The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude / 中华创伤杂志(英文版)

PURPOSE@#Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.@*METHODS@#From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests.@*RESULTS@#A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ@*CONCLUSION@#PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

Hematomas parenquimatosas encefálicos hipertensivos serie de 145 pacientes: evaluación de resultados / Hypertensive encephalic parenchymatous hematomas series of 145 patients: evaluation of results

Los hematomas intracraneanos hipertensivos constituyen el 20 por ciento del total de los accidentes vasculares encefálicos. Tienen una incidencia de aproximadamente 100 casos cada 100.000 habitantes y una mortalidad global de casi el 50 por ciento. En nuestro país, la relación entre la hipertensión arterial mal controlada y mal tratada, con una hemorragia encefálica espontánea en el adulto, es significativa. Tomando en cuenta lo anterior y la gama de posibilidades terapéuticas y diagnósticas con que se cuenta actualmente, es que los autores realizan una valoración actualizada de la indicación quirúrgica en los hematomas de origen hipertensivo. Es así que en un período de 9 meses se reunió un total de 145 pacientes con hematomas hipertensivos, de los cuales 69 fueron operados y 76 no; se efectuó un análisis de ambos grupos por separado, comparándolos posteriormente. El objetivo del trabajo es tener una idea de la evolución de los pacientes operados y los no operados, según los criterios generales tomados en nuestro medio