Analysis of Related Factors of 1-year Outcome of Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage

doi:10.3969/j.issn.1673-5765.2018.07.004

Abstract

Abstract:

Objective To study 1-year clinical outcomes after minimally invasive catheter evacuation followed by urokinase for clot removal in patients with acute supratentorial spontaneous intracerebral hemorrhage (ICH) and determine the factors associated with the 1-year outcome. Methods Supratentorial spontaneous ICH patients who had undergone minimally invasive catheter evacuation followed by urokinase for clot removal during January 2014 and September 2016 were collected . Patients' demographic and clinical information, surgery information and one-year modified Rankin scale (mRS) were recorded. The main clinical outcome was poor outcome, defined as mRS score >3 at 1 year. The multi-factor logistic regression analysis was used to determine factors associated with 1-year clinical outcome after ICH. Results A total of 117 patients with supratentorial spontaneous ICH and having undergone minimally invasive surgery were enrolled in the study. The mean age was (56.5±12.5) years and the mean baseline hematoma volume was (59.0±28.5) ml. 59 (50.4%) ICH patients had 1-year poor outcome after surgery. Multi-factor Logistic regression analysis revealed that baseline hematoma volume 20-50 ml [odds ratio (OR) 0.161, 95% confidence interval (CI) 0.034-0.748, P =0.020] and age≤60 years (OR 0.169, 95%CI 0.055-0.515, P =0.002) were independent protective factors of 1-year poor outcome. Conclusion Baseline hematoma volume and age were independent predictors of 1-year outcome in acute ICH patients who had undergone minimally invasive surgery, which could allow better selection of ICH patients appropriate for minimally invasive surgery.

Key words: Intracerebral hemorrhage; Minimally invasive surgery; Outcome; Influence factor

摘要：

目的探讨幕上高血压性脑出血（intracerebral h emorrhage，ICH）微创颅内血肿抽吸引流术1年预后及其相关因素。

方法收集2014年1月-2016年8月就诊的进行微创颅内血肿抽吸引流术的幕上高血压性ICH患者。记录患者人口学特征等基本信息、临床信息、手术治疗信息及1年改良Rankin量表（modified Rankin scale， mRS）评分。主要临床结局为1年预后不良，定义为1年mRS>3分。用多因素Logistic回归分析1年预后不良的相关因素。

结果研究共纳入117例完成微创颅内血肿抽吸引流术的幕上高血压性I C H患者。平均年龄（56.5±12.5）岁，基线血肿体积（59.0±28.5）ml。59例（50.4%）ICH患者1年预后不良。多因素Logistic 回归分析显示，基线血肿体积20～50 ml[比值比（odds ratio，OR）0.161，95%置信区间（confidence interval，CI）0.034～0.748，P =0.020]、年龄≤60岁（OR 0.169，95%CI 0.055～0.515，P =0.002）是1年预后不良的保护性因素。

结论基线血肿体积和年龄是幕上高血压性ICH微创颅内血肿抽吸引流术1年预后的独立影响因素，该结论为选择微创颅内血肿抽吸引流术适宜人群提供依据。

关键词: 脑出血; 微创颅内血肿抽吸引流术; 预后; 影响因素

WANG Wen-Juan, LIU Li-Ping, YANG Zhong-Hua, YANG Bo, LI Jin-Xin, Du Yang, ZHAO Xing-Quan. Analysis of Related Factors of 1-year Outcome of Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2018, 13(07): 656-661.

王文娟, 刘丽萍, 杨中华, 杨波, 李金鑫, 杜洋, 赵性泉. 幕上高血压性脑出血微创颅内血肿抽吸引流术1年预后相关因素分析[J]. 中国卒中杂志, 2018, 13(07): 656-661.

References

[1] FEIGIN V L，LAWES C M，BENNETT D A，et

al. Worldwide stroke incidence and early case

fatality reported in 56 population-based studies：A

systematic review[J]. Lancet Neurol，2009，8（4）：

355-369.

[2] VAN ASCH C J，LUITSE M J，RINKEL G J，et

al. Incidence，case fatality，and functional outcome

of intracerebral haemorrhage over time，according

to age，sex，and ethnic origin：A systematic review

and meta-analysis[J]. Lancet Neurol，2010，9（2）：

167-176.

[3] JIANG B，WANG W Z，CHEN H，et al. Incidence

and trends of stroke and its subtypes in China：

Results from three large cities[J]. Stroke，2006，37

（1）：63-68.

[4] ZHANG L F，YANG J，HONG Z，et al. Proportion

of different subtypes of stroke in China[J]. Stroke，

2003，34（9）：2091-2096.

[5] YANG Q D，NIU Q，ZHOU Y H，et al. Incidence of

cerebral hemorrhage in the Changsha community. A

prospective study from 1986 to 2000[J]. Cerebrovasc

Dis，2004，17（4）：303-313.

[6] WANG W J，LU J J，WANG Y J，et al. Clinical

characteristics，management，and functional

outcomes in Chinese patients within the first year

after intracerebral hemorrhage：Analysis from China

national stroke registry[J]. CNS Neurosci Ther，2012，

18（9）：773-780.

