Therapeutic effects comparison of different surgical methods for hypertensive intracerebral hemorrhage and logistic regression analysis of postoperative rebleeding influencing factors

Abstract

Objective To discuss the therapeutic effects of neuronavigation assisted minimally invasive puncture hematomas drainage (NAMIEH), small-window craniotomy evacuation of hematoma (SWCEH) and large bone flap evacuation of hematoma (LBFEH) for hypertensive intracerebral hemorrhage and logistic regression analysis of postoperative rebleeding influencing factors. Methods The clinical data of 134 patients with hypertensive intracerebral hemorrhage admitted to Department of neurosurgery, 901th Hospital of PLA Joint Logistics Support Force from September 2016 to March 2019 were retrospectively analyzed, and divided into NAMIEH group (38 cases), SWCEH group (45 cases) and LBFEH group (51 cases) according to the different surgical treatment methods. Compared the preoperative and postoperative 7, 14 d bleeding volume, GCS scores, NIHSS scores, Barthel indexes and the clinical effects after treatment, the Logistic regression analysis was used to analysis the postoperative rebleeding influencing factors of patients with hypertensive intracerebral hemorrhage. Results The preoperative bleeding volume, GCS score, NIHSS score and Barthel index of the 3 groups had no significant statistical differences (P<0.05); The postoperative 7, 14 d bleeding volume, GCS scores, NIHSS scores and Barthel indexes of the three groups had significant statistical differences (P<0.05); The preoperative and postoperative 7, 14 d bleeding volume and NIHSS scores of the NAMIEH group, SWCEH group and LBFEH group decreased significantly in turn, GCS score and Barthel index increased significantly in turn, and there were significant statistical differences at any two time points in the group (P<0.05). The incidence of rebleeding, residual hematoma and postoperative complications of the NAMIEH group and SWCEH group were significantly lower than the LBFEH group, and the rebleeding (10.53%), residual hematoma (5.26%) and postoperative complications (15.79%) were significantly lower than the SWCEH group respectively (P<0.05). Regarding the postoperative rebleeding of hypertensive cerebral hemorrhage patients as dependent variable, logistic regression analysis was carried out on the possible influencing factors of postoperative rebleeding in univariate analysis. The results showed that associated with diabetes, preoperative systolic blood pressure, the operative occasion, hematoma shape, break into the ventricle, preoperative bleeding volume, preoperative GCS score, preoperative NIHSS score, preoperative Barthel index, abnormal coagulation function, postoperative complications and total duration of hospitalization were independent influencing factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage (P<0.05). Conclusion The clinical effect of MIEH in treating hypertensive cerebral hemorrhage is better than SWCEH and LBFEH, can effectively promote the recovery of nerve function and reduce the incidence of rebleeding and postoperative complications; Moreover, associated with diabetes, preoperative systolic blood pressure, time from onset to operation et al were independent influencing factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage. Key words: Neuronavigation assisted minimally invasive puncture hematomas drainage; Small-window craniotomy evacuation of hematoma; Large bone flap evacuation of hematoma; Hypertensive cerebral hemorrhage