| Background:Spontaneous Intracerebral Hemorrhage(sICH)is a sever cerebrovascular diseases with the highest mortality and disability,and lack of effective treatments.About 40% of ICH will be combined with Intraventricular Hemorrhage(IVH),which accounts for about 15% of the stroke,and it is an independent risk factor for poor prognosis of ICH.The worse prognosis of patients with ICH breaking into the ventricle was found in the clinical work of our department,we need to review the preliminary work,and current studies are still controversial about the factors influencing the worsening prognosis of ICH with ventricular rupture.Objective:To compare and analyze the influence of sICH on the prognosis of patients with or without ventricular rupture,and to explore the risk factors of sICH patients with ventricular hemorrhage.Methods: A retrospective analysis of 1342 patients with sICH from 2010 to 2016 in our hospital.All patients met the inclusion exclusion criteria,with those demographic information,prevalence,past history,imaging data,laboratory examination,hospitalization and disease assessment,and follow-up data were collected.The patients were divided into two groups according to whether they had broken into ventricles or not,and the prognostic differences between the two groups were compared and analyzed.Results:1.Of the 1342 patients,455(33.9%)patients with ventricular rupture and 887(66.1%)patients without.2.Statistically significant difference was found in group with ventricular rupture whose average length of stay(25.1±26.7 days),mRS score at discharge [4(3,5)points],poor outcome(80.2%),mortality(14.1%),and group without ventricular rupture whose average length of stay(20.9±21.8 days),mRS score at discharge [3(2,4)points],poor outcome(61.7%),mortality(2.5%)(P <0.05).3.821 patients follow-up were completed,of which there are 273 patients with ventricular rupture and 548 patients without.Statistically significant difference was found in group with ventricular rupture whose mRS score [3(2,6)points],poor outcome(61.5%),mortality(29.7%),and group without ventricular rupture whose mRS score [2(1,4)points],poor outcome(40.0%),mortality(19.3%)(P < 0.05).4.When lobar hemorrhage or hematoma volume ≥30 ml,the prognosis of sICH with ventricular rupture or not was not significantly different(P > 0.05).5.Univariate Logistic regression analysis showed that broken into ventricles(OR=2.521,P=0.000)was an independent risk factor for poor prognosis of patients with sICH.Multivariate logistic regression analysis of the group without ventricular rupture and the group with ventricular rupture showed that,the course of disease>24 hours(OR=0.566,P=0.001 vs OR=0.547,P=0.032)were protective factors in both groups;admission GCS<8 scores(OR=5.146,P=0.004 vs OR=11.013,P=0.000),irregular hematoma shape(OR=2.053,P=0.000 vs OR=3.648,P=0.000),pulmonary infection(OR=2.356,P=0.000 vs OR=1.994,P=0.012)were both risk factors.6.Of the infratentorial intracerebral hemorrhage patients,51(3.8%)patients with cerebellar hemorrhage and 14(1.0%)patients with brainstem hemorrhage.The average hematoma volume has 12.33(6.82,19.64)ml of cerebellar hemorrhage and 6.75(3.82,16.59)ml of brainstem hemorrhage.Compare cerebellar hemorrhage with brainstem hemorrhage,there was no significant difference in ventricular rupture(54.9% vs 35.7%),the fourth ventricle cast(58.8% vs 35.7%),hydrocephalus(43.1% vs 21.4%),intracranial infection(7.8% vs 0),pulmonary infection(56.9% vs 78.6%),gastrointestinal bleeding(3.9% vs 21.4%),poor outcome(51.0% vs 50.0%),and mortality(9.8% vs 28.6%)(P > 0.05).7.Of the 455 patients with ventricular rupture after sICH,184(40.4%)patients with a cast fourth ventricle and 271(59.6%)patients without.Compare the two groups of patients with a cast fourth and patients without,there is significant difference in hydrocephalus(24.5% vs 6.6%),external ventricular drainage(67.9% vs 16.6%),intracranial infection(10.3% vs 3.7%),pulmonary infection(83.7% vs 62.0%),poor outcome(59.2% vs 46.5%)and mortality(45.1% vs 24.0%)(P < 0.05).8.The age,sex,hematoma volume,location,shape,density and admission GCS score of patients were analyzed by forest map subgroup,statistical difference was found only in subgroup of hematoma location(P <0.05).Conclusion:1.Ventricular rupture is an independent risk factor of the prognosis of patients with sICH.2.The prognosis of patients with ventricular rupture is generally worse than that without ventricular rupture in spontaneous ganglionic intracerebral hemorrhage and inferatentorial intracerebral hemorrhage,while the prognosis difference is not statistically significant in lobar hemorrhage.3.Patients with a cast fourth ventricle after sICH have higher incidences of hydrocephalus,intracranial infection,pulmonary infection,and a worse poor prognosis. |
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