Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage

BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.

Changes of TXA_2 and PGI_2 during Postoperative Hypertensive Crisis in Patients with Hypertensive Intracerebral Hemorrhage

In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups： group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups （P〈0.01）. Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups （P〈0.05）. The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.

Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage

Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with his-tologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0 years vs 66.5 years, P<0.05). There was a significantly higher number of hematomas> ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, su-barachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate he-matomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.

L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage

There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve roots.Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule.The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs.We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage.In a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over time.At 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic side.At 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots.In addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord.Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved.These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal ankle.Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage.All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.IACUC-1906009)in June 2019.

The Correlation between Hypertensive Intracerebral Hemorrhage and Internal Carotid Atherosclerosis Investigated by Carniocervial CTA

Objective: To investigate the relationship between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis and its risk factors by CTA (Computed tomography angiography). Methods: The clinical materials of hypertensive intracerebral hemorrhage patients with carniocervial CTA from January 2018 to August 2019 in Puren Hospital of Wuhan were analyzed retrospectively. The correlation and risk factors between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis were studied by logistic regression and descriptive analysis, at the same time, the application value of carniocervial CTA in patients with cerebral hemorrhage was evaluated. Results: There was a correlation between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis (χ2 = 5.319, P = 0.021 1), which indicated that internal carotid atherosclerosis was the risk factor of hypertensive intracerebral hemorrhage, and there was no significant correlation between the location of internal carotid atherosclerosis, multiple atherosclerosis of internal carotid artery and hypertensive intracerebral hemorrhage. Monofactor analysis showed that the risk factors of hypertensive intracerebral hemorrhage with internal carotid atherosclerosis were sex, age, diabetes and hyperlipidemia. According to the logistic regression analysis, hyperlipidemia and diabetes were independent risk factors for hypertensive. Conclusion: The occurrence of hypertensive intracerebral hemorrhage is related to internal carotid atherosclerosis and is affected by many factors. Carniocervial CTA is helpful to the diagnosis of cerebral hemorrhage.

Progress in Analgesic-Sedative Treatment in Perioperative Period of Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage (HICH) refers to intra cerebral hemorrhage at basal ganglia, thalamus, ventricle, cerebellum and brainstem in patients with history of explicit hypertension disease, excluding secondary cerebral hemorrhage caused by trauma, vascular structural disorders, coagulation disorders, hematologic diseases, systematic diseases and neoplastic diseases. HICH is characteristic of high morbidity, fatality rate, disability rate and recurrence rate. HICH is the most common type of spontaneous cerebral hemorrhage and various surgical interventions are one of the major treatments for HICH. Surgical treatment is to eliminate hematoma, relieve oppression of hematoma on surrounding brain tissues, lower intracranial pressure and alleviate secondary brain tissue damages, thus enabling to decrease fatality rate of patients and improve the long-term quality of life. Patients with HICH often may have different degrees of coma, pains, dysphoria, anxiety and delirium in the postoperative period. After central pivot was damaged, the sympathetic central excitability spreading is strengthened in the state of cortical inhibition, which also might be accompanied by paroxysmal sympathetic hyperexcitation syndrome to strengthen disease conditions of patients and thereby influence subsequent treatment. Several professional guidelines all recommend analgesic-sedative treatment as an important component of ICU therapy. However, it lacks support by large sample sized clinical research results of analgesic-sedative treatment of HICH in the postoperative period. This study analyzed literature concerning analgesic-sedative treatment of HICH in the postoperative period in recent years, aiming to guide specific clinical implementation.

Effect of urokinase in combined with minimally invasive intracranial hematoma evacuation on serum ferritin, serum P substance, inflammatory factors and vascular endothelial function in patients with hypertensive intracerebral hemorrhage

