Efficacy Analysis Of Gelatin Sponge Packing Technique In The Treatment Of Hypertensive Massive Intracerebral Hematoma

Objective To investigate the clinical efficacy of gelatin sponge packing technique in the treatment of hypertensive massive intracerebral hematoma.Methods The clinical data of 354 patients with hypertensive massive intracerebral hemorrhage who underwent emergency craniotomy and hematoma evacuation in Fuyang People’s Hospital of Anhui Medical University from January 2020 to January 2022 were retrospectively analyzed.The patients were divided into three groups according to the different treatment methods of hematoma cavity after hematoma evacuation.In group A,hemostatic gauze was applied to the medial wall of the hematoma cavity.In group B,hemostatic gauze was applied to the inner wall of the hematoma cavity,and then gelatin sponge was used to pack the hematoma cavity.In group C,hemostatic gauze was applied to the inner wall of the hematoma cavity,and then fluid gelatin was used to fill the hematoma cavity.According to the site and nature of the hemorrhage,each group was divided into basal ganglia cerebral hemorrhage(X)and subcortical vascular amyloidosis hemorrhage(Y).Groups B and C each were divided into 5 groups: B1-B5 and C1-C5,according to the ratio of filling volume / preoperative hematoma volume.Group A was not divided due to the small volume of hemostatic gauze.The preoperative and perioperative clinical data,postoperative rebleeding and other adverse events data,postoperative quality of life and other follow-up data were collected and compared among the three groups.ResultsBy comparison between groups,the cases of postoperative rebleeding,cases of hypostatic pneumonia and mortality of group B were lower than those of the other two groups(P <0.05).The postoperative drainage volume of group B and C was lower than that of group A(P <0.05),but the number of severe brain edema cases was higher than that of group A(P <0.05).There were no significant differences in intraoperative blood loss,intraoperative decompressive craniectomy cases,the hematoma clearance rate and postoperative intracranial infection cases among the three groups(P> 0.05).After 6months of follow-up,the Qo L of patients in group B recovered to the level of mild dependence faster and the hospitalization cost was the lowest(P <0.05).It is worth noting that there was no postoperative rebleeding case in the BY group,and the Qo L score at 1 month after operation was higher than that in the other two groups(P <0.05).By intra-group comparison,it can be concluded that the optimal filling volume is40%-60% of the preoperative hematoma volume.Conclusion“Gelatin sponge packing technique” is a combination of the hypertensive massive intracerebral hematoma surgery and the normal perfusion pressure breakthrough theory(NPPB).This technique is highly effective in reducing the incidence of postoperative rebleeding and promoting patients rehabilitation,particularly for those with subcortical amyloidosis hemorrhage.