BACKGROUND： At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemorrhage to treat spontaneous intracerebral hemorrhage （ICH）. Surgical treatment can decrease fatality rate of ICH p...BACKGROUND： At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemorrhage to treat spontaneous intracerebral hemorrhage （ICH）. Surgical treatment can decrease fatality rate of ICH patients; however, some reports suggest that there are no obvious differences of therapeutic effects between surgical treatment and medical therapy because of various states, operative indications, contraindications and operative styles. OBJECTIVE： To observe the effect of surgical treatment on ICH prognosis, especially on fatality rate.DESIGN ： Retrospective-case study.SETTING： Huaibei People＇s Hospital.PARTICIPANTS： ① A total of 241 ICH patients selected from Huaibei People＇s Hospital from January 1988 to May 1989 were regarded as group A. They were all coincidence with Diagnostic Criteria of Intracerebral Hemorrhage in the National Cerebrovascular Disease Academic Meeting. There were 164 males and 87 females aged 34-94 years, and among them, 230 patients were older than 50 years （95.4%）. Hemorrhage sites： Among 142 patients, 85 cases had internal capsule hemorrhage, 18 external capsule hemorrhage, 15 thalamic hemorrhage, 9 cerebellar hemorrhage, 7 brain stem hemorrhage, 7 cerebral lobe hemorrhage, and 1 corpus callosum hemorrhage. Hemorrhage volume： Among 89 clear records, 44 cases had of 1-10 mL, 35 of 11-30 mL, 5 of 31-40 mL, and 5 of 41-80 mL. Except 2 patients, other ones were treated with medical operation. ② A total of 203 ICH patients selected from the same hospital from January 2003 to December 2005 were regarded as group B. Among them, 72 cases were treated with operation, but other 131 ones were treated with non-operation. They were all diagnosed with CT. There were 113 males and 90 females aged 30-88 years, and among them, 183 patients were older than 50 years （90.1%）, Hemorrhage sites： Among 203 patients, 104 cases had internal capsule hemorrhage, 17 external capsule hemorrhage, 19 thalamic hemorrhage, 9 cerebellar hemorrhage, 12 brain stem hemorrhage, 30 cerebral lobe hemorrhage, and 12 ventricular hemorrhage. Hemorrhage volume： Among 142 clear records, 53 cases had of 1- 10 mL, 42 of 11-30 mL, 16 of 31-40 mL, and 31 of 41-200 mL. Patients in both two groups consented, METHODS ： ① Therapeutic scheme： Both therapeutic methods and medicines in the both two groups were similar to each other. The main methods were as follows： dehydrating, controlling blood pressure, modifying agent of cerebral metabolism and preventing and curing complications. Therapeutic operation styles of group B： 23 patients accepted intracerebral hematoma clearance; 1 decompression by removal of cranio-bone flap; 14 centesis of lateral ventricle; 34 basilyst suction, Therapeutic styles of group A： 2 patients accepted intracerebral hematoma clearance, and others from the same as group B.② Effect estimate criteria： General recovery： Muscular force was above grade Ⅳ; meanwhile, patients could walk by themselves and care themselves partially; Improvement： Consciousness, hemiplegia and Iogagnosia took a turn for the better; Death.③ Statistical analysis： Four-table Chi-square test was used to compare differences of enumeration data. MAIN OUTCOME MEASURES： ① General prognosis of patients in the two groups; ② Prognosis of patients with various hemorrhage sites and volumes. RESULTS： All 444 patients were involved in the final analysis. ① Compared results of prognosis of patients in the two groups： Fatality rate was 18% （3/17） in group B, which was lower than that in group A [67% （12/18）, X^2=8.58, P 〈 0.05]; general recovery rate was 82% （14/17） in group B, which was higher than that in group A [11% （2/18）, X^2=17.88, P 〈 0.01]. ② Compared results of prognosis of patients with various hemorrhage sites in the two groups： Fatality rate of external capsule hemorrhage was decreased in group B as compared with that in group A （P 〈 0.05）; however, there was no significant difference at other hemorrhage sites. ③ Compared results of prognosis of patients with various hemorrhage volumes in the two groups： Fatality rate of patients with hemorrhage volume of 1-10 mL was 9% （5/53） in group B, which was lower than that in group A [64% （28/44）, X^2=7.20, P 〈 0.01]; general recovery rate was 85% （45/53） in group B, which was higher than that in group A [29% （13/44）, X^2=31,47, P 〈 0.01]. Fatality rate of patients with hemorrhage volume of 11-30 mL was 36% （15/42） in group B, which was lower than that in group A [71% （25/35）, X^2=30.64, P 〈 0.01]; general recovery rate was 50% （21/42） in group B, which was higher than that in group A [11% （4/35）, X^2=12,94, P 〈 0,01]. Fatality rate of patients with hemorrhage volume of 31-40 mL was 6% （1/16） in group B, which was lower than that in group A [60% （3/5）, X^2=9,76, P〈 0.05].CONELUSEON： Fatality rate of ICH patients who accepted more operative therapies is decreased as compared with those patients who have less operative therapies, and the prognosis is effective.展开更多