Objective: To investigate the effects of minimally invasive evacuation of intracranial hematoma on serum SP, SF, vascular endothelial function and inflammatory factors of patients with hypertensive intracerebral hemorrhage. Methods: According to random data table method, a total of 120 patients with hypertensive cerebral hemorrhage from September 2016 to May 2017 were divided into observation group and the control group, 60 cases in each group. The control group was treated with conventional treatment;on the basis of conventional treatment, the observation group underwent minimally invasive evacuation of intracranial hematoma. The levels of serum SF, SP, vascular endothelial function and inflammatory factors changes were compared between the two groups before and after the treatment. Results: Before treatment, the levels of serum SP, SF, NO, ET-1, hs-CRP, IL-6, TNF-α in the two groups were not statistically significant. The levels of hs-CRP, IL-6, TNF-α, SF, ET-1 after treatment in two groups were significantly lower than those in the same group before treatment, and the observation group levels were significantly lower than those in the control group;the levels of SP, NO in the two groups after treatment were significantly higher than before treatment, and the observation group was higher than that the control group with significant difference. Conclusion: The minimally invasive intracranial hematoma evacuation for patients with HICH can effectively improve the levels of SP, SF, inflammatory factors and vascular endothelial function, which is helpful to relieve cerebral edema and lower intracranial pressure, and improve the quality of treatment.

Analysis of surgical indication and efficacy in hypertensive intracerebral hemorrhage

Objective To analyze the clinical data of patients who suffered from hypertensive intra cerebral hemorrhage (HICH) in West China Hospital of Sichuan University from 2006 to 2009,to evaluate the efficacy and prognosis of surgical treatment and conservative treatment in HICH, to investigate the surgical and

Analysis of correlation between MSCT classification and prognosis of basal ganglia hypertensive intracerebral hemorrhage

Objective:To investigate the correlation between MSCT grading and the prognosis of basal ganglia hypertensive intracerebral hemorrhage.Methods:A total of 86 patients with basal ganglia hypertensive cerebral hemorrhage admitted to our hospital from May 2017 to March 2018 were selected.The clinical data and imaging data were collected from 86 patients.The MSCT images were observed and summarized by two radiologists.Based on the morphology of cisterna ambiens and brain stem,the correlation of MSCT grading to Glasgow Coma Scale(GCS)and Glasgow Outcome Scale(GOS)grading was analyzed by use of Spearman correlation analysis.Results:Among 86 patients,the number of MSCT gradeⅠ,Ⅱ,ⅢandⅣwere 29 cases,38 cases,9 cases and 10 cases respectively.There was no significant correlation between MSCT grading and age,sex as well as types of combined underlying diseases in the patients with basal ganglia hypertensive intracerebral hemorrhage(p>0.05).Spearman correlation analysis showed that there was a positive correlation between MSCT grading and GCS score of basal ganglia hypertensive intracerebral hemorrhage.The higher MSCT grade was,the higher GCS score was(r=0.719,p<0.001).There was a positive correlation between MSCT grading and GOS grading of basal ganglia hypertensive intracerebral hemorrhage.The higher MSCT grade was,the higher GOS grade was,leading to a poor prognosis(r=0.734,p<0.001).86 cases of basal ganglia hypertensive intracerebral hemorrhage showed round or quasi-circular high-density shadows in MSCT images,the CT value ranged from 50 Hu to 80 Hu.Low-density bands surrounded the hematoma in the acute stage,and space-occupying effect could be seen in some patients,which resulted in the compression of ventricular sulcus and cistern and the displacement of midline structure.Subacute basal ganglia hypertensive intracerebral hemorrhage patients showed a relative decrease in the density of hematoma,with the extent of edema gradually reduced,the focus showed a high-density shadow in the center;chronic basal ganglia hypertensive intracerebral hemorrhage focus showed a cystic low-density shadow.Conclusion:MSCT grading of basal ganglia hypertensive intracerebral hemorrhage is positively correlated to GCS and GOS grading.MSCT grading can contribute to the prognostic evaluation to the patients.

Tripartite intensive intervention for prevention of rebleeding in elderly patients with hypertensive cerebral hemorrhage

