| Part Ⅰ Neuroendoscope and Small Bone Window Craniotomy in the Treatment of Hypertensive Intracerebral Hemorrhage ComparisonObjective:Hypertensive intracerebral hemorrhage is one of the most common types of intracerebral hemorrhage in our country.It has the characteristics of high incidence,high morbidity and high mortality.Surgery is the most important method for clinical treatment of hypertensive intracerebral hemorrhage.Traditional craniotomy and endoscopic surgery are two types of surgical procedures.However,the current clinical treatment of small craniotomy and endoscopic surgery remains controversial.Small craniotomy craniotomy has been more mature,but in the process of removing intracranial hematoma will inevitably damage some normal brain tissue,may affect the prognosis.Neuroendoscopic surgery is a minimally invasive surgical method,the damage of normal brain tissue in patients with small,but its scope of application and clinical efficacy has not yet been fully studied.In this regard,we collected and recorded the clinical data of patients with hypertensive intracerebral hemorrhage who underwent minimally invasive endoscopic neurosurgery and small craniotomy in our hospital.Analysis of a number of clinical indicators,the efficacy of the two surgical methods compared for the clinical treatment of hypertensive intracerebral hemorrhage select the appropriate surgical basis.MethodsAccording to the inclusion and exclusion criteria,the clinical data of 124 hypertensive intracerebral hemorrhage patients who were treated in Department of Neurosurgery of The First Affiliated Hospital of Scochow University and Department of Neurosurgery of Chongming branch during July 2014 ~2017 August were collected.According to patients receiving different treatment methods,divided into neuroendoscope group 54 cases and 70 cases of small bone window group.The two groups were compared in terms of sex,age,operation time,intraoperative blood loss,preoperative hematoma volume,postoperative hematoma volume,hematoma clearance,rebleeding rate,postoperative hospital stay,total cost of treatment,mortality,postoperative complications The incidence of disease,ADL scores at 1 month and 6 months after operation,and neurological deficits(NFDS score)at 1 week and 4 weeks after operation.All patients were followed up for 6 months.OutcomesThe gender composition ratio,mean age,mean systolic blood pressure at admission,mean blood loss,bleeding site,mean MESSS score,mean preoperative GCS score,admission HGB,admission PLT were no difference In addition,compared with the small bone window group,the patients in the endoscopic group had lower average postoperative residual hematoma volume,higher hematoma clearance rate,shorter average operation time and less intraoperative blood loss(P <0.05).The mean days of ICU and average length of hospital stay were shorter(P <0.05),mean hospitalization costs were lower(P <0.05).The rates of postoperative bleeding,complications and mortality were significantly different between the two groups No statistical significance(P> 0.05).Finally,comparing the postoperative neurological function and prognosis of the two groups,NFDS scores of both groups were significantly decreased and ADL scores increased significantly at 1 week and 4 weeks after operation,and there was significant difference between the two groups(P <0.05).Conclusion1.Relative to the small craniotomy craniotomy surgery,endoscopic assisted hematoma removal surgery for hypertensive intracerebral hemorrhage shorter operation time,less bleeding surgery,hematoma clearance rate higher,shorter postoperative hospital stay,patients spend Lower2.Endoscopic assisted hematoma removal surgery and small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage postoperative rebleeding rate,complication rate and mortality no significant difference;3.Compared with small craniotomy craniotomy surgery,endoscopic assisted hematoma removal surgery for hypertensive intracerebral hemorrhage to improve the neurological function of patients better,is conducive to the long-term prognosis of patients.4.Endoscopic assisted hematoma removal of hypertensive cerebral hemorrhage surgery is safe and effective.Part Ⅱ Aspirin on Hypertensive Cerebral Hemorrhage After HemorrhageObjectiveHypertensive intracerebral hemorrhage is one of the most common cerebrovascular diseases in our country and the second most important cause of death among Chinese residents.With the aggravation of our country’s aging and people’s pursuit of healthy living,the prevention of cerebrovascular disease receives more and more people’s attention.Aspirin is the most widely used clinical anti-platelet aggregation of oral drugs,its efficacy in the prevention and treatment of cardiovascular and cerebrovascular disease has been recognized worldwide,and is widely used clinically as a secondary prevention of cardiovascular and cerebrovascular diseases.This has also led to the long-term oral administration of aspirin in many patients with cerebral hemorrhage and is used to improve cerebral blood circulation postoperatively in patients with cerebral hemorrhage.However,in recent years,studies have reported that the incidence of postoperative hemorrhage in patients with long-term oral aspirin has a significant increase in postoperative bleeding compared with those without taking aspirin,which seriously affects the prognosis of patients.In this regard,we collected and recorded the clinical data of patients with hypertensive intracerebral hemorrhage who underwent minimally invasive endoscopic neurosurgery and small craniotomy in our hospital.According to the occurrence of postoperative rebleeding analysis to explore the long-term oral administration of aspirin on hypertensive intracerebral hemorrhage after rebleeding impact for the clinician hypertensive intracerebral hemorrhage provide some reference.MethodsAccording to the inclusion and exclusion criteria,the clinical data of 124 hypertensive intracerebral hemorrhage patients who were treated in Department of Neurosurgery of The First Affiliated Hospital of Scochow University and Department of Neurosurgery of Chongming branch during July 2014 ~2017 August were collected.According to whether patients with postoperative bleeding,re-bleeding group was divided into 13 cases and 111 cases without hemorrhage.Univariate analysis and multivariate Logistic analysis were used to compare the gender,bleeding location,operation method,cerebral hemorrhage,admission GCS score,HGB on admission,PLT on admission,whether there was hernia,whether aspirin and so on.OutcomesClinical data of two groups of patients were compared by univariate analysis to show if herniation was associated with hypertensive intracerebral hemorrhage,such as gender,site of bleeding,surgical procedure,amount of cerebral hemorrhage,GCS score at admission,HGB at admission,PLT at admission No significant effect of postoperative bleeding,age,grade of hypertension,taking aspirin on patients with hypertensive intracerebral hemorrhage after hemorrhage have an impact.Further use of multivariate logistic analysis showed that age would affect the patients with hypertensive intracerebral hemorrhage after rebleeding,but not as an independent risk factor;and hypertension grade and oral aspirin in patients with hypertensive intracerebral hemorrhage occurred rebleeding(Hazard ratio,OR =4.429、3.63,P <0.05).Conclusion:1.Sex,location of bleeding,surgical approach,cerebral hemorrhage,admission GCS score,admission HGB,admission PLT,whether or not hernia occurred in patients with hypertensive intracerebral hemorrhage no significant effect of rebleeding;2.Hypertension classification and oral aspirin are independent risk factors for postoperative hemorrhage in patients with hypertensive intracerebral hemorrhage,and their risk levels increase in turn(OR =4.429、3.63,P <0.05);3.Recommended clinical for the above factors and independent risk factors,targeted to take various measures to prevent postoperative hypertensive intracerebral hemorrhage rebleeding,is conducive to the long-term prognosis of patients. |
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