A Comparative Study Of The Two Kinds Of Operations In Treating Hypertensive Intracerebral Hemorrhage

Objective:compara the effectiveness and difference two kinds of operations---small bone flap craniotomy and microinvasive craniopuncture therapy in treating hypertensive intracerebral hemorrhage,for choose suitable means of operation to provide evidence.Methods:(1)A clinical trial method was used in the study.The 200 patients with hypertensive intracerebral hemorrhage(HICH)come from Shanxi province hospital from June 2003 to October 2006.The 200 patients were divided to two groups——microinvasive craniopuncture therapy group 100 patients and small bone flap craniotomy group 100 patients. (2)Before the operation compare general characteristic of two group patients,including age, sex,consciousness,position of intracerebral hemorrhage,degree of intracerebral hemorrhage, time of suffer from the disease to operation etc.To evaluate patients' neurological impairment degree according 4th term on the whole country cerebral vascular disease academic meeting evaluation standard.evaluation standard is made of eight parts,including consciousness,level gaze function,face paralysis,speech,muscle power of upper limbs,muscle power of hands, muscle power of under limbs,ability of walk.Total 45 score,the more neurological impairment degree the more score,light degree 0-15 score,middle degree 16-30 score,serious degree 31-45 score.(3)To evaluation the curative effect:the case fatality during hospital;the neurological impairment degree in the 14th day after operation;activities of daily living(ADL)---Barthel index(BI);(4)To compara two groups average time of operation,disappear time of blood;(5)To compare two groups intracerebral again hemorrhage rate;(6)To compare two groups the time in the hospital and cost in the hospital.Results:(1)Before the operation there was no significant difference between the two groups in the following factor,including general characteristic,consciousness,position of intracerebral hemorrhage,degree of intracerebral hemorrhage,time of suffer from the disease to operation etc.(2)In the 14th day after operation,there were significant progress on neurological impairment degree in two groups,(small bone flap craniotomy before operation 38.9±8.6scores,after operation 21.8±5.77 scores,t=12.57,p＜0.001;microinvasive craniopuncture therapy before operation 37.6±7.9 scores,after operation 20.7±5.69 scores,t=11.34,p＜0.001),but there was no significant difference between the two groups in neurological function(t=0.92,p＞0.20).(3)By the last time in hospital there was significant difference in patients with favorable outcomes(Barthel index≥75)between the two groups (x~2=3.91,p＜0.05),which showed a better progress in microinvasive craniopuncture therapy group.(4)There was no significant difference between the two groups in the case fatality rate during hospital,small bone flap craniotomy group is 21%,microinvasive craniopuncture therapy group is 18%(x~2=0.29,p＞0.5)(5)The microinvasive craniopuncture therapy group average time of operation is 51.2±10.3 min,small bone flap craniotomy group average time of operation is 108.6±12.8 min,there was significant difference two groups(t=12.31,p＜0.05). Disappear time of blood microinvasive craniopuncture therapy group is 5.8±0.9 days,small bone flap craniotomy group is 3.9±0.8 days,there was significant difference two groups (t=10.07,p＜0.05).(6)After operation intracerebral again hemorrhage rate microinvasive craniopuncture therapy group is 17%,small bone flap craniotomy group is 15%,there was no significant difference two groups.But intracerebral again hemorrhage case fatality rate microinvasive craniopuncture therapy group is 7/17,small bone flap craniotomy group is 11/15, there was significant difference two groups(x~2=4.07,p＜0.05).(7)The time in hospital small bone flap craniotomy group is 24.5±3.8days,microinvasive craniopuncture therapy group is 22.5±4.3days,there was significant difference two groups(t=3.48,p＜0.05).Cost in the hospital small bone flap craniotomy group is 16287.6±1134.2yuan,microinvasive craniopuncture therapy group is 12973.4±1153.6yuan,there was significant difference two groups (t=20.49,p＜0.05)Conclusion:Compara microinvasive craniopuncture therapy group with small bone flap craniotomy group:average time of operation in microinvasive craniopuncture therapy group is shorter than small bone flap craniotomy group,the time in the hospital microinvasive craniopuncture therapy group is shorter than small bone flap craniotomy group,cost in the hospital microinvasive craniopuncture therapy group is lower than small bone flap craniotomy group,activities of daily living(Barthel index)microinvasive craniopuncture therapy group is better than small bone flap craniotomy group,but there was no significant difference in the case fatality rate during hospital and neurological function.Two groups intracerebral again hemorrhage rate there was no significant difference,but intracerebral again hemorrhage case fatality rate there was significant difference two groups.