BACKGROUND Hypertensive cerebral hemorrhage(HICH)is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure.The condition is characterized by high disability and high mortality.Hematoma formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and disability.Consequently,minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial hypertension.Therefore,special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma clearance.AIM The study aim was to determine the value of intensive intervention,including doctors,nurses,and patient families,for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal event METHODS A total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned intervention.The control group was given conventional nursing intervention and the observation group was given tripartite intensive intervention.The length of hospital stay,cost,complication rate,satisfaction rate,and rebleeding rate during hospitalization were recorded.Changes in cerebral blood flow indicators were recorded in both groups.Changes in the National Institutes of Health Stroke Scale(NIHSS)score,quality of life index(QLI)score,and health behavior score were evaluated at the National Institutes of Health.RESULTS Duration of hospitalization was shorter in the in the observation group than in the control group,the hospitalization cost was less than in the control group,and the rate of rebleeding during hospitalization was lower than in the control group(all P<0.05).There were no significant differences between the two groups before treatment(all P>0.05).The mean flow rate(Qmean)and mean velocity(Vmean)of the two groups increased(P<0.05),and the dynamic resistance and peripheral resistance decreased(P<0.05).The Qmean and Vmean in the intervention group were higher than those in the control group(P<0.05).Moreover,the dynamic resistance and peripheral resistance of the blood vessels were also lower in the intervention group than in the control group(P<0.05).The difference in health behavior scores between the two groups before treatment was not significant(P>0.05).In both groups,the scores for healthy behaviors such as emotion control,medication adherence,dietary management,exercise management,and selfmonitoring were higher after than before treatment(P<0.05),and the scores of healthy behaviors in the intervention group were higher than those in the control group(P<0.05).There was no significant difference in the NIHSS and QLI scores between the two groups before treatment(P>0.05).The QLI scores of the two groups increased(P<0.05),and the NIHSS scores decreased(P<0.05).The QLI scores of the intervention group were higher than those of the control group(P<0.05),and the NIHSS score was correspondingly lower than that of the control group(P<0.05).The incidence of respiratory infections,pressure sores,central hyperpyrexia,and deep venous thrombosis was lower in the intervention group than in the control group.Accordingly,the satisfaction rate was higher in the treatment group than that in the control group(P<0.05).CONCLUSION Intensive intervention by doctors,nurses,and families of elderly patients with HICH reduced the rate of rebleeding during hospitalization.It also reduced the incidence of complications,promoted rehabilitation,improved the quality of life,and enhanced nerve function.Additionally,it improved satisfaction and promoted healthy behaviors.

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Hemostatic Therapy for Intracerebral Hemorrhage

Objective: To reduce the blood pressure and elevate intracranial pressure using nimodipine (Nimotop Intravenous (IV) infusion). Thus, intracerebral hemorrhage was controlled, and the purpose of hemostasis was achieved. Methods: Sixty-eight patients with intracerebral hemorrhage were divided into a treatment group (n = 51), and a control group (n = 35). Nimotop solution (10 mg) was administered as a fast-flowing IV infusion in the treatment group, and 250 ml 20% mannitol infusion was given to patients in the control group twice every day. Patients in both groups received treatment for seven days, and the blood pressure on the treatment day was measured. A brain Computed Tomography (CT) scan was performed as a reexamination within two weeks. Results: The blood pressure in the treatment group was decreased from 179/104 to 151/91 mmHg, averagely, and in the control group was decreased from 181/108 to 180/103 mmHg, averagely. The difference between these two groups was statistically significant (P < 0.01). Hematoma enlargement occurred in 20 patients (53.3%) in the treatment group, and four patients in the control group (8.57%). The difference between both groups was statistically significant (P < 0.01). There were eight deaths in the treatment group. Seven deaths were caused by cerebral hernia, and one was caused by complications. There was one death in the control group caused by lung infection and gastrointestinal bleeding. Conclusion: Nimodipine can dilate the arteries, reduce blood pressure, and elevate intracranial pressure, lowering pressure gradients across vessel wall which destroy the vessel wall. Also, nimodipine can prevent hemorrhage as well as recurrent hemorrhage, and can used as the first choice of rescue drug. What’s more, dehydration drugs such as mannitol should not be used in the early stage of intracerebral hemorrhage in order to prevent hematoma enlargement.

