Minimally invasive puncture combined with a high frequency of urokinase therapy improves outcomes in patients with HICH

Jianbing Xiong; Yuanbing Chen; Ruolong Wang; Shanshan Hu; Ji Xu; Xiaoye Mo; Xiaogang Li; Yong Zhou; Chaxiang Guan; Jun Huang; Feng Su

doi:10.1016/j.neurot.2023.10.003

Minimally invasive puncture combined with a high frequency of urokinase therapy improves outcomes in patients with HICH

Neurotherapeutics. 2024 Jan;21(1):e00293. doi: 10.1016/j.neurot.2023.10.003. Epub 2023 Dec 21.

Authors

Jianbing Xiong¹, Yuanbing Chen², Ruolong Wang³, Shanshan Hu³, Ji Xu³, Xiaoye Mo³, Xiaogang Li³, Yong Zhou⁴, Chaxiang Guan⁴, Jun Huang⁵, Feng Su⁶

Affiliations

¹ Department of Emergency, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Department of Physiology, School of Basic Medical Science, Central South University, Changsha, Hunan, 410078, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
² Department of Neurosurgery, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
³ Department of Emergency, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
⁴ Department of Physiology, School of Basic Medical Science, Central South University, Changsha, Hunan, 410078, China.
⁵ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China.
⁶ Department of Emergency, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: sufeng@csu.edu.cn.

Abstract

Minimally invasive puncture combined with urokinase is widely used in the treatment of hypertensive intracerebral hemorrhage (HICH). However, the appropriate frequency of urokinase following minimally invasive puncture in patients is still unclear. In total, 55 patients were enrolled in this study. According to the frequency of urokinase (10.0 × 10⁴ units) administration, 30 patients received urokinase at Q4h, while the other 25 patients received urokinase at Q8h. In the univariate analysis, preoperative GCS (p = 0.0002), postoperative GCS (p = 0.0007), the volume of residual hematoma (p = 0.0179), and the frequency of urokinase (p = 0.0110) were associated with unfavorable outcomes in patients with HICH in the basal ganglia. The multivariate analysis revealed that the frequency of urokinase was independently associated with unfavorable outcomes in patients with HICH in the basal ganglia (p = 0.038, 1.109-35.380). The drainage time was significantly shorter in the Q4h group (14.17 ± 0.86 h) than in the Q8h group (27.36 ± 1.39 h) (p < 0.0001). The GOS (4.37 ± 0.18), BI (75.52 ± 2.39), and mRS (1.67 ± 0.24) in the Q4h group were significantly ameliorated compared to those in the Q8h group (GOS 3.56 ± 0.18, BI 64.13 ± 2.22, and mRS 2.64 ± 0.28, respectively) (p = 0.0004, p = 0.0002, and p = 0.0018) at 3 months of follow-up. Thus, minimally invasive puncture combined with urokinase is safe and efficient. Increasing the frequency of urokinase administration can produce faster and better postoperative recovery for patients with HICH in the basal ganglia.

Keywords: Basal ganglia; Hypertensive intracerebral hemorrhage (HICH); Minimally invasive puncture; Outcome; Urokinase.

MeSH terms

Drainage
Humans
Punctures*
Retrospective Studies
Treatment Outcome
Urokinase-Type Plasminogen Activator* / therapeutic use

Substances

Urokinase-Type Plasminogen Activator