The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation

Abstract To comparatively study the size of and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient’s influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with...

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Autores principales:	Guoqing Sun, Tingkai Fu, Zhaoyan Liu, Yuhai Zhang, Xiangtao Chen, Shigang Jin, Feng Chi
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/dcba4a9d43a4415cbc2976d6fc4408c2
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spelling	oai:doaj.org-article:dcba4a9d43a4415cbc2976d6fc4408c22021-12-02T11:35:58ZThe rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation10.1038/s41598-021-84108-w2045-2322https://doaj.org/article/dcba4a9d43a4415cbc2976d6fc4408c22021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-84108-whttps://doaj.org/toc/2045-2322Abstract To comparatively study the size of and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient’s influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the ‘brain-haematoma’ pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the ‘brain-haematoma’ pressure gradient was large, averaging 251.1 ± 20.6 mmH2O, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the ‘brain-haematoma’ pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function. Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20–08,091.Guoqing SunTingkai FuZhaoyan LiuYuhai ZhangXiangtao ChenShigang JinFeng ChiNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Guoqing Sun Tingkai Fu Zhaoyan Liu Yuhai Zhang Xiangtao Chen Shigang Jin Feng Chi The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
description	Abstract To comparatively study the size of and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient’s influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the ‘brain-haematoma’ pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the ‘brain-haematoma’ pressure gradient was large, averaging 251.1 ± 20.6 mmH2O, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the ‘brain-haematoma’ pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the ‘brain-haematoma’ pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function. Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20–08,091.
format	article
author	Guoqing Sun Tingkai Fu Zhaoyan Liu Yuhai Zhang Xiangtao Chen Shigang Jin Feng Chi
author_facet	Guoqing Sun Tingkai Fu Zhaoyan Liu Yuhai Zhang Xiangtao Chen Shigang Jin Feng Chi
author_sort	Guoqing Sun
title	The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
title_short	The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
title_full	The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
title_fullStr	The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
title_full_unstemmed	The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
title_sort	rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/dcba4a9d43a4415cbc2976d6fc4408c2
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The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation

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