Analysis of clinical diagnosis and treatment of hypertensive intracerebral hemorrhage in a group of young and middle⁃aged adults

Abstract

Objective The disease burden of hypertensive cerebral hemorrhage was heavy, and the age of hypertensive cerebral hemorrhage patients was trending younger in China. This paper retrospectively analyzed the clinical data of a group of young and middle⁃aged adults with hypertensive cerebral hemorrhage, and made a detailed analysis of its clinical characteristics, so as to provide reference for the development of treatment programs. Methods A total of 120 young and middle⁃aged adults with hypertensive cerebral hemorrhage admitted in Tianjin Huanhu Hospital from January 1, 2020 to December 31, 2021 were included. According to severity of the disease, 120 patients were divided into non⁃surgery group (n=22), borehole drainage group (n=47) and endoscopic surgery group (n=51). The postoperative hematoma clearance rate, drainage tube indwelling time, length of hospital stay, Glasgow Coma Scale (GCS) score at discharge, and incidence of postoperative complications were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis at 3 and 6 months after discharge. Results The length of hospital stay (H=3.445, P=0.000), GCS score at discharge (H=15.767, P=0.000), the incidence of postoperative bronchoppneumonitis (χ²=19.336, P=0.000) and hypoproteinemia (χ²=17.650, P=0.000), mRS scores at 3 months (H=9.651, P=0.008) and 6 months (H=8.962, P=0.011) after discharge in different groups were significant differences. Compared with the non⁃surgery group, the length of hospital stay was shorter in the endoscopic surgery group and the borehole drainage group (Z=3.816, P=0.000; Z=3.254, P=0.000), and GCS score at discharge decreased (Z=3.795, P=0.000; Z=3.104, P=0.002), postoperative bronchopneumonia (χ²=17.223, P=0.000; χ²=10.251, P=0.001) and hypoproteinemia (χ²=13.310, P=0.000) increased, and mRS score at 3 months after discharge increased (Z=2.783, P=0.009; Z=2.270, P=0.035), but the mRS score at 6 months after discharge was close to that of the non⁃surgery group (P＞0.05, for all). Compared with the two surgical methods, the hematoma clearance rate of the endoscopic surgery group was higher than that of the borehole drainage group (Z=⁃6.424, P=0.000), and the induration time of the drainage tube was shorter than that of the borehole drainage group (Z=⁃3.856, P=0.000). There were no significant differences in the length of hospital stay, GCS score at discharge, postoperative intracranial rebleeding, seizures, intracranial infection, upper gastrointestinal stress ulcer with bleeding, water and electrolyte metabolism disorders, hypoproteinemia, lower extremity deep vein thrombosis and other complications, and mRS score at 3 and 6 months after discharge (P＞0.05, for all). Conclusions Poorly controlled hypertension and bad living habits are common in young and middle⁃aged adults with intracerebral hemorrhage. Minimally invasive surgery (drilling and drainage of hematoma and endoscopic hematoma removal) is safe and reliable.

doi：10.3969/j.issn.1672⁃6731.2022.10.005