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Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study.

Wang GQ, Li SQ, Huang YH, Zhang WW, Ruan WW, Qin JZ, Li Y, Yin WM, Li YJ, Ren ZJ, Zhu JQ, Ding YY, Peng JQ, Li PJ - Mil Med Res (2014)

Bottom Line: The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B.Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).For patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.

ABSTRACT

Background: The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage (MIPD) could improve patient outcome compared with decompressive craniectomy (DC).

Methods: Consecutive patients with ICH (≧30 mL in basal ganglia within 24 hours of ictus) were non-randomly assigned to receive MIPD (group A) or DC (group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale.

Results: A total of 198 patients met the per protocol analysis (84 in group A and 114 in group B). The initial Glasgow Coma Scale (GCS) score was 8.1 ± 3.4 and the National Institutes of Health Stroke Scale (NIHSS) score was 20.8 ± 5.3. The mean hematoma volume (HV) was 56.7 ± 23.0 mL, and there was extended intraventricular hemorrhage (IVH) in 134 patients. There were no significant intergroup differences in the above baseline data, except group A had a higher mean age than that of group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025). The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B. However, the mortality for patients ≦60 years, NIHSS < 15 or HV≦60 mL was significantly lower in group A than that in group B (all P < 0.05). The cumulative functional independence at 1 year was 26.8%, and the difference between group A (33/84, 39.3%) and group B (20/114, 17.5%) was significant (P = 0.001). Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).

Conclusions: For patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.

No MeSH data available.


Related in: MedlinePlus

Trial profile. A total of 553 consecutive patients with ICH were admitted. Of these patients, 492 were admitted to the General Hospital of Beijing Military Region and 61 were admitted to the Xianghe Hospital. Based on the inclusion/exclusion criteria, 355 were excluded, and 198 were available according to the per protocol sample. Of those, 84 received minimally invasive puncture and drainage (group A), and 114 underwent decompressive craniectomy (group B) hematoma evacuations. Nine were lost during follow up at 30 days (1 and 4) and 1 year (1 and 3 in group A and group B, respectively). For those patients, their last observed data were used as their final results for intention-to-treat analysis.
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Fig2: Trial profile. A total of 553 consecutive patients with ICH were admitted. Of these patients, 492 were admitted to the General Hospital of Beijing Military Region and 61 were admitted to the Xianghe Hospital. Based on the inclusion/exclusion criteria, 355 were excluded, and 198 were available according to the per protocol sample. Of those, 84 received minimally invasive puncture and drainage (group A), and 114 underwent decompressive craniectomy (group B) hematoma evacuations. Nine were lost during follow up at 30 days (1 and 4) and 1 year (1 and 3 in group A and group B, respectively). For those patients, their last observed data were used as their final results for intention-to-treat analysis.

Mentions: Baseline data are shown in Table 1 and Figure 2. A total of 553 consecutive patients with spontaneous ICH in the basal ganglia were admitted. Of these patients, 355 were excluded (most for having HV < 30 mL, refusing the operation, or having additional complications). Therefore, 198 patients were available for this study, including 9 cases that were lost during follow up. There were 84 cases in group A and 114 cases in group B, of which 2 and 7 were lost in each group, respectively, during follow up. The mean age was 57.1 ± 12.8 years (ranged 31–95), and the age of group A was older than group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025). The mean HV was 56.7 ± 23.0 mL (ranged 10–144 mL). Patients with IVH accounted for 67.7% of the total patient population used. Except for age, there were no other significant differences between the two groups in their baseline data, including gender, blood pressure, initial GCS, NIHSS and the time from ictus to operation.Table 1


Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study.

Wang GQ, Li SQ, Huang YH, Zhang WW, Ruan WW, Qin JZ, Li Y, Yin WM, Li YJ, Ren ZJ, Zhu JQ, Ding YY, Peng JQ, Li PJ - Mil Med Res (2014)

Trial profile. A total of 553 consecutive patients with ICH were admitted. Of these patients, 492 were admitted to the General Hospital of Beijing Military Region and 61 were admitted to the Xianghe Hospital. Based on the inclusion/exclusion criteria, 355 were excluded, and 198 were available according to the per protocol sample. Of those, 84 received minimally invasive puncture and drainage (group A), and 114 underwent decompressive craniectomy (group B) hematoma evacuations. Nine were lost during follow up at 30 days (1 and 4) and 1 year (1 and 3 in group A and group B, respectively). For those patients, their last observed data were used as their final results for intention-to-treat analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4340857&req=5

Fig2: Trial profile. A total of 553 consecutive patients with ICH were admitted. Of these patients, 492 were admitted to the General Hospital of Beijing Military Region and 61 were admitted to the Xianghe Hospital. Based on the inclusion/exclusion criteria, 355 were excluded, and 198 were available according to the per protocol sample. Of those, 84 received minimally invasive puncture and drainage (group A), and 114 underwent decompressive craniectomy (group B) hematoma evacuations. Nine were lost during follow up at 30 days (1 and 4) and 1 year (1 and 3 in group A and group B, respectively). For those patients, their last observed data were used as their final results for intention-to-treat analysis.
Mentions: Baseline data are shown in Table 1 and Figure 2. A total of 553 consecutive patients with spontaneous ICH in the basal ganglia were admitted. Of these patients, 355 were excluded (most for having HV < 30 mL, refusing the operation, or having additional complications). Therefore, 198 patients were available for this study, including 9 cases that were lost during follow up. There were 84 cases in group A and 114 cases in group B, of which 2 and 7 were lost in each group, respectively, during follow up. The mean age was 57.1 ± 12.8 years (ranged 31–95), and the age of group A was older than group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025). The mean HV was 56.7 ± 23.0 mL (ranged 10–144 mL). Patients with IVH accounted for 67.7% of the total patient population used. Except for age, there were no other significant differences between the two groups in their baseline data, including gender, blood pressure, initial GCS, NIHSS and the time from ictus to operation.Table 1

Bottom Line: The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B.Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).For patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, General Hospital of Beijing Command, Beijing, 100700 China.

ABSTRACT

Background: The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage (MIPD) could improve patient outcome compared with decompressive craniectomy (DC).

Methods: Consecutive patients with ICH (≧30 mL in basal ganglia within 24 hours of ictus) were non-randomly assigned to receive MIPD (group A) or DC (group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale.

Results: A total of 198 patients met the per protocol analysis (84 in group A and 114 in group B). The initial Glasgow Coma Scale (GCS) score was 8.1 ± 3.4 and the National Institutes of Health Stroke Scale (NIHSS) score was 20.8 ± 5.3. The mean hematoma volume (HV) was 56.7 ± 23.0 mL, and there was extended intraventricular hemorrhage (IVH) in 134 patients. There were no significant intergroup differences in the above baseline data, except group A had a higher mean age than that of group B (59.4 ± 14.5 vs. 55.3 ± 11.1 years, P = 0.025). The cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B. However, the mortality for patients ≦60 years, NIHSS < 15 or HV≦60 mL was significantly lower in group A than that in group B (all P < 0.05). The cumulative functional independence at 1 year was 26.8%, and the difference between group A (33/84, 39.3%) and group B (20/114, 17.5%) was significant (P = 0.001). Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies, age, GCS, HV, IVH and pulmonary infection (all P <0.05).

Conclusions: For patients with hypertensive spontaneous ICH (HV≧30 mL in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≦60 years of age, NIHSS < 15 or HV≦60 mL.

No MeSH data available.


Related in: MedlinePlus