Comparison of therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage in basal ganglia region in elderly patients and their prognostic factors analysis

Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis. Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage, group B(n=23)was given small bone window for removal of hematoma, group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B, respectively.The changes of intracranial pressure before and after operation, prognosis and post-operative complications were compared. Results The intracranial pressure was significantly decreased at 3rd day, 7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76, P<0.05), and the score of GCS was also higher in group C and D at 7th day after operation than in group A, B at the same time points(F=4.72, P<0.05). At 14th and 28th day after operation, the score of GCS was higher in group C than in group A and B(F=19.24, P<0.05), and higher in group C than in group D at 28th day after operation(F=22.26, P<0.05). The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87, P<0.05). The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04, P<0.05). The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99, all P<0.05). Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH, and its combination with ICP can early change intracranial pressure and further improves the prognosis. Key words: Hypertensive intracerebral hemorrhage; Basal ganglia region; Intracranial pressure monitoring; Minimally invasive hematoma drainage; Small bone window for removal of hematoma; Prognosis