| Objective:To explore the related factors affecting the prognosis of patients with spontaneous cerebellar hemorrhage to provide decision-making basis for clinical treatment of cerebellar hemorrhage,and to observe the effects of stereotactic minimally invasive intracranial hematoma evacuation,routine craniotomy and drug conservative treatment on the prognosis of patients with cerebellar hemorrhage.Methods:A total of 173 patients with cerebellar hemorrhage who were hospitalized in the affiliated Hospital of Gui Zhou Medical University from January 2014 to January2021 were selected by inclusion criteria and exclusion criteria.First of all,the related factors affecting the prognosis of patients with spontaneous cerebellar hemorrhage were analyzed.105patients with SCH were divided into two groups:good prognosis group(n=72)and poor prognosis group(n=33).Then the effect of surgical treatment on the clinical prognosis of SCH patients with hematoma diameter larger than 3.6cm was studied.The patients were divided into drug treatment group(n=27),stereotactic minimally invasive technique group(n=30)and craniotomy group(n=15).Secondly,the effects of different treatment methods on the prognosis of SCH patients with hematoma larger than 10ml were analyzed.The patients with hematoma volume more than 10ml were divided into two groups:drug conservative treatment group(n=27)and operation group(including stereotactic minimally invasive surgery group and craniotomy group).The patients with spontaneous cerebellar hemorrhage were observed at the end of 3 months after discharge.The difference of curative effect between conservative drug treatment and surgical treatment.All patients were treated according to Chinese guidelines for intracerebral hemorrhage.All patients were followed up to 3 months after discharge,and the prognosis was evaluated with modified Rankin scale score.All patients recorded and counted the general data,clinical data and the diameter and volume of hematoma scanned by computerized tomography(CT).Glasgow coma scale score,National Institutes of Health Stroke scale score and m RS score were used to evaluate the patient’s condition.Follow-up and record the occurrence of secondary lung disease,secondary heart disease,secondary epilepsy,death and so on.Results:1.Independent predictors of adverse prognosis of spontaneous cerebellar hemorrhage:m RS was used to evaluate the prognosis of patients with spontaneous cerebellar hemorrhage at 3 months of follow-up.Through the comparative analysis of good prognosis group(m RS≤3)and poor prognosis group(m RS>3),there were 5independent risk factors affecting the prognosis of SCH patients treated with conservative drugs:(1)admission GCS score,(2)enlarged hematoma after admission,(3)posterior fossa contraction sign,(4)hematoma diameter,(5)complicated diabetes mellitus.The presence of enlarged hematoma or diabetes mellitus or posterior fossa contraction sign after admission indicated a poor prognosis(P<0.05).Time-dependent receiver operation characteristic curve analysis of GCS score correlation on admission showed that the best predictor of GCS at admission was 12points(sensitivity 0.891,specificity 0.825,Youden index 0.716,AUC 0.929,95%confidence interval was 0.804～0.961,P<0.05).The OR value of GCS score at admission was 0.806 less than 1,and when the score was less than 12,it suggested a poor prognosis.The time ROC curve analysis of the correlation between the diameter of hematoma in hospitalized patients showed that the diameter of hematoma in hospitalized patients was the best predictor when the diameter of hematoma was3.6cm(sensitive 0.717,specific 0.913,Yoden index 0.630,AUC 0.820,95%confidence interval was 0.657～0.861,P<0.05).The OR value of the diameter of hematoma on admission was 2.191 more than 1.When the diameter of hematoma more than 3.6cm,the prognosis of the patients was poor.2.Effect of surgical treatment on the prognosis of patients with spontaneous cerebellar hemorrhage:according to the prognostic analysis of 3-month follow-up,it was found that both craniotomy and stereotactic minimally invasive therapy could reduce the terminal mortality of patients with cerebellar hemorrhage whose hematoma diameter was larger than 3.6cm(P=0.047),but could not improve the proportion of patients with good prognosis in 3 months.When the volume of hematoma on admission was more than 10ml,the patients were followed up until 3 months after discharge.Comparison of efficacy between the drug conservative treatment group,the stereotactic minimally invasive treatment group and the craniotomy treatment group showed that 22 patients(57.7%)had good prognosis in the stereotactic minimally invasive treatment group and 8 patients(44.5%)had good prognosis in the craniotomy treatment group.Compared with the conservative treatment group,there were 7 patients with good prognosis(25.9%),X~2=6.530,P=0.038,and the difference was statistically significant(P<0.05).The survival rate of 65.8%(25 cases)in the stereotactic minimally invasive surgery group and 50%(9 cases)in the craniotomy group was higher than that of 33.4%(9 cases)in the conservative drug treatment group(X~2=6.690,P=0.035),and the difference was statistically significant(P<0.05).There was no significant difference between the stereotactic minimally invasive treatment group and the craniotomy group(X~2=0.888,P=0.346),(P<0.05).Conclusions:1.Conscious state on admission(GCS score on admission),hematoma diameter,diabetes mellitus,enlarged hematoma after admission and posterior fossa contraction sign were independent predictors of 3-month prognosis of patients with spontaneous cerebellar hemorrhage.GCS score less than 12 and hematoma diameter greater than3.6cm on admission suggest poor clinical prognosis in patients with SCH.2.For patients with a hematoma larger than 3.6cm in diameter,surgical treatment(craniotomy or stereotactic minimally invasive surgery)significantly reduced mortality in SCH patients,but had no significant effect on functional outcomes at 3 months.3.When the hematoma volume of hospitalized patients was more than 10ml,surgical treatment(either craniotomy to remove the hematoma or stereotactic minimally invasive technique)could reduce the proportion of poor prognosis at 3months and reduce the mortality rate of patients with spontaneous cerebellar hemorrhage.There is no significant difference in prognosis between stereotactic minimally invasive surgery and craniotomy,that is,for patients with SCH with hematoma volume greater than 10ml,stereotactic minimally invasive surgery can be chosen to save the patient’s life. |
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