Clinical Application Of Frontal-puncture Drainage In The Treatment Of Hypertensive Intracerebral Hemorrhage

Objective:To explore Operation method,curative effect and clinical application value in the treatment of hypertensive intracerebral hemorrhage.Information and methods:From September 2015 to December 2017,the patients with hypertensive intracerebral hemorrhage who were treated in the second Department of Neurology,Sino-Japanese Friendship Hospital of Jilin University were analyzed retrospectively.Selection criteria:(1)Intracerebral hemorrhage in basal ganglia area was greater than 30 ml,less than 60 ml;(2)with hemiplegia or aphasia within 6 hours of onset,the space occupying effect had been formed,and the midline structure shift was less than 1 cm.Exclusion criteria:(1)Bleeding greater than 60 ml(2)The displacement of midline structure is more than 1 cm;(3)moderate to severe coma with unstable vital signs;(4)Severe medical diseases(heart function and liver and kidney dysfunction)can not tolerate surgery patients;(5)patients with aneurysm or vascular malformation were found by CTA,DSA or MRA.(6)obvious obstacle of coagulation function;The patients were divided into,frontal puncture group and traction group.The frontal puncture group and the temporal puncture group were examined by CT and located before operation,and the two groups were operated under general anesthesia.After operation,the frontal puncture group and the temporal puncture group were treated same as conservative treatment group,except for the daily CT review of the head according to the morning to decide whether to continue to perform hematomolysis therapy with the drainaging catheter injection of urokinase.The condition of muscle strength of the affected limbs was collected in the first month and 3 months after the onset of the disease.According to the scoring classification(0-2 points as poor condition;3-5 points as good condition)of the frontal treatment group,the temporal treatment group and the conservative treatment group,the improvement of the muscle strength of the affected limbs in the first month and 3 months after the onset of the disease was analyzed statistically.All the discharged patients in the three groups were followed up for 3-6 months.The GOS scores of 1 month and 3 months after the onset were collected and the prognosis of the three groups was evaluated.Scores of 1-3 and 4-5 were classified as poor prognosis and good prognosis respectively.The GOS scores of the frontal puncture group,the temporal puncture treatment group and the conservative treatment group were compared in the first month and 3 months after the onset of the disease.Comparison of transfrontal puncture group and temporal puncture group postoperative 1st day and third day's hematoma clearance rate.The average cost of hospitalization,average length of stay and complications(incidence of intracranial infection and pneumonia)during hospitalization were compared frontal puncture group and temporal puncture group.Comparison of the difference of treatment methods in intracerebral hemorrhage patients with the medium amount bleeding(30~60ml)in the basal ganglia and its influence on the prognosis of patients with intracerebral hemorrhage.Results:According to the above criteria,a total of 43 cases were enrolled,including 20 in the premenstrual puncture group and 23 in the puncture group.The difference between the two groups of data in the general data was not statistically significant between the two groups of patients,that is,there was comparability between the two groups of data.The difference in muscle strength between the two groups was statistically significant at 1 month after the onset of disease.The difference in limb muscle strength at 3 months was statistically significant.There was a statistically significant difference between the two treatments in the GOS score at 1 month after onset.The percentage of patients with good prognosis in the frontal puncture group was better than other treatment groups.There was no statistically significant difference in the GOS scores at 3 months after onset between the amount of puncture and transsputum puncture(P>0.05).In the minimally invasive surgery group,the average hematoma clearance rate on the first postoperative day was greater than that of transvaginal surgery,and the average hematoma clearance rate on the third postoperative day in the frontal group was greater than that in the transvaginal group and statistical analysis was performed.It was concluded that there was a difference between the two groups in the hematoma clearance rate on the first day,but there was no statistical significance.The difference between hematoma clearance on the third postoperative day was statistically significant.The difference in the incidence of complications between the surgery groups in the statistics of the incidence of treatment in the study was statistically significant.In the two groups of patients during the hospitalization period,1 patient had intracranial infection,2 had pneumonia,and 3 had ion disorder.Seven cases of intracranial infection,9 cases of pneumonia,and 10 cases of ion disturbances were found by puncture.There was a statistically significant difference between the two groups.The average length of stay in the two groups was 21.09±2.86 days in the menopause group at 19.35±2.91 days.There was no statistical difference between the average length of stay in the two groups.Among them,the hospitalization fee for the group treated by the amount of puncture was 9.01±11,000 yuan,and that by the squatting group was 10.47±10.80 yuan.There was a significant difference between the two treatment methods for hospitalization costs(P<0.05).Conclusion:1.Tracheal puncture drainage tube through the long axis of hematoma,compared with the temporal puncture,can improve hematoma clearance,improve prognosis.2.For hematoma volume 30 to 60 ml of hypertensive intracerebral hemorrhage,basal ganglia cerebral hemorrhage by volume puncture treatment is superior to the temporal group,it is recommended that the preferred puncture drainage.