Effects Of Stereotactic Minimally Invasive Surgery Plus Urokinase On Cerebral Edema And Prognosis After Intracerebral Hemorrhage

Objective:To compare the effects of the degree of perihematoma edema and the short-term efficacy after stereotactic minimally invasive surgery plus urokinase treatment and conservative treatment,and to explore the correlation between EED and short-term prognosis.Methods:We retrospectively analyzed the clinical data of 96 patients who received stereotactic minimally invasive surgery plus urokinase treatment or conservative treatment from Zhangjiajie Hospital of Hunan Normal University between January2015 and June 2019.Patients were matched at a 1:1 ratio using the propensity score matching method in the SPSS22.0 software.The matching variables included age,gender,whether it broke into the ventricle,ICH score,GCS score,baseline hematoma volume,baseline blood glucose,and baseline systolic pressure and baseline diastolic pressure.28 patients who underwent stereotactic minimally invasive surgery plus urokinase treatment(stereotactic group)and 28 patients who underwent conservative treatment(conservative treatment group)were included in the study.Results:There were no deaths during treatment in both groups.EED,hematoma volume,and total volume changed significantly with time,and the differences were statistically significant(P<0.01).The interaction between the two groups of hematoma volume and total volume and the measurement time was statistically significant(P<0.01).There was no statistically significant difference between the two groups of EEDs on admission,on the first and on the third day after treatment(t=-1.246,P=0.218;t=0.150,P=0.881;t=-1.487,P=0.143)Hematoma volume in the stereotactic group was smaller than that in the conservative treatment group on the first,the third and the seventh day after treatment(t=2.942,P<0.01;t=4.370,P<0.01;t=5.879,P<0.01),the difference was statistically significant.The total volume of the stereotactic group was smaller than that of the conservative treatment group on the first,the third and the seventh day after treatment(t=2.912,P<0.01;t=3.825,P<0.01;t=6.087,P<0.01),the difference was statistically significant.The incidences of intracranial infection,urinary tract infection,and stroke-associated pneumonia were similar in the two groups during treatment(X~2=2.333,P=0.127;X~2=1.018,P=0.333;X~2=0.08,P=0.778),and the difference was not statistically significant.The ADL scores after treatment in the two groups were similar(t=-0.153,P=0.879),and the difference was not statistically significant.The mRS score of one month after treatment was 3 of 2points,15 of 4 points,6 of 5 points in the stereotactic group,and 2 of 2 points,18of 4 points,3 of 5 points in the conservative treatment group(W=5.31×102,P=0.578),there was no significant difference.There was a weak negative correlation between EED and ADL score of 1 month after treatment at admission,which was statistically significant(r=-0.269,P=0.045).There was no significant correlation between EED and ADL score of 1 month after treatment on the first and the third day after treatment(P>0.05).There was no statistically significant correlation between the EED and the mRS score of 1 month after treatment on admission,the first day and the third day after treatment(P>0.05).Conclusion:Stereotactic minimally invasive surgery plus urokinase treatment can significantly reduce mass effect compared with conservative treatment,but it has not significantly improved compared with conservative treatment in terms of perihematomal edema,incidence of complications and recent functional prognosis after intracerebral hemorrhage.There was no significant correlation between the perihematomal edema and the recent prognosis.