Observation on cerebral perfusion changes and efficacy after precise control of catheter drainage in the treatment of hypertensive cerebral hemorrhage
Objective To observe the efficacy of precisely controlled hematoma drainage mode in the treatment of hypertensive cerebral hemorrhage during and after catheter drainage and its impact on cerebral perfusion.Methods Patients with basal ganglia-thalamic area hemorrhage admitted to the Neurosurgery Department of Hunan Brain Hospital of Hunan Province from January 2021 to January 2023 were prospectively included,and they were randomly divided into a precision-controlled hematoma drainage group(experimental group)and a conventional hematoma drainage group(control group)using the random number table method.The preoperative clinical data,operation duration,residual hematoma volume 24 hours after operation,and hematoma re-expansion within 72 hours after operation were compared between the two groups of patients.Magnetic resonance perfusion-weighted imaging(PWI)examination was performed on the 5th day after operation in the two groups to analyzed their differences in cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)in the hematoma area and penumbra zone of the patients.At 6 months after surgery,the daily life of the two groups of patients was evaluated based on the ADL(Activities of Daily Living)scores.Results There were no statistically significant differences in age,gender,preoperative Glasgow Coma Score(GCS),hematoma side,intraparenchymal hematoma volume,or Graeb score between the two groups(all P＞0.05).The operation duration of the experimental group and the control group were 108.8±9.1 min and 92.0±5.6 min respectively,the residual hematoma volume at 24 hours after operation was 18.1±2.2 ml and 25.1±2.8 ml,the ADL scores at 6 months after operation were 72.5±22.2 and 61.5±23.9 respectively,arid the differences in the above indicators were statistically significant(all P＜0.05).The number of patients with hematoma enlargement at 72 hours after surgery was 0 and 5 in the experimental and control groups respectively(P=0.065).The PWI results on the 5th day after surgery showed that compared with the control group,the CBF and CBV values in the hematoma area and penumbra area of the experimental group were increased,the MTT and TTP values were shortened,and the differences were statistically significant(all P＜0.01).Conclusion Application of precise control of the hematoma drainage mode in the whole process of catheterization and drainage surgery for hypertensive cerebral hemorrhage may prolong the operation time,while it may facilitate the drainage of the hematoma,enhance the blood perfusion of the hematoma and its surrounding areas,and improve the patient's prognosis.
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