文摘BACKGROUND： At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemorrhage to treat spontaneous intracerebral hemorrhage （ICH）. Surgical treatment can decrease fatality rate of ICH patients; however, some reports suggest that there are no obvious differences of therapeutic effects between surgical treatment and medical therapy because of various states, operative indications, contraindications and operative styles. OBJECTIVE： To observe the effect of surgical treatment on ICH prognosis, especially on fatality rate.DESIGN ： Retrospective-case study.SETTING： Huaibei People＇s Hospital.PARTICIPANTS： ① A total of 241 ICH patients selected from Huaibei People＇s Hospital from January 1988 to May 1989 were regarded as group A. They were all coincidence with Diagnostic Criteria of Intracerebral Hemorrhage in the National Cerebrovascular Disease Academic Meeting. There were 164 males and 87 females aged 34-94 years, and among them, 230 patients were older than 50 years （95.4%）. Hemorrhage sites： Among 142 patients, 85 cases had internal capsule hemorrhage, 18 external capsule hemorrhage, 15 thalamic hemorrhage, 9 cerebellar hemorrhage, 7 brain stem hemorrhage, 7 cerebral lobe hemorrhage, and 1 corpus callosum hemorrhage. Hemorrhage volume： Among 89 clear records, 44 cases had of 1-10 mL, 35 of 11-30 mL, 5 of 31-40 mL, and 5 of 41-80 mL. Except 2 patients, other ones were treated with medical operation. ② A total of 203 ICH patients selected from the same hospital from January 2003 to December 2005 were regarded as group B. Among them, 72 cases were treated with operation, but other 131 ones were treated with non-operation. They were all diagnosed with CT. There were 113 males and 90 females aged 30-88 years, and among them, 183 patients were older than 50 years （90.1%）, Hemorrhage sites： Among 203 patients, 104 cases had internal capsule hemorrhage, 17 external capsule hemorrhage, 19 thalamic hemorrhage, 9 cerebellar hemorrhage, 12 brain stem hemorrhage, 30 cerebral lobe hemorrhage, and 12 ventricular hemorrhage. Hemorrhage volume： Among 142 clear records, 53 cases had of 1- 10 mL, 42 of 11-30 mL, 16 of 31-40 mL, and 31 of 41-200 mL. Patients in both two groups consented, METHODS ： ① Therapeutic scheme： Both therapeutic methods and medicines in the both two groups were similar to each other. The main methods were as follows： dehydrating, controlling blood pressure, modifying agent of cerebral metabolism and preventing and curing complications. Therapeutic operation styles of group B： 23 patients accepted intracerebral hematoma clearance; 1 decompression by removal of cranio-bone flap; 14 centesis of lateral ventricle; 34 basilyst suction, Therapeutic styles of group A： 2 patients accepted intracerebral hematoma clearance, and others from the same as group B.② Effect estimate criteria： General recovery： Muscular force was above grade Ⅳ; meanwhile, patients could walk by themselves and care themselves partially; Improvement： Consciousness, hemiplegia and Iogagnosia took a turn for the better; Death.③ Statistical analysis： Four-table Chi-square test was used to compare differences of enumeration data. MAIN OUTCOME MEASURES： ① General prognosis of patients in the two groups; ② Prognosis of patients with various hemorrhage sites and volumes. RESULTS： All 444 patients were involved in the final analysis. ① Compared results of prognosis of patients in the two groups： Fatality rate was 18% （3/17） in group B, which was lower than that in group A [67% （12/18）, X^2=8.58, P 〈 0.05]; general recovery rate was 82% （14/17） in group B, which was higher than that in group A [11% （2/18）, X^2=17.88, P 〈 0.01]. ② Compared results of prognosis of patients with various hemorrhage sites in the two groups： Fatality rate of external capsule hemorrhage was decreased in group B as compared with that in group A （P 〈 0.05）; however, there was no significant difference at other hemorrhage sites. ③ Compared results of prognosis of patients with various hemorrhage volumes in the two groups： Fatality rate of patients with hemorrhage volume of 1-10 mL was 9% （5/53） in group B, which was lower than that in group A [64% （28/44）, X^2=7.20, P 〈 0.01]; general recovery rate was 85% （45/53） in group B, which was higher than that in group A [29% （13/44）, X^2=31,47, P 〈 0.01]. Fatality rate of patients with hemorrhage volume of 11-30 mL was 36% （15/42） in group B, which was lower than that in group A [71% （25/35）, X^2=30.64, P 〈 0.01]; general recovery rate was 50% （21/42） in group B, which was higher than that in group A [11% （4/35）, X^2=12,94, P 〈 0,01]. Fatality rate of patients with hemorrhage volume of 31-40 mL was 6% （1/16） in group B, which was lower than that in group A [60% （3/5）, X^2=9,76, P〈 0.05].CONELUSEON： Fatality rate of ICH patients who accepted more operative therapies is decreased as compared with those patients who have less operative therapies, and the prognosis is effective.
