Prognostic factors in acute hypertensive intracerebral hemorrhage: impact of minimally invasive puncture and drainage.

Abstract

Objective: To analyze the prognostic factors in patients with acute hypertensive intracerebral hemorrhage (HICH) undergoing minimally invasive puncture and drainage, providing scientific evidence to enhance clinical treatment strategies.

Methods: A retrospective analysis was conducted on 350 patients with acute HICH treated at Gansu Provincial Hospital of Traditional Chinese Medicine and the First People's Hospital of Lanzhou City from March 2017 to January 2024. Patients were divided into two groups based on surgical method: the control group (n = 211) received traditional craniotomy, while the observation group (n = 139) underwent minimally invasive puncture and drainage. Functional scores, inflammatory markers, clinical efficacy, surgical time, first hematoma clearance rate, and hospitalization duration were compared between the groups. Patients were classified into poor prognosis (Glasgow Outcome Scale (GOS) score < 3) and improved prognosis (GOS score ≥ 3) groups. Logistic regression analysis identified independent risk factors for poor prognosis and examined their interaction with patient outcomes.

Results: Postoperative functional scores (National Institutes of Health Stroke Scale (NIHSS) score, GOS score, and Barthel Index) in the observation group were significantly better than those in the control group (all P < 0.001). Inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)) were significantly lower post-treatment in the observation group compared to those in the control group (all P < 0.001). Multivariate logistic regression identified age (P = 0.003, OR = 0.573), time from onset to admission (P = 0.026, OR = 0.535), duration of hypertension (P = 0.006, OR = 1.766), and postoperative IL-6 levels (P = 0.048, OR = 1.870) as independent risk factors for poor prognosis. Prognosis was statistically associated with age (P = 0.040, OR = 0.978), time from onset to admission (P = 0.022, OR = 0.956), duration of hypertension (P = 0.022, OR = 1.085), and post-treatment IL-6 levels (P = 0.043, OR = 1.030).

Conclusion: Minimally invasive puncture and drainage offer superior neurological recovery, reduced inflammatory response, and improved long-term prognosis compared to traditional craniotomy in the treatment of hypertensive intracerebral hemorrhage.