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.
Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
Objective To explore whether there is enough clinical evidence to confirm that stereotactic aspiration does more good than harm in patients with cerebral hemorrhage. Method A systematic review of all relevant clinical studies on stereotactic aspiration in the treatment of cerebral hemorrhage. Results Eight randomized controlled trials (RCTs) including 757 patients and 17 nonrandomized controlled studies including 1 766 patients, as well as 20 uncontrolled studies including 1 244 patients were identified . All studies reported positive results regarding the effects. However, the quality of the included studies were generally poor. The main problem was that most trials reported them as a RCT, but no description of the method of randomization. Conclusions Stereotactic aspiration in the treatment of cerebral hemorrhage is promising based on present evidence. However, at present, we can not draw definite conclusion whether the treatment does more good than harm compared with noninvasive medical treatment because of the poor quality of included studies. Therefore, more high quality RCTs are required.
Objective To evaluate the relationship between angiotension-converting enzyme (ACE) gene polymorphism and susceptibility to cerebral hemorrhage among the Han Chinese population. Methods We electronically searched CNKI, CBM, VIP, and Wanfang technological periodical full-text databases from January, 1998 to January, 2009. We identified case-control studies of ACE gene polymorphism and cerebral hemorrhage among the Han Chinese population, and assessed the quality of included studies. The data were quantitatively analyzed by RevMan 4.3 software. Results Meta-analysis results showed that the pooled OR value of cerebral hemorrhage subjects among the Han Chinese population with at least one D allele was 1.42 (95%CI1.13 to1.78). The pooled OR values of cerebral hemorrhage with DD and II genotype were 1.9 (95%CI1.32 to 2.74) and 0.80 (95%CI0.63 to 1.01) respectively. Conclusion ACE gene polymorphism is significantly associated with susceptibility to cerebral hemorrhage in the Han Chinese `population.
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 explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.
Objective To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.
【Abstract】Objective To investigate the diagnostic and therapeutic value of selective angiography and embolization treatment in massive biliary hemorrhage in emergency. Methods Eleven cases of massive biliary bleeding were selectively angiographied and embolized with thread segment and gelatin sponge grain by Seldinger technique in emergency. Results Massive biliary bleeding in this series included bleeding after biliary surgery (7), post-laparoscopic cholecystectomy bleeding (1), bleeding from traumatic injury to liver (1), and rupture of huge hepatic cancer (2). There were 9 cases with abnormal angiographic findings including contrast medium leakage (9), tumor vessels and tumor tissue staining (2) and signs of pseudo-aneurysm formation (4). All the bleedings were stopped after emergency intervention but 2 cases with recurrent massive bleeding after 48 hours. Conclusion Emergency trans-catheter embolization treatment is an effective and safe method for biliary massive hemorrhage. It is also important to keep the biliary tract unobstructed.
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
Objetive To investigate the clinical characteristics, diagnosis, and treatment for diffuse alveolar hemorrhage. Methods The clinical data of 17 patients admitted to respiratory ICU with diffuse alveolar hemorrhage from July 1998 to May 2008 were reviewed. Results In the 17 cases, Wegener granulomatosis accounted for 6 cases, microscopic polyangiitis for 3 cases, systemic lupus erythematosis for 4 cases,mitral stenosis for 2 cases, and idiopathic pulmonary hemosiderosis for 1 cases. Clinical presentations included fever ( 76. 4% ) , hemoptysis( 47% ) , anaemia ( 100% ) , dyspnea ( 100% ) , hypoxaemia ( 100% ) ,and elevated total count of white blood cells ( 76. 4% ) . The titer of antineutrophil cytoplasmic antibody ( c-ANCA, p-ANCA) was 1∶( 46. 0 ±3. 7) , 1 ∶( 108. 0 ±16. 1) , respectively. Hemoglobin was ( 78. 0 ±2. 4) g/L. Bronchoalveolar lavage fluid presented with blood accounted for 35. 3% . Siderophages was found in all cases. Computed tomography showed areas of consolidation interspersed with areas of ground-glass attenuation and reticular interstitial opacities. Mortality was 29. 4% . Conclusions Diffuse alveolar hemorrhage is an acute life-threatening event. The clinical presentations of hemoptysis, dyspnea, and anaemia, and chest imaging studies provide clues to diagnosis of diffuse alveolar hemorrhage. Corticosteroids and immunosuppressive agents have proven effective in diffuse alveolar hemorrhage.