HICH患者血清VEGF、MIP-1α、CD40水平变化及与预后的关系

目的 探究高血压脑出血(HICH)患者血清血管内皮生长因子(VEGF)、巨噬细胞炎症蛋白-1α(MIP-1α)、CD40水平变化及与预后的关系。方法 选取2020年1月至2023年1月期间于达州市中西医结合医院/成都医学院附属达州市中西医结合医院神经外科就诊的208例HICH患者及同期就诊的208例非HICH的脑血管疾病患者临床资料,分别纳入HICH组和对照组,比较两组患者入院时血清VEGF、MIP-1α、CD40水平差异,经受试者工作特征曲线(ROC)分析入院时血清VEGF、MIP-1α、CD40水平对HICH患者的诊断效能。记录HICH组患者格拉斯哥预后量表(GOS)评分结果,并以其作为预后评估标准将其分为预后不良组(GOS≤3分,n=89)和预后良好组(GOS>3分,n=119)两亚组,比较两亚组患者入院时血清VEGF、MIP-1α、CD40水平和GOS评分的关系;经Pearson相关系数分析HICH患者入院时血清VEGF、MIP-1α、CD40水平与GOS评分的相关性。结果 HICH组入院时的血清VEGF、MIP-1α、CD40水平显著高于对照组,差异有统计学意义(P<0.05)。经受试者工作特征曲线(ROC)分析,血清VEGF、MIP-1α、CD40水平三者单一和联合指标检测的ROC曲线下面积(AUC)值分别是0.828、0.874、0.843、0.930;截断值分别是356.73 pg/mL、350.81 ng/mL、420.60 pg/mL;敏感度分别是66.35%、66.83%、60.01%、86.06%;特异度分别是88.94%、93.27%、91.35%、85.58%(P<0.05)。根据预后评估标准,HICH组中89例患者为预后不良,119例患者预后良好。其中,预后不良组入院时的血清VEGF、MIP-1α、CD40水平显著高于预后良好组,差异有统计学意义(P<0.05)。Pearson相关系数分析显示,HICH患者入院时血清VEGF、MIP-1α、CD40水平与GOS评分呈负相关(P<0.05)。结论 血清VEGF、MIP-1α、CD40等因子在HICH患者中呈现高表达,且影响患者的预后情况,可作为早期临床上的辅助指标,为HICH患者的治疗和康复提供更精准的指导。

机器人辅助下HICH患者颅内血肿穿刺引流术

高血压脑出血(HICH)是一种致死率和致残率均较高的脑卒中类型,外科手术作为HICH的重要治疗方式之一,能有效解除血肿压迫、缓解颅内高压。随着神经外科手术机器人的不断完善与升级,微创外科技术在HICH治疗中已取得重大突破,机器人辅助颅内血肿穿刺引流可有效提高引流管置入精准度并缩短手术时间,在治疗HICH患者中具有明显优势。本文将介绍机器人辅助下颅内血肿穿刺引流术的详细操作步骤,为HICH患者的临床治疗提供参考。

Ang-1、HO-1、NGF和MMSE评分在HICH疗效评价中的价值

目的探讨血管生成素-1(Ang-1)、血红素氧化酶1(HO-1)、神经生长因子(NGF)和简易智能精神状态检查量表(MMSE)评分在高血压脑出血(HICH)疗效评估中的价值。方法选取2018年2月—2022年2月张家口市第一医院HICH患者152例(HICH组)和健康体检者68名(正常对照组)。所有患者均接受去骨瓣血肿清除术、支持治疗和脑蛋白水解物治疗,根据疗效分为有效组(105例)和无效组(47例)。分别检测HICH患者治疗前、治疗后和正常对照者的血清Ang-1、HO-1、NGF水平,采用MMSE评分评估HICH患者的认知功能。采用多因素Logistic回归分析评估HICH无效的危险因素。采用受试者工作特征(ROC)曲线评价Ang-1、HO-1、NGF、MMSE评分判断HICH疗效的效能。结果HICH组治疗前血清Ang-1、NGF水平和MMSE评分低于正常对照组(P<0.05),血清HO-1水平高于正常对照组(P<0.05)。有效组治疗后血清Ang-1、NGF水平和MMSE评分显著高于治疗前(P<0.05),血清HO-1水平低于治疗前(P<0.05);无效组治疗前、治疗后各项指标差异均无统计学意义(P>0.05)。无效组治疗前、治疗后血清Ang-1、NGF水平和MMSE评分均显著低于有效组(P<0.05),血清HO-1水平均显著高于有效组(P<0.05)。高血压3级和治疗前HO-1升高、Ang-1降低、NGF降低、MMSE评分降低是HICH患者治疗无效的危险因素[比值比(OR)值分别为2.324、1.442、0.549、0.671、0.716,95%可信区间(CI)分别为1.357~5.468、1.203~4.535、0.211~0.884、0.316~0.854、0.461~0.973,P<0.05]。血清Ang-1、HO-1、NGF水平和MMSE评分单项和联合检测判断HICH疗效的ROC曲线下面积(AUC)分别为0.859、0.848、0.856、0.820、0.958。结论血清Ang-1、NGF、HO-1水平与HICH患者的临床疗效有关,或可作为HICH疗效评估的潜在指标。

