The Clinical Comparative Analysis Of Hypertensive Intracerebral Hemorrhage (HICH) Between Stereotactic Biopsy And Conservative Treatment

Objective:High mortality and morbidity of hypertensive intracerebral hemorrhage,depending on the apart and amount of bleeding, the prognosis is different significantly, the same as the treatment time window was greatly affected patient’s outcomes, therefore,if not treatment timely,cerebral hernia may occur, and cause brain damage irreversibly, resulte in poor prognosis, severe neurological dysfunction,even death.At present, a large amount of bleeding, it advocates surgical procedures aggressively, out of ideas when conservative treatment is less blood, so we compare stereotactic biopsy and drainage with conservative treatment of hypertensive intracerebral hemorrhage between 20-30ml of bleeding to discuss the cost of hospitalization, length of stay and post-restoration role and provide some guidance for the treatment of hypertensive cerebral hemorrhage.Methods:A retrospective analysis of 92 cases of March 2010-December 2012 in our hospital with hypertensive cerebral hemorrhage, bleeding 20-30mL, divided into two groups according to the surgical approach,as soon as possible to clear intracerebral hematoma, reducing the release of toxic substances, reducing cerebral edema, to take the procedure of stereotactic biopsy and drainage under local anesthesia to cure in intraoperative, and use CT scanning to make a target position.according to the target position,we underwent stereotactic surgery to adequate drainage, and be urokinase (Urokinase) injection, clipping 2-3 hour drainage, about 5-7 days before removal the drainage tube. Another group of drugs for medical conservative treatment, review of head CT scan regularly, and according to the results to have a dehydrating agent. Comparison of clinical data of hospitalization time, cost and physical dysfunction.to divided into conservative treatment according to the treatment and stereotactic and analyze two groups in hospitalization time and expense, to 3 month GOS as a standard to compare two treatment groups and make a statistical analysis.Results:For hospitalization time, the stereotactic group(14.4±8.3d) was less than conservative treatment group (24.5±14.1d), the cost of hospitalization in former group(26296.28±5292.12 yuan)was belower than poster group(31769.48± 6342.83yuan), Following up and evaluated by Glasgow Outcome Scale for at least 3 months the stereotactic group, amang them good recovery in 39 cases,5 cases shows poor recovery, no craniotomy cases; conservative treatment group were 30,18, of which two cases of cerebral edema due to heavy craniotomy; 3 months follow-up,23 cases shows good recovery in stereotactic group and 16 cases of mild hemiplegia, there is severe in 5 cases, conservative treatment group were 20,8,20. Then stereotactic group in these areas have an outstanding advantage over conservative treatment group (P<0.05).Conclusions:In Clinical, we found that the conservative treatment group had varying degrees of cerebral edema, a heavier extent, occurred earlier, lasted a long time,and the dehydrating agent is still heavy, even some patients with acute renal failure.it delays treatment with intracerebral hemorrhage in some patients, and even leads to cerebral hernia, to take the surgrey of hematoma evacuation again, and the prognosis is poor. The 44 patients in the postoperative stereotactic group has some brain edema, but to a lesser extent, less dehydrating agent applications to use, and even individual patients without the use of a dehydrating agent, it is shorten the hospital stay,lower costs, better prognosis.there is better short-term and long-term efficacy on stereotactic treatment. Comparing with conservative treatment have better short and long term effects.