| Objective: To compare the timing and clinical effect of neuroendoscopic surgery and hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage.Methods: Collected from the Department of Neurosurgery of Jiangxi Provincial People’s Hospital from October 2019 to October 2021.There were 88 cases of hypertensive cerebral hemorrhage in the surgical treatment,including 12 cases of endoscopic intracranial hematoma removal(endoscopic group)and 76 cases of intracranial hematoma puncture and drainage(puncture group),which were retrospectively analyzed,and all cases met the diagnostic criteria for hypertensive cerebral hemorrhage and were supported by imaging data.Collected the patient’s age,sex,hematoma site,preoperative bleeding volume,GCS score at admission,time from onset of surgery,complications,length of hospitalization,cost of hospitalization,GOS score and ADL score in March after surgery;When comparing the efficacy of endoscopic intracranial hematoma removal and hematoma puncture and drainage in patients with hypertensive cerebral hemorrhage,as well as the difference in prognosis between different surgical timings and patient prognosis,the t-test was used for quantitative data subject to normal distribution,the non-parametric rank test was used for those who did not obey the normal distribution,and the chi-square test or Fisher’s precise probability method was used for classified data;Screening of prognosis-related influencing factors in patients with hypertensive encephalopathy using univariate logistic regression analysis;Further combining the clinical significance and the results of univariate regression analysis,multi-factor logistic regression analysis was used to adjust the confounding factors,and the influence of different treatment methods and surgical timing on prognosis was analyzed.Result: 1.In the comparison of efficacy,the clearance rate of hematoma in the endoscopic group was 94.00%(92.00%,95.75%),which was higher than that of the puncture group of 79.50%(74.00%,85.00%),P<0.001;There was no significant difference between the two groups in the occurrence of complications such as lung infection,intracranial infection,stress ulcer,and intracranial rebleed(P>0.05).The good prognosis rate of GOS score in the endoscopic group was 72.73%,and the good prognosis rate of the puncture group was 40.58%,and the difference in the good prognosis rate of GOS score between the two groups was not statistically significant(P=0.057).The good prognosis rate of ADL score in the endoscopic group was 81.81%,and the good prognosis rate of the puncture group was 66.67%,and there was no significant difference in the good prognosis rate of ADL score between the two groups(P=0.488).2.In the comparison of the timing of surgical treatment,there were 1 ultra-early patient and 10 early patients in the endoscopic group;There were 26 ultra-early patients and 43 early patients in the puncture group.Patients treated with ultra-early treatment in the endoscopic group had a good prognosis in ADL score.The good prognosis rates of GOS and ADL in patients treated ultra-early in the puncture group were 46.15% and 69.23%,respectively.In the early group,the good prognosis rate of GOS and the good prognosis rate of ADL were not statistically significant in the comparison between the endoscopic group and the puncture group(P>0.05).3.Logistic regression analysis showed that the higher the GCS score at admission,the less likely the prognosis of the GOS score was,OR=0.35(95%CI: 0.20~0.61);The higher the GCS score at admission,the less likely it is that the ADL score will have a poor prognosis,OR =0.26(95% CI: 0.14~0.47),and the longer the onset time from surgery,the greater the likelihood of a poor ADL score prognosis,OR =1.08(95% CI: 1.00~1.16).After adjusting the variables of sex,age,GCS score at admission,bleeding volume,and postoperative hematoma clearance,the surgical treatment mode had no statistical significance for the prognosis of GOS score and ADL score prognosis(P>0.05).Conclusions:1.Endoscopic clearance was significantly better than hematoma puncture and drainage,but there was no significant difference in prognosis.2.Hematoma puncture and drainage is performed in the early stage,and its prognosis is not significantly different from that of neuroendoscopic surgery.3.The more the GCS score at admission,the likelihood of the poor prognosis was low;The older the age,the longer the onset of surgery,the likelihood of a poor prognosis was high. |
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