Maslehaty Homajoun, Petridis Athanasios K, Barth Harald, Doukas Alexandros, Mehdorn Hubertus Maximilian
Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany.
Clin Pract. 2012 May 17;2(3):e56. doi: 10.4081/cp.2012.e56. eCollection 2012 May 29.
The aim of this study was to present the data of a large cohort of patients with spontaneous supratentorial intracerebral hemorrhage (ICH), who were treated in our department and give a current overview considering special clinical characteristics, performed therapy and different predictive factors for morbidity and mortality. We reviewed the data of all patients with spontaneous ICH, who were treated in our department in a time span of 11 years through an analysis of our prospective database. Patients with spontaneous supratentorial ICH were included in the study. Patients with hemorrhage associated to vascular malformation or to cerebral ischemic stroke were excluded. The clinical performance at time of admission and discharge were scored using the Glasgow coma scale (GCS) and the Glasgow outcome scale (GOS) respectively. The patients' cohort was divided into surgically and conservatively treated groups. Statistical analysis [Analysis of Variance (ANOVA) and χ(2)-test] was done for various parameters to analyze their impact on morbidity and mortality. In total, we analyzed the data of 817 patients (364 female and 453 male). Two hundred and sixty-nine patients (32%) were treated conservatively and 556 patients (68%) underwent surgical procedures, i.e. cerebrospinal fluid drainage in 110 (19.8%), craniotomy in 338 (60.7%) and application of both methods in 108 patients (19.4%). Total mortality rate was estimated with 23.5%. GCS<8, age over 70 years, intraventricular and basal ganglia hemorrhage, coumadin medication, combination of co-morbidities, hypertensive hemorrhage and postoperative re-bleeding were statistically significant risk factors for worse outcome (GOS 1 and 2) in the operated group. Similar to the observations of the operated group, GCS<8, age over 70 years and coumadin medication were statistically significant for worse outcome in the conservative group. In contrast, lobar plus basal ganglia ICH and multi-lobar hemorrhages were the most significant factors for worse outcome in the conservative group. The results of our study show that ICH remains a multifarious disease and challenges neurosurgeons repeatedly. Selection of the treatment modality and prediction for neurofunc-tional outcome underlies various parameters. Treatment recommendations of ICH remain an unsolved issue. The consideration of the GCS grade at admission is the most important predictive factor. Old age is not an absolute contraindication for surgery, but cumulative multi-morbidity, especially cerebrovascular and cardiovascular diseases and oral anticoagulant therapy should be regarded critically in view of surgical treatment.
本研究的目的是呈现一大组在我科接受治疗的自发性幕上脑出血（ICH）患者的数据，并结合特殊临床特征、所实施的治疗方法以及不同的发病和死亡预测因素给出当前的概述。我们通过分析前瞻性数据库，回顾了11年间在我科接受治疗的所有自发性ICH患者的数据。纳入研究的患者为自发性幕上ICH患者。排除与血管畸形或脑缺血性卒中相关的出血患者。分别使用格拉斯哥昏迷量表（GCS）和格拉斯哥预后量表（GOS）对入院时和出院时的临床表现进行评分。将患者队列分为手术治疗组和保守治疗组。对各种参数进行统计分析[方差分析（ANOVA）和χ²检验]，以分析它们对发病率和死亡率的影响。我们总共分析了817例患者的数据（女性364例，男性453例）。269例患者（32%）接受保守治疗，556例患者（68%）接受了手术治疗，即110例（19.8%）进行了脑脊液引流，338例（60.7%）进行了开颅手术，108例患者（19.4%）两种方法都采用了。总死亡率估计为23.5%。在手术组中，GCS<8、年龄超过70岁、脑室内和基底节出血、华法林用药、合并症、高血压性出血以及术后再出血是预后较差（GOS 1和2）的统计学显著危险因素。与手术组的观察结果相似，在保守组中，GCS<8、年龄超过70岁和华法林用药对预后较差具有统计学显著性。相比之下，脑叶加基底节ICH和多脑叶出血是保守组中预后较差的最显著因素。我们的研究结果表明，ICH仍然是一种多方面的疾病，不断给神经外科医生带来挑战。治疗方式的选择以及神经功能预后的预测基于各种参数。ICH的治疗建议仍然是一个未解决的问题。考虑入院时的GCS分级是最重要的预测因素。高龄并非手术的绝对禁忌证，但鉴于手术治疗，累积的多种合并症，尤其是脑血管和心血管疾病以及口服抗凝治疗应予以严格考虑。
