The Value Of Brain CT Blend Sign In Predicting Postoperative Rebleeding And Prognosis In Patients With Spontaneous Supratentorial Intracerebral Hemorrhage Undergoing Craniotomy

Objective:To explore the effect of brain CT blend sign on rebleeding and prognosis of patients with spontaneous supratentorial intracerebral hemorrhage after craniotomy.Methods:Part1 A total of 369 patients with spontaneous supratentorial intracerebral hemorrhage who underwent craniotomy in the Department of Neurosurgery of the second people’s Hospital of Guiyang City from January 2019 to December2022 were enrolled retrospectively.According to the characteristics of CT on admission,the patients were divided into blend sign group(n = 88)and non-blend sign group(n = 281).The baseline data of the two groups were compared.According to whether there was postoperative rebleeding or not,the patients were divided into postoperative rebleeding group(n = 33)and non-rebleeding group(n = 336).The independent correlation between CT blend sign and postoperative rebleeding was analyzed by binary Logistic regression model.Part2 A total of 259 patients with spontaneous supratentorial intracerebral hemorrhage who underwent craniotomy in the Department of Neurosurgery of the second people’s Hospital of Guiyang City from January 2019 to September2022 were enrolled retrospectively.According to the characteristics of CT on admission,the patients were divided into blend sign group(n = 64)and non-blend sign group(n = 195).The baseline data of the two groups were compared.According to the prognosis of 6 months after operation,the patients were divided into two groups: good outcome group(n = 97)and poor outcome group(n = 162).Binary Logistic regression model was used to analyze the independent correlation between CT blend sign and prognosis 6 months after operation.Results:Part1 There were significant differences in hypertension history,anticoagulant use history,baseline CT time,hematoma clearance rate,lymphocyte count and lymphocyte percentage between rebleeding group and non-rebleeding group,but there was no significant difference in blend sign.Taking postoperative rebleeding as dependent variable and the above indexes as independent variables,the related factors of postoperative rebleeding were analyzed by binary Logistic regression to determine the independent predictors of postoperative rebleeding.The results of regression analysis showed that the history of hypertension,history of anticoagulant use and hematoma clearance rate were predictive factors of postoperative rebleeding,and the greater the history of anticoagulant use,the higher the probability of postoperative rebleeding.With a history of hypertension and the greater the clearance rate of hematoma,the lower the probability of postoperative rebleeding.Part2 There were differences in systolic blood pressure,blend sign,time from onset to operation,hematoma clearance rate,hematoma ≥ 15 ml at 2 days after operation,hematoma ≥ 15 ml at 1 week after operation,red blood cell count,hemoglobin,hematocrit,alanine aminotransferase,globulin,urea and glucose at admission between good outcome group and poor outcome group.Taking the prognosis as dependent variable and the above-mentioned indexes as independent variables,binary Logistic regression analysis was used to determine the correlation between blend sign and prognosis.The results of regression analysis showed that the blend sign was not related to the prognosis6 months after operation.Systolic blood pressure,the time from onset to operation ≤ 24 hours,alanine aminotransferase,globulin and urea were independent predictors of prognosis.The higher the content of globulin and urea,the higher the probability of poor prognosis,and the higher the content of alanine aminotransferase,the time from onset to operation ≤ 24 hours,the lower the probability of poor prognosis.Conclusions:Part1(1).The blend sign was not associated with rebleeding in patients with supratentorial intracerebral hemorrhage after craniotomy.(2).The higher the clearance rate of hematoma after craniotomy,the lower the incidence of postoperative rebleeding.(3).Patients with a history of anticoagulant use,the higher the probability of postoperative rebleeding,with a history of hypertension,the lower the probability of postoperative rebleeding.Part2(1)The blend sign don’t effect the prognosis of patients with supratentorial intracerebral hemorrhage after craniotomy.Patients with positive blend sign at admission should undergo craniotomy if they are suitable for craniotomy.(2)The higher the systolic blood pressure on admission and the time from onset to operation ≤24 hours,the higher the probability of poor prognosis.(3)The higher the content of globulin and urea,the higher the probability of poor prognosis,and the higher the content of alanine aminotransferase,the lower the probability of poor prognosis.