The Impact Of Hypertensive Intracerebral Hemorrhage Craniotomy Prognostic Factors

OBJECTIVE: Clinical data including gender, age, pupillary changes (with orwithout herniation), GCS score, midline shift and the bleeding site, bleeding is breakinginto the ventricle, and postoperative complications such as postoperative bleeding,upper gastrointestinal effects of bleeding, lung infections and other factors are collectedand analyzed to study their impact on the prognosis of hypertensive cerebralhemorrhage (HICH) after craniotomy. Based on clinical practice, meanwhile, possibleintervening measures for prognosis improvement were also put forward in this study.METHODS:236craniotomy treated HICH cases in the department ofNeurosurgery of the First Affiliated Hospital of Dalian Medical University since June2012to December2013were taken in to this retrospective analysis. Clinical dataincluding patient gender, age, pupillary changes (with or without herniation) from thetime of admission, GCS score, bleeding site, hematoma volume, midline shift,intraventricular hemorrhage and postoperative complications such as re-bleeding, uppergastrointestinal bleeding, lung infection and other factors affecting the disease prognosiswere collected. GOS score of each patient was calculated30days later after the surgeryto determine the patient’s neurological function recovery. Patients with GOS score3-5were considered favorable prognosis (FP), patients with GOS score3-5were consideredpoor prognosis (PP). Then, the correlation between the prognosis and these collectedfactors were analyzed by univariate analysis (x2test for two categorical variables,multiline x list data x2test for categorical variables data); SPSS19.0statistical softwarewas applied for statistical analysis.RESUTLS:30days after operation， about142HICH patients had a favorable prognosis with GOS score3-5points; a total of94cases with poor prognosis（1-2points）. GCS score, hematoma volume, re-bleeding and postoperative lung infectionexhibited significant impact on the prognosis of HICH patients after craniotomy,（respectively χ2=40.311, P <0.001；χ2=25.384,P＜0.001；χ2=22.763，P＜0.001；χ2=23.036， P＜0.001); Other factors including dilated pupils, midline shift andintraventricular hemorrhage significantly worsen the outcome of HICH patients aftercraniotomy（χ2=10.796,P＜0.05；χ2=15.269, P＜0.001；χ2=14.696，P＜0.001，respectively）However, the impact of patient’s gender and age on the prognosis of patients withcraniotomy was not statistically significant (χ2=1.145, P>0.05; χ2=6.503, P>0.05);preoperative bleeding site of craniotomy prognosis was not statistically significanteither (χ2=4.489, P>0.05); postoperative gastrointestinal bleeding also has negativeimpact on the prognosis of patients with craniotomy (χ2=0.136P>0.05);CONCLUSION: Take all the data into consideration,many factors influen-ce theprognosis of HICH patients after surgical operation,but the key factors includingpreoperative GCS score,pupillary changes,postoperative re-bleeding,the degree ofmidline shift,whether breaking into the ventricle,pulmonary infections and intracranialhematoma volume,can be used as prognostic evaluation of patients with cerebralhemorrhage after craniotomy hypertension pointer.In other words,our finding may helpclinicians a lot in the choice of appropriate treatment methods to improve the outcomeof craniotomy treated HICH patients.