Activating Blood Circulation to Remove Stasis Treatment of Hypertensive Intracerebral Hemorrhage:A Multi-Center Prospective Randomized Open-Label Blinded-Endpoint Trial

Objective： To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation （TRABC） in treatment of hypertensive intracerebral hemorrhage （HICH）. Methods： This was a multi-center prospective randomized open-label blinded-endpoint （PROBE） trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale （mRS）. Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale （NIHSS） scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. Results： After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups （P〈0.01）. Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group （P=0.038）. Average Barthel scores in the treatment group after treatment was 89.11 ＋ 19.93, and in the control group 82.18 ＋ 24.02 （P=0.003）. NIHSS scores of the two groups after treatment decreased significantly compared with before treatment （P=0.001）. Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment （P〈0.05）. There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. Conclusion： The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

Changes of vasoactive polypeptides during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage

Background Hypertensive crisis could be found after operation in patients with hypertensive intracerebral hemorrhage （HICH）. The aim of this study was to explore the changes and th; roles of some vasoactive polypeptides during postoperative hypertensive crisis in patients with HICH. Methods A total of 31 patients, who were admitted for craniotomy, were enrolled into this study. After the operation, the patients were divided into three groups. Group I consisted of 9 patients with postoperative hypertensive crisis, and group Ⅱ was composed of 13 patients without postoperative hypertensive crisis. Nine patients, who denied history of hypertension or HICH, were set as group Ⅲ. The levels of some vasoactivators in the three groups were measured before and after the operation. The differences in the results among the groups were analyzed using the ANOVA. The data collected before and after the operation in the group Ⅰ was compared by Wilcoxon test. Results The concentration of endothelin in group Ⅰ was significantly higher than that in group Ⅲ （P〈0.05）. The level of thromboxane A2 and the ratio of thromboxane B2 to 6-keto-PGF1α in group Ⅰ were significantly higher than those in the other two groups （P〈0.05）. In group Ⅰ, the levels of plasma renin activity, angiotensin Ⅱ, aldosterone, catecholamine, and endothelin before the operation were significantly higher than those determined after the operation （P〉0.05）. Conclusions Postoperative hypertensive crisis may be due to the increased thromboxane A2 and relatively inadequate prostacyclin, especially 6-keto-PGF1α. The increased level of endothelin and intraoperative stimulation also play a certain role in the development of postoperative hypertensive crisis.

Endoscopic treatment of hypertensive intracerebral hemorrhage:A technical review

Hypertensive intracerebral hemorrhage (ICH) is still a highlighting global issue. Endoscopic evacuation as a minimally invasive treatment became an alternative other than conventional craniotomy and catheter drainage for ICH. However, there is no unified indication or standardized procedure on endoscopic treatment of ICH. Here we explored the literature and gathered information from different studies, to review the background, technical points, and existing problems of endoscopic treatment for ICH.

小骨窗开颅血肿清除术与经额中回入路透明套管下神经内镜手术治疗HICH的效果

目的:探讨小骨窗开颅血肿清除术与经额中回入路透明套管下神经内镜手术治疗高血压脑出血(HICH)的效果。方法:回顾性分析2020年6月—2022年6月在远安县人民医院实施手术治疗的84例HICH患者的临床资料。根据不同手术方法将其分为开颅组和内镜组,各42例。开颅组实施小骨窗开颅血肿清除术,内镜组实施经额中回入路透明套管下神经内镜手术。比较两组临床疗效,围手术期指标,术前和术后24 h的颅内压,术前及术后3个月神经功能、日常生活活动能力,预后情况及并发症。结果:内镜组总有效率为高于开颅组,差异有统计学意义(P<0.05)。两组手术时间比较,差异无统计学意义(P>0.05);内镜组术中出血量、术后残留血肿量均少于开颅组,血肿清除率高于开颅组,术后ICU时间短于开颅组,差异有统计学意义(P<0.05)。术后24 h,内镜组颅内压低于开颅组,术后3个月美国国立卫生研究院卒中量表(NIHSS)评分低于开颅组,Barthel指数(BI)评分高于开颅组,差异有统计学意义(P<0.05)。内镜组预后情况优于开颅组,差异有统计学意义(P<0.05)。内镜组术后并发症发生率低于开颅组,差异有统计学意义(P<0.05)。结论:经额中回入路透明套管下神经内镜手术可提高HICH患者临床疗效,促进术后恢复,改善神经功能和日常生活活动能力。