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Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.
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Objective@#To explore the effects of minimally invasive intracranial hematoma removal in the treatment of cerebral hemorrhage, and its influence on neurological functional recovery, serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-8(IL-8), tumor necrosis factor-alpha (TNF-α).@*Methods@#From January 2016 to December 2017, 100 patients with cerebral hemorrhage admitted to Zhejiang Xin'an International Hospital were selected and randomly divided into two groups according to the digital table, with 50 cases in each group.The control group was given routine symptomatic treatment, the observation group received minimally invasive intracranial hematoma removal combined with conventional treatment.The curative effect, restoration of nerve function, the levels of hs-CRP, IL-6, IL-8 and TNF- were observed in the two groups.@*Results@#After treatment, the blood loss and edema volume around the hematoma in the two groups were declined significantly (t=5.74, 9.32, 7.41, 9.32, all P<0.05), and the improvements of the observation group was better than those of the control group (t=8.29, 5.28, all P<0.05). The excellent and good rate of the observation group was 90%(45/50), which was significantly higher than 72%(36/50) of the control group (χ2=3.62, P<0.05). After treatment, the NDS scores of the two group were significantly lower than those before treatment (t=4.64, 5.75, all P<0.05), the GCS scores of the two groups were significantly improved (t=5.41, 7.86, all P<0.05). The NDS score of the observation group was significantly lower than that of the control group (t=5.31, P<0.05), the GCS score of the observation group was significantly higher than that of the control group(t=3.84, P<0.05). After treatment, the levels of inflammatory factors in the two groups were significantly reduced compared with those before treatment (t=3.27, 3.75, 3.38, 3.61, 5.74, 4.39, 6.52, 8.26, all P<0.05), the levels of inflammatory factors in the observation group were significantly lower than those in the control group (t=4.37, 3.92, 8.52, 4.28, all P<0.05).@*Conclusion@#Minimally invasive removal of intracranial hematoma combined with conventional treatment in the treatment of patients with cerebral hemorrhage can obtain satisfactory clinical effect, can promote neural functional recovery, improve inflammatory factor levels (hs-CRP, IL-6, IL-8, TNF alpha), it is worthy of application.
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Objective To explore the effects of minimally invasive intracranial hematoma removal in the treatment of cerebral hemorrhage,and its influence on neurological functional recovery,serum levels of high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6),interleukin-8 (IL-8),tumor necrosis factor-alpha (TNF-α).Methods From January 2016 to December 2017,100 patients with cerebral hemorrhage admitted to Zhejiang Xin'an International Hospital were selected and randomly divided into two groups according to the digital table,with 50 cases in each group.The control group was given routine symptomatic treatment,the observation group received minimally invasive intracranial hematoma removal combined with conventional treatment.The curative effect,restoration of nerve function,the levels of hs-CRP,IL-6,IL-8 and TNF-were observed in the two groups.Results After treatment,the blood loss and edema volume around the hematoma in the two groups were declined significantly (t =5.74,9.32,7.41,9.32,all P ＜ 0.05),and the improvements of the observation group was better than those of the control group (t =8.29,5.28,all P ＜ 0.05).The excellent and good rate of the observation group was 90％ (45/50),which was significantly higher than 72％ (36/50) of the control group (x2 =3.62,P ＜ 0.05).After treatment,the NDS scores of the two group were significantly lower than those before treatment (t =4.64,5.75,all P ＜ 0.05),the GCS scores of the two groups were significantly improved (t =5.41,7.86,all P ＜ 0.05).The NDS score of the observation group was significantly lower than that of the control group (t =5.31,P ＜ 0.05),the GCS score of the observation group was significantly higher than that of the control group (t =3.84,P ＜ 0.05).After treatment,the levels of inflammatory factors in the two groups were significantly reduced compared with those before treatment (t =3.27,3.75,3.38,3.61,5.74,4.39,6.52,8.26,all P ＜ 0.05),the levels of inflammatory factors in the observation group were significantly lower than those in the control group (t =4.37,3.92,8.52,4.28,all P ＜0.05).Conclusion Minimally invasive removal of intracranial hematoma combined with conventional treatment in the treatment of patients with cerebral hemorrhage can obtain satisfactory clinical effect,can promote neural functional recovery,improve inflammatory factor levels (hs-CRP,IL-6,IL-8,TNF alpha),it is worthy of application.
