Risk Factors of Early Neurological Deterioration of Patients after Minimally Invasive Surgery in Supratentorial Hypertensive Intracerebral Hemorrhage
Objective To analyze the risk factors of early neurological deterioration(END)after minimally invasive surgery of patients with supratentorial hypertensive intracerebral hemorrhage(ICH).Methods This study was a retrospective case study.Supratentorial hypertensive ICH patients who had undergone minimally invasive surgery in the Emergency Neurology Department,Beijing Tiantan Hospital,Capital Medical University from October 2018 to December 2022 were continuously included.Patients'demographic characteristics and clinical information,as well as imaging information like hematoma volume,location,and peri-hematoma perfusion,were recorded.The evaluation criteria of END was that the NIHSS score increased by≥4 points or the GCS score decreased by≥2 points within 24 hours after surgery.The variables with statistically significant differences selected by univariate analysis were incorporated into the binary logistic regression model(regression method)to analyze the independent risk factors affecting the END of patients.At the same time,the ROC curve of independent risk factors was plotted and the AUC was calculated.De Long test was used to compare the prediction ability of different independent risk factors.Results A total of 157 patients were enrolled,with an average age of(57.1±13.1)years.END occurred in 20 patients(12.7%).Multivariate logistic regression analysis showed that preoperative hematoma volume(OR1.024,95%CI1.001-1.047,P=0.043)and postoperative hematoma expansion(OR41.605,95%CI7.405-233.765,P＜0.001)and preoperative hypoperfusion volume(OR1.011,95%CI1.002-1.020,P=0.012)could independently predict the occurrence of END.The AUC,sensitivity,and specificity of ROC for preoperative hypoperfusion volume were 0.921,0.824,and 0.891.The cut-off value was 119.0 mL.De Long test indicated that the prediction efficacy of preoperative hypoperfusion volume was better than that of preoperative hematoma volume and postoperative hematoma expansion(P<0.05).Conclusions Preoperative hypoperfusion volume was independently correlated with END of patients after minimally invasive surgery in supratentorial hypertensive intracerebral hemorrhage.The greater the hypoperfusion volume,the higher the risk of END.
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