Stereotactic Minimally Invasive Surgery In ICH Evacuation Reduces Mortality And Improves Prognosis In Patients With Lobar Hemorrhage

Objective:Retrospectively analyse the clinical data of patients with simple lobar hemorrhage,and compare the effects of two different treatment modalities of drug conservative therapy and stereotactic minimal invasive therapy on the prognosis of simple lobar hemorrhage.Methods:289 samples according to inclusion criteria and exclusion criteria were collected from patients with simple lobar hemorrhage admitted to the emergency neurology department of the Affiliated Hospital of Guizhou Medical University on January 1,2014 and July 31,2020.According to the prognosis,the 289 patients were divided into the favourable prognosis group(n = 171)and the unfavourable prognosis group(n = 118).By univariate analyzing the general clinical data of the two groups and using Proportional Hazards Model(COX Model)to analyze the different indicators,the independent predictor was concluded.When analyzing the receiver operating characteristic curve(ROC curve)of hematoma volume,which affects the prognosis of patients,the best truncation value of hematoma volume was 33.66 ml.Then samples with hematoma volume ranging from 33 ml to 90 ml were selected and divided into the conservative treatment group(39 cases)and the minimally invasive treatment group(82 cases),which there was no difference in baseline data between these two groups.Based on prognosis at 6 months follow-up,including the mortality at 6 months and the Extended Glasgow Outcome Scale Score(GOSE),a comparative analysis was conducted between the groups to compare the effects of the two treatments on the prognosis of simple lobar hemorrhage.Results:1)Dividing the admitted patients into the favourable prognosis group and the unfavourable prognosis group,analyzing the single factor of the various indicators between these two groups,and analyzing the different indicators by COX Model,the results showed that in COX regression analysis,the age of patients,the hematoma volume when admitted and whether breaking into the ventricle,P < 0.05,which was statistical significant,were the independent predictors to assess the prognosis of patients.ROC curve analysis based on prognosis was performed for the independent predictor of hematoma volume,indicating that hematoma volume below 33.66 ml was associated with better prognosis,while hematoma volume above 33.66 ml was associated with poorer prognosis.2)Samples with hematoma volume between 33 ml and 90 ml were selected for the study,and a comparative analysis was made between the conservative group and the minimally invasive surgery group.There was no significant difference in the mortality rate and the incidence of complications between the two groups at discharge,and the mortality rate at 6 months in the minimally invasive surgery group was significantly lower than that in the conservative group(P=0.04).According to the prognosis evaluation after 6 months,the prognostic analysis on account of the GOSE score was based on the score of the Glasgow Coma Scale(GCS)when admitted.The chi-square test was performed between the two groups,P=0.046,P<0.05,suggesting that the improvement of prognosis in the minimally invasive surgery group was better than that in the conservative treatment group.In the analysis of secondary outcomes and subgroups,the results came out that there was no significant difference in the efficacy of the two treatments for lobar hemorrhage,P >0.05 at different sites;when the hematoma volume was greater than33.66 ml and the GCS score was between 9 and 12 points,a comparison was made between the two groups(P=0.019,P<0.05),and the difference was statistically significant.Minimally invasive treatment was superior to conservative treatment in improving the prognosisConclusions:1.The age of patients,hematoma volume at admission and whether the hematoma was ruptured into the ventricle were independent predictors of the prognosis of patients with lobar hemorrhage;2.Minimally invasive treatment can reduce long-term mortality and improve neurological function when the amount of hematoma in lobar hemorrhage is above33.66 ml.3.According to the subgroup analysis,when the hematoma volume of patients with lobar hemorrhage is greater than 33.66 ml,and the GCS scores among 9 to 12 points,and minimally invasive treatment was superior to conservative treatment in improving prognosis.