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Objective To analyze the risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage,and provide a basis for clinical prevention of postoperative recurrent hemorrhage. Methods The clinical data of 413 patients with hypertensive intracerebral hemorrhage in our hospital from January 2007 to December 2017 were retrospectively analyzed.The possible correlation factors of postopera-tive recurrent hemorrhage and the high-risk factors were collected and summarized. Results According to univariate unconditional logistic regression analysis, there was a significant correlation between systolic blood pressure, GCS score, bleeding volume, coagulation dysfunction and the use of sedative analgesics with the hypertensive cerebral hemorrhage after surgery(P<0.05);they were also the risk factors of post-operative rebleeding after hypertensive cerebral hemorrhage according to the multivariate unconditional logistic regression analysis (P<0.05). Conclusion The results indicate that there are many factors influencing postoperative rebleeding in patients with hypertensive cerebral hemorrhage.In the perioperative period,higher systolic blood pressure,deeper consciousness disorder,more bleeding,and coagulation dysfunction are independent factors influencing postoperative re-bleeding, and more attention should be paid to it.
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Objective To explore the application effect of a new lighted surgical aspirator in deep brain hematoma removal operation.Methods Totally 153 patients of non-traumatic basis festival area cerebral hemorrhage were randomly divided into a control group and a treatment group.Both the groups underwent clearance of intracranial hematoma and decompressive craniectomy surgical operation in the operating room,with the common aspirator involved in the control group and the lighted one in the treatment group.Results There was no significant difference between the rates of hematomal removal in the groups (P＞0.05).The treatment group had the operating time less by 59.85 min and the hospital stay decreased by 15.23 d than those in the control group (P＜0.05).The GOS score and daily viability of the treatment group was also statistically higher than those of the control group (P＜0.05),and the effective rate in the treatment group was also more than that in the control group by 24.9％ (P＜0.05).Conclusion The new aspirator solves the problems in visual field and light source,decreases the operating time and improves the disease prognosis.
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Objective To explore the curative efficacy,methods and prevention of complications of surgical operations treatment of posted sides chronic subdural hematoma in the adult patients.Methods The clinical data of 11 adult patients suffered from posted sides chronic subdural hematoma were analyzed retrospectively.The patients were all treated by different surgical operations.Results The hematomas about 60mL to 110mL were all cleared away by operation.Postoperative hematoma removal or basic cleared.All patients were cured to discharge.11 patients were followed up for 3 -6 months.According to the activities of daily living (ADL)grading system,all patients were classified as normal.Follow -up examination with CT/MR scans in 11 patients showed 10 cases of normal findings, 1 case with the contralateral limitations mild subdural effusion,by coned cranial indwelling drainage tube turn better. Conclusion Reasonable choice different surgical operations of hematoma is suited to adult patients with posted sides chronic subdural hematoma,providing a satisfactory effect and reduce the complicated syndrome and recurrence rate.
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Hypertensive pontine hemorrhage usually causes profound, irreversible neurological deficits, with ominous prognosis, and is often fatal. There is controversy as to the appropriate treatment modality, but in general, surgical intervention is considered unethical. The authors report the outcome of hypertensive pontine hemorrhage in 13 patients whose Glasgow Coma Scale was 4-9, who on brain CT scan were seen to have over 10cc of hematoma and who underwent suboccipital craniectomy for hematoma removal. These patients could be divided in two groups: 'early'(9 patients), who underwent surgery within 24 hours of ictus, and 'late'(4 patients), who underwent surgery 6 to 20 days after ictus: all had shown neurological deterioration in spite of optimal medical treatment. Surgical outcome did not vary according to the extent of hematoma removal. For patients in the 'early' group, surgery was not useful, but three in the 'late' group, the GCS score improved to between 7 and 11. This study suggests that in hypertensive pontine hemorrhage, an early direct approach may not improve outcome, but for selected patients, who deteriorate during conservative treatment, surgery may be beneficial.