[7] HEMPHILL J C，BONOVICH D C，BESMERTIS

L，et al. The ICH score：A simple，reliable grading

scale for intracerebral hemorrhage[J]. Stroke，2001，

32（4）：891-897.

[8] HACHINSKI V，DONNAN G A，GORELICK P

B，et al. Stroke：Working toward a prioritized world

agenda[J]. Stroke，2010，41（6）：1084-1099. [9] CADILHAC D A，DEWEY H M，VOS T，et al. The

health loss from ischemic stroke and intracerebral

hemorrhage：evidence from the North East

Melbourne Stroke Incidence Study（NEMESIS）[J/

OL]. Health Qual Life Outcomes，2010，8：49. https：

//doi.org/10.1186/1477-7525-8-49.

[10] CHRISTENSEN M C，MAYER S，FERRAN J M.

Quality of life after intracerebral hemorrhage：results

of the Factor Seven for Acute Hemorrhagic stroke

（FAST）trial[J]. Stroke，2009，40（5）：1677-1682.

[11] MENDELOW A D，GREGSON B A，ROWAN E

N，et al. Early surgery versus initial conservative

treatment in patients with spontaneous supratentorial

lobar intracerebral haematomas（STICH II）：a

randomised trial[J]. Lancet，2013，382（9890）：397-

408.

[12] MENDELOW A D，GREGSON B A，ROWAN E

N，et al. Early Surgery versus Initial Conservative

Treatment in Patients with Traumatic Intracerebral

Hemorrhage（STITCH[Trauma]）：The First

Randomized Trial[J]. J Neurotrauma. 2015，32（17）：

1312-1323.

[13] HANLEY D F，THOMPSON R E，MUSCHELLI

J，et al. Safety and efficacy of minimally invasive

surgery plus alteplase in intracerebral haemorrhage

evacuation（MISTIE）：a randomised，controlled，

open-label，phase 2 trial[J]. Lancet Neurol，2016，15

（12）：1228-1237.

[14] Stroke--1989. Recommendations on stroke

prevention，diagnosis，and therapy. Report

of the WHO Task Force on Stroke and other

Cerebrovascular Disorders[J]. Stroke，1989，20（10）：

1407-1431.

[15] KOTHARI R U，BROTT T，BRODERICK J P，et al.

The ABCs of measuring intracerebral hemorrhage

volumes[J]. Stroke，1996，27（8）：1304-1305.

[16] WANG Y，CUI L，JI X，et al. The China

National Stroke Registry for patients with acute

cerebrovascular events：design，rationale，and

baseline patient characteristics[J]. Int J Stroke，2011，

6（4）：355-361.

[17] THABET A M，KOTTAPALLY M，HEMPHILL J C，

3rd. Management of intracerebral hemorrhage[J/OL].

Handb Clin Neurol，2017，140：177-194. https：//doi.

org/10.1016/B978-0-444-63600-3.00011-8.

[18] SUN H，LIU H，LI D，et al. An effective treatment

for cerebral hemorrhage：minimally invasive

craniopuncture combined with urokinase infusion

therapy[J]. Neurol Res，2010，32（4）：371-377.

[19] WANG W Z，JIANG B，LIU H M，et al. Minimally

invasive craniopuncture therapy vs. conservative

treatment for spontaneous intracerebral hemorrhage：

results from a randomized clinical trial in China[J].

Int J Stroke，2009，4（1）：11-16.

[20] BRODERICK J，CONNOLLY S，FELDMANN E，

et al. Guidelines for the management of spontaneous

intracerebral hemorrhage in adults：2007 update：a

guideline from the American Heart Association/

American Stroke Association Stroke Council，High

Blood Pressure Research Council，and the Quality

of Care and Outcomes in Research Interdisciplinary

Working Group[J]. Stroke. 2007，38（6）：2001-2023.

[21] AUER L M，DEINSBERGER W，NIEDERKORN

K，et al. Endoscopic surgery versus medical

treatment for spontaneous intracerebral hematoma：

a randomized study[J]. J Neurosurg，1989，70（4）：

530-535.

[22] ZHOU X，CHEN J，LI Q，et al. Minimally invasive

surgery for spontaneous supratentorial intracerebral

hemorrhage：a meta-analysis of randomized

controlled trials[J]. Stroke，2012，43（11）：2923-2930.

[23] KIM Y Z，KIM K H. Even in patients with a small

hemorrhagic volume，stereotactic-guided evacuation

of spontaneous intracerebral hemorrhage improves

functional outcome[J]. J Korean Neurosurg Soc，

2009，46：109-115.

[24] ZHOU H，ZHANG Y，LIU L，et al. Minimally

invasive stereotactic puncture and thrombolysis

therapy improves long-term outcome after acute

intracerebral hemorrhage[J]. J Neurol，2011，258（4）：

661-669.

[25] 王德江，王硕，赵元立，等. 高血压脑出血外科治疗

近期预后多因素分析[J]. 中华医学杂志，2005，85

（44）：3118-3122.

[26] 杨波，王晶，温淼，等. 微创颅内血肿抽吸引流术早

期预后影响因素分析[J]. 中国卒中杂志，2015，10

（11）：947-952.