The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude

作     者：Lin-Jie Wei Chi Lin Xing-Sen Xue Guo-Dong Dun Jian-Bo Zhang Yan-Xiang Tong Jia-Xiong Wang Shi-Ji Yang Ling Wang Zhi Chen Hua Feng Gang Zhu Lin-Jie Wei;Chi Lin;Xing-Sen Xue;Guo-Dong Dun;Jian-Bo Zhang;Yan-Xiang Tong;Jia-Xiong Wang;Shi-Ji Yang;Ling Wang;Zhi Chen;Hua Feng;Gang Zhu

作者机构：Department of NeurosurgerySouthwest HospitalThird Military Medical University(Army Medical University)Chongqing400038China Department of NeurosurgeryPLA 956th HospitalLinzhiTibetChina Department of NeurosurgeryFirst People's Hospital of Honghe CityHonghe Yunnan ProvinceChina Department of Clinical LaboratoryPLA 956th HospitalLinzhiTibetChina 

出 版 物：《Chinese Journal of Traumatology》 (中华创伤杂志（英文版）)

年 卷 期：2021年第24卷第6期

页      面：328-332页

核心收录：

学科分类：0403[教育学-体育学] 1002[医学-临床医学] 10[医学] 

基　　金：supported by Grant No.SWH2017JSZD07 from The First Affiliated Hospital of Army Medical University's"Science and Technology Innovation Program" Grant No.81571116 from the National Natural Science Foundation of China. 

主　　题：Intracranial hemorrhage Hypertensive High altitude Cerebral hernia Hematoma puncture drainage Decompressive craniectomy 

摘      要：Purpose:Rapid decompressive craniectomy(DC)was the most effective method for the treatment of hypertensive intracerebral hemorrhage(HICH)with cerebral hernia,but the mortality and disability rate is still high.We suspected that hematoma puncture drainage(PD)+DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.Methods:From December 2013 to July 2019,patients with HICH from Linzhi,Tibet and Honghe,Yunnan Province were retrospectively analyzed.The selection criteria were as follows:(1)altitude≥1500 m;(2)HICH patients with cerebral hernia;(3)Glascow coma scale score of 4-8 and time from onset to admission≤3 h;(4)good liver and kidney function;and(5)complete case data.The included patients were divided into DC group and PD+DC group.The patients were followed up for 6 months.The outcome was assessed by Glasgow outcome scale(GOS)score,Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis.A good outcome was defined as independent(GOS score,4-5)and poor outcome defined as dependent(GOS score,3-1).All data analyses were performed using SPSS 19,and comparison between two groups was conducted using separatet-tests or Chi-square tests.Results:A total of 65 patients was included.The age ranged 34-90 years(mean,63.00±14.04 years).Among them,31 patients had the operation of PD+DC,whereas 34 patients underwent DC.The two groups had no significant difference in the basic characteristics.After 6 months of follow-up,in the PD+DC group there were 8 death,4 vegetative state,4 severe disability(GOS score 1-3,poor outcome 51.6%);8 moderate disability,and 7 good recovery(GOS score 4-5,good outcome 48.4%);while in the DC group the result was 15 death,6 vegetative state,5 severe disability(poor outcome 76.5%),4 moderate disability and 4 good recovery(good outcome 23.5%).The GOS score and good outcome were significantly less in DC group than in PD+DC group(Z=-1.993,p=0.046;χ2=4.38,p=0.043).However,there was no significant difference regarding the survival curve between PD+DC group and DC group.The correlation between the time from admission to operation and GOS at 6 months(r=-0.41,R2=0.002,p=0.829)was not significant in the PD+DC group,but significant in the DC group(r=-0.357,R2=0.128,p=0.038).Conclusion:PD+DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.