Objective To explore an approach of evidence-based treatment for acute hypertensive cerebral hemorrhage. Methods (1) Thoroughly evaluating the patient’s condition. (2) Formulating clinical problems. (3) We searched The Cochrane Library (Issue 1, 2006), Ovid EBM REVIEWS (2001 to 2006), MEDLINE (1980 to 2006) and CNKI (1994 to 2006) for evidence. (4) Assessing evidence. (5) Applying evidence. Results Total 13 relevant studies were retrieved. Results indicated that all kinds of interventions for the treatment of hypertensive cerebral hemorrhage showed different degrees of efficacy, including the Stroke Unit, blood pressure control, mannitol, hemostyptic and neuroprotective agents, promotion of blood circulation and resolving of blood stasis, stereotactic aspiration etc. However, the effects of other interventions need further validation except Stroke Units which had higher quality evidence. Based on the patient’ specific conditions, we recommended the following evidence-based treatment plan: immediate transfer to the Stroke Unit; sequential application of reptilase (within 6 h), citicoline (within 24 h), mannitol and Compound Danshen Injection (after 24 h); temporary withhold of enalapril meleate; monitoring of blood pressure, ECG, renal function and electrolytes; and if intracranial hemorrhage occurs again during the treatment, stereotactic aspiration should be applied. Conclusions Through evidence-based method, an individualized treatment plan could obviously improve the treatment effectiveness and reduce the incidence of adverse effects in patients with hypertensive cerebral hemorrhage.
摘要:目的:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.
Objective To investigate the etiological and clinical characteristics of 1298 cases with spontaneous intracerebral hemorrhage. Methods A retrospective analysis was conducted to investigate the epidemiology and clinical characteristics of 1298 patients who suffered from spontaneous intracerebral hemorrhage and were hospitalized in Neurology Dept. of Anhui Provincial Hospital from 2005 to 2009. Results Among 1 298 patients, 822 (63.33%) were male while 476 (36.67%) were female. The constituent ratio of male and female patients was significantly different; the patients mainly suffered from spontaneous intracerebral hemorrhage in winter and spring which was commonly caused by hypertension accounting for 65.87% and was mostly happened on basal ganglia site (n=895, 68.95%). Conclusions The incidence of spontaneous cerebral hemorrhage is related with age, season and hypertension, it is very important to be prevented effectively and to well control the blood pressure.
ObjectiveTo study the brain tissue oxygen and prognosis index of the postoperative patients with hypertensive intracerebral hemorrhage (HICH) associated with secondary brain insults. MethodsA total of 120 patients with HICH from January 2006 to June 2013 were treated by neurosurgical intervention. Postoperative monitoring of factors affecting the secondary brain insults in the 120 patients and of brain tissue oxygen in 10 patients was performed and statistically analysis was carried out. ResultsSecondary brain insults had a significant influence on the prognosis of postoperative patients with hypertensive intracerebral hemorrhage, and was correlated with brain tissue oxygen metabolism. ConclusionAbnormal secondary brain insults affect brain tissue oxygen metabolism, which may further deteriorate the brain damage and can lead to poor prognosis.
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions. MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012. ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead. ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
ObjectiveTo explore the influencing factors for the prognosis of intracerebral hemorrhage in extremely old patients. MethodsWe retrospectively analyzed the clinical data of 104 extremely old intracerebral hemorrhage patients (≥80 years old) treated between June 2010 and June 2013. According to Glass Outcome Score, the patients were divided into good outcome group (with a score of 4-5) and poor outcome group (with a score of 1-3). The age, gender, consciousness on admission, mean arterial pressure, systolic blood pressure on admission, and complication rate were analyzed and compared between the two groups of patients. ResultsA total of 104 patients were recruited in our study, with 62 in the good outcome group and 42 in the poor outcome group. The gender, age, average arterial pressure on admission between the two groups were not significantly different (P>0.05). The consciousness score at admission in the good outcome group (13.79±2.38) was significantly higher than that of the poor outcome group (8.24±3.80, P<0.05). The complication rate (45.2% vs. 88.1%) and systolic blood pressure on admission [(168.87±25.03) vs. (181.83±29.82) mm Hg (1 mm Hg=0.133 kPa] in the good outcome group were both significantly lower than those in the poor outcome group (P<0.05). ConclusionFor extremely old intracerebral hemorrhage patients, consciousness score and systolic blood pressure at admission, and complication rate are the influencing factors for the prognosis. In addition, a systolic pressure on admission above 180 mm Hg can be a risk factor for poor prognosis in extremely old patients.
