Study On The Effect Of High Dose Methyl-dimethylprednisolone On Relieving Cerebral Edema Caused By Spontaneous Intracerebral Hemorrhage

Objective:Cerebral hemorrhage is a common acute and severe disease in craniocerebral diseases,which seriously threatens the lives of patients.Cerebral edema is a secondary symptom of injured brain tissue and the main reason for the intracranial pressure to continuously increase after the patient’s intracranial hematoma has been stable.The development of cerebral edema is the key to conservative treatment for patients whose intracranial hematoma volume does not meet the indications for surgery,or whose hematoma volume is near the margin of surgical indications with mild clinical symptoms.MPPT is widely used in the treatment of the central system,but it is seriously controversial to apply in cerebral hemorrhage disease,so it is rarely used by clinicians.In this study,CT imaging is used as a visual observation of brain tissue changes to investigate whether MPPT has a significant effect in controlling the development of cerebral edema after the occurrence of cerebral hemorrhage.Methods:Screening research subjects,we review the case data(from January 2018 to December 2019)of patients with spontaneous cerebral hemorrhage undergoing conservative treatment admitted to the First Department of Neurosurgery,Shengjing Hospital,China Medical University.Case data meeting the following conditions are included in the study object: the amount of intracranial hematoma do not reach the indication for surgery,or the amount of hematoma is about the edge of the surgical indication but clinical symptoms are slight;aged 30-65 years old;the first head CT is completed within 8 hours after admission,with head CT countercheck within 3-5 days of onset,and during the duration of the study,conservative treatment is continued without surgery.Check the doctor’s advice and group them.According to the use of glucocorticoids during the treatment,they are divided into three groups: high-dose group,medium-dose group,and blank control group.High-dose group: Methylprednisolone 500 mg once a day after admission is given intravenously for 3 days as a high-dose shock therapy.After 3 days,it is switched to the medium-dose group administration mode for a total treatment period of 7 days.Medium-dose group: 80 mg methylprednisolone every 12 hours or 160 mg methylprednisolone once a day is given intravenously after admission,the total duration of treatment is 7 days;some patients who have a treatment regimen of dexamethasone 10 mg intravenously at intervals of 12 hours can be classified into the middle-dose treatment group,according to the dose conversion formula between different types of glucocorticoids.Blank control group: glucocorticoid is not used during the course of the study.Select two different stages “within 8 hours” and “peak edema(3-5 days after onset)” as the time phase,review and collect CT imaging of head by using PACS imaging workstation,to contrast the development of hematoma and the edema area around it.Collect progress notes,laboratory sheets,nursing records.etc of patients,notice the restoration of neurological function and adverse reaction.Results:For patients while the course disease come to the peak stage of edema,the evolution of hematoma of three treatment groups has no statistic difference,on the part of control the development of edema around the hematoma,high-dose grouop performs better than medium-dose group and blank control group(P <0.05),medium-dose group and blank control group performs no differences(P> 0.05).On the restoration of neurological function,there is some association with the use of GC(P <0.05).On the adverse reaction,the case cannot prove the association between using GC and the risk of GLU rising or stress ulcer(P> 0.05).Conclusions:For patients of ICH under conservative treatment,early application of [methylprednisolone impingement treatment] has significant effects in alleviating cerebral edema caused by spontaneous intracerebral hemorrhage,performs better on the restoration of sense and activity etc of neurological functions,but the treatment cannot accelerate the elimination and absorption of hematoma.At the early stage of ICH,the rising risk of GLU rising or stress ulcer and etc adverse reactions,cannot be proved has the association with the using if GC by this case.