Analysis of the effect and prognostic factors of minimally invasive hard channel intracranial hematoma aspiration / 国际外科学杂志

ABSTRACT

Objective:To investigate the specific effect of minimally invasive hard channel intracranial hematoma crush suction flow on patients with cerebral hemorrhage, and to analyze the prognostic factors.Methods:A total of 80 patients with primary intracerebral hemorrhage who were treated in Bengbu First Peopl′s hospital from Aug. 2014 to Aug. 2018 were selected, with 52 males and 28 females, aged from 48 to 81 years and averaged (66.07±13.34) years. The prognosis of patients was assessed using the Bathel Index (BI), and the patients were divided into a control group (BI≥ 60 point considered a good prognosis, n=54) and an experimental group (BI<60 point considered a poor prognosis, n=26). Suspicious prognostic factors were formulated, including gender, age, average drainage time, average puncture needle indwelling time, average hospital stay, Glasgow score, time from injury to operation, bleeding volume, cause of disease, bleeding site, postoperative rebleeding to carry out univariate analysis between groups, and incorporate the difference items in univariate analysis into multivariate logistics regression analysis to explore related prognostic factors were compared by single factor analysis, and the difference items in the single factor analysis were included into the multivariate logistics regression analysis for the related prognostic factors exploring. Results:The hemorrhages was successfully cleared in all patients, and the average drainage time was (5.07±1.25) days. Mean needle retention time was (4.84 ± 1.37) d. Mean length of stay time was (15.26±1.44) days. Allpatients completed follow-up after operation. During 1 year of follow-up, 12 patients showed obvious brain atrophy, subdural broadening and effusion. All patients were followed up for 3 years, and their symptoms completely disappeared and their daily living ability recovered. No death was occured during the follow-up. According to the BI assessment results, the scores of 54 patients were ≥60, with an average score of (74.57±4.36). The scores of 26 patients were <60, with an average score of (48.24±5.12). The age, time from injury to operation and amount of blood loss of control group were significantly lower than those of experiment group, and Glasgow scores were significantly higher than those of experiment group, with statistically significant differences ( P<0.05). The percentage of patients in control group with infratentorial hemorrhage (14.81%) was significantly lower than that in experiment group (34.62%), and the rate of postoperative re-bleeding (1.85%) was significantly lower than that in experiment group (23.08%), with statistically significant differences ( P<0.05). Glasgow score was positively correlated with the prognosis of patients ( OR=3.449, P=0.005). The time from injury to operation was negatively correlated with the prognosis ( OR=0.580, P=0.023). Supratente hemorrhage was a protective factor for patient prognosis ( OR=3.813, P=0.024). Postoperative re-bleeding was correlated with the patients ( OR=19.963, P=0.008). A ROC curve was drawn with Glasgow score and the time from injury to operation. Glasgow score was selected as cut-off point at 7.5 point, with sensitivity of 96.30% and specificity of 88.46%. The time from injury to operation was selected as the cut-off point at 8.35 h, with sensitivity of 84.62% and specificity of 92.59%. Conclusion:Minimally invasive hard channel crush suction flow is effective and safe in the treatment of intracranial hematoma. The severity of cerebral hemorrhage, infratentorial hemorrhage and postoperative re-bleeding are prognostic factors.