The real-time monitoring of cerebral hemorrhage can reduce its disability and fatality rates greatly. On the basis of magnetic induction phase shift, we in this study used filter and amplifier hardware module, NI-PXI data-acquisition system and LabVIEW software to set up an experiment system. We used Band-pass sample method and correlation phase demodulation algorithm in the system. In order to test and evaluate the performance of the system, we carried out saline simulation experiments of brain hemorrhage. We also carried out rabbit cerebral hemorrhage experiments. The results of both saline simulation and animal experiments suggested that our monitoring system had a high phase detection precision, and it needed only about 0.030 4s to finish a single phase shift measurement, and the change of phase shift was directly proportional to the volume of saline or blood. The experimental results were consistent with theory. As a result, this system has the ability of real-time monitoring the progression of cerebral hemorrhage precisely, with many distinguished features, such as low cost, high phase detection precision, high sensitivity of response so that it has showed a good application prospect.
This study was aimed to improve the sensitivity of magnetic induction phase shift detection system for cerebral hemorrhage. In the study, a cerebral hemorrhage model with 13 rabbits was established by injection of autologous blood and the cerebral hemorrhage was detected by utilizing magnetic induction phase shift spectroscopy (MIPSS) detection method under the feature band. Sixty five groups of phase shift spectroscopy data were obtained. According to the characteristics of cerebral hemorrhage phase shift spectroscopy under the feature band, an effective method, B-F distribution, to diagnose the severity of cerebral hemorrhage was designed. The results showed that using MIPSS detection method under feature band, the phase shift obviously growed with increase of injection volume of autologous blood, and the phase shift induced by a 3-mL injection reached-7.750 3°±1.420 4°. B-F distribution could effectively diagnose the severity of cerebral hemorrhage. It can be concluded that the sensitivity of the cerebral hemorrhage magnetic induction detection system is improved by one order of magnitude with the MIPSS detection method under the feature band.
This study aims to evaluate the ability of C-arm cone-beam CT to detect intracranial hematomas in canine models. Twenty one healthy canines were divided into seven groups and each group had three animals. Autologous blood and contrast agent (3 mL) were slowly injected into the left/right frontal lobes of each animal. Canines in the first group, the control group, were only injected with autologous blood without contrast agent. Each animal in all the 7 groups was scanned with C-arm cone-beam CT and multislice computed tomography (MSCT) after 5 minutes. The attenuation values and their standard deviations of the hematoma and uniformed brain tissues were measured to calculate the image noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR). A scale with scores 1-3 was used to rate the quality of the reconstructed image of different hematoma as a subjective evaluation, and all the experimental data were processed with statistical treatment. The results revealed that when the density of hematoma was less than 65 HU, hematomata were not very clear on C-arm CT images, and when the density of hematoma was more than 65 HU, hematomata showed clearly on both C-arm CT and MSCT images and the scores of them were close. The coherence between the two physicians was very reliable. The same results were obtained with C-arm cone-beam CT and MSCT grades in measuring SD value, SNR, and CNR. The reasonable choice of density detection range of intracranial hematoma with C-arm cone-beam CT could be effectively applied to monitoring the intracranial hemorrhage during interventional diagnosis and treatment.
ObjectiveTo systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. MethodsSuch databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). ConclusionKey hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.