brain stem hematoma puncture and drainage plus Lateral ventricles puncture and drainage group>craniotomy hematoma clearance group>Lateral ventricles puncture and external drainage group>Conservative management group,in which the GOS score of PBSH patients after 6 months of treatment in the stereotactic brain stem hematoma puncture and drainage plus Lateral ventricles puncture and drainage group and craniotomy hematoma clearance group was significantly higher than that in the Conservative management group(P<0.05),And the surgical time of 285 minutes in the craniotomy hematoma removal group was significantly higher than190 minutes in the stereotactic hematoma puncture group(P<0.05).(4)Analysis of risk factors affecting mortality within 30 days in PBSH patients showed hematoma volume(OR=1.181,95% CI: 1.023-1.363,P<0.05),hematoma type 3(OR=2.917,95% CI: 1.337-6.364,P<0.05)The widespread(E)subtypes of type2 and type 3(OR=4.592,95% CI: 2.024-10.415,P<0.05)and the presence of pontine hemorrhage in the midbrain or medulla oblongata(OR=10.612,95% CI: 4.038-27.890,P<0.05)are four risk factors for mortality within 30 days in PBSH patients,Hematoma volume(OR=1.178,95% CI: 1.001-1.386,P<0.05)and pontine associated midbrain or medullary hemorrhage(OR=10.894,95% CI: 3.573-33.221,P<0.05)are independent risk factors for mortality within 30 days in PBSH patients.Conclusion:(1)For primary pontine hemorrhage,different treatment methods have different prognoses.Stereotactic pontine hematoma puncture and craniotomy hematoma removal have better prognoses than conservative treatment.Stereotactic pontine hematoma puncture and drainage combined with lateral ventricle puncture drainage have better prognoses than simple lateral ventricle puncture external drainage.(2)Compared with craniotomy hematoma removal surgery,stereotactic hematoma puncture surgery has the advantages of less trauma,convenient operation,and shorter surgical time.(3)Hematoma volume,pons combined with midbrain or medullary hemorrhage are independent risk factors for death within 30 days in PBSH patients;Hematoma volume and hematoma type 3(hematoma spanning both sides of the midline and crossing the 3/4 boundary)are independent risk factors for poor prognosis in PBSH patients,and hematoma volume is of great value in diagnosing poor prognosis in PBSH patients.