Comparison of minimally invasive and bone flap removal for hypertensive intracerebral hemorrhage and analysis of prognostic factors

Yang Xueming; Zhang Zhiwei; Cai Zhiqiang; Li Xiang; Zhang Heng; Tang Hui

doi:10.11986/j.issn.1673-873X.2024.12.05

Abstract：Objective To compare the clinical effects of minimally invasive and bone flap removal in the treatment of hyper-tensive intracerebral hemorrhage,and to analyze the prognostic factors.Methods The clinical and follow-up data of 204 ca-ses with hypertensive intracerebral hemorrhage admitted to our hospital from February 2018 to December 2023 were retro-spectively analyzed,and they were divided into study group(n=102)and control group(n=102)according to the treatment plan in the data.The control group was treated with the removal of hematoma with bone flap,and the study group was trea-ted with minimally invasive hematoma.The operation time,intraoperative blood loss,hematoma clearance rate,postopera-tive cerebral edema volume,and postoperative short-term curative effect of the two groups were observed and recorded.The related factors affecting the prognosis of hypertensive cerebral hemorrhage after hematoma clearance were analyzed by multi-variate logistic regression.Results The operation time in the control group was longer than that in the study group,the vol-ume of blood loss during operation,the volume of brain edema after operation were larger than those in study group,and the volume of brain edema after operation,the clearance rate of hematoma was lower than that of control group,the difference was significant(P<0.05).The total effective rate of control group was 77.45%,which was significantly lower than that of study group(95.10%),the difference was significant(χ2=13.412,P<0.05);The good prognosis rate of the control group was 25.49%,which was significantly lower than that of the study group(84.31%),the difference was significant(χ2=71.273,P<0.001).Preoperative GCS score(OR=3.507,95%CI:1.528-6.117),hematoma clearance rate(OR=1.109,95%CI:1.026-1.119),amount of blood loss on admission(OR=1.440,95%CI:1.105-1.878),hypertensive his-tory(OR=1.245,95%CI:1.016-1.527),and hemorrhage into the ventricle(OR=1.478,95%CI:1.098-1.989)were all risk factors for the prognosis of patients(P<0.05).Conclusion Minimally invasive hematoma removal has better clini-cal effect on hypertensive intracerebral hemorrhage,which can effectively reduce operation time,intraoperative blood loss and increase hematoma clearance rate.In addition,preoperative GCS score,hematoma clearance rate,amount of blood loss at admission,and bleeding into the ventricle are all risk factors affecting the prognosis of patients.