盐源山蛭注射液治疗脑出血的实验研究

目的 :探索纯化的盐源山蛭注射液促进血肿吸收的作用及其作用机理。方法 :采用定量胶源酶注入大鼠尾状核建立脑出血模型 ,观察盐源山蛭注射液对鼠脑内血肿容积、脑水含量、血浆 F。 a活性、 AT- 活性、 D- D含量及组织病理变化的影响。 BWC采用称重法 ,酶活性测定采用发色底物法 ,D- D含量测定采用 EL IAS测定。结果 :(1)盐源山蛭注射液治疗后 6 d、 10 d的脑内血肿明显缩小 ;使治疗后 3d、 6 d的 BWC明显减轻。 (2 )盐源山蛭注射液能抑制脑出血后 F。 a活性的升高 ,不影响 AT- 活性 ,增加纤溶活性。 (3)盐源山蛭注射液能加快脑出血后的病理组织修复。结论 :(1)盐源山蛭注射对大鼠脑出血后脑内血肿有治疗作用 ;(2 )作用机制可能为 :拮抗凝血形成的稳定因素 ,激活内源性纤溶系统 ,促进胶质细胞增生 。

Perihematomal Perfusion Typing and Spot Sign of Acute Intracerebral Hemorrhage with Multimode Computed Tomography: A Preliminary Study

Objective To explore the perihematomal perfusion typing and spot sign on computed tomography angiography(CTA) source images in order to assist in individualizing therapeutic decisions for patients with intracerebral hemorrhage by possibly forecasting perihematomal ischemia and hematoma enlargement. Methods We examined 58 patients with spontaneous intracerebral hemorrhage by computed tomography perfusion and CTA within 6 hours after symptom onset. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. The perfusion of hematoma region and perihematoma region was evaluated for presence or absence of the perihematomal penumbra. Three kinds of perihematoma perfusion typing were defined according to the perfusion of hematoma region and perihematoma region. CTA source images was reviewed to make sure presence or absence of the spot sign. Results Finally, 53 patients(34 males, 19 females) were enrolled in our study according to exclusion criteria. Finally, 21 patients were classified into the normal group, 23 patients were classified into the mild group, and 9 patients were classified into the severe group. There were significant differences in hematoma size between the presence and absence of the perihematomal penumbra group(P<0.05). Thirteen(24.5%) patients presented with spot sign. Hematoma expansion occurred in 15(28.3%) patients on follow-up. In which 12 patients were with spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, and 92.5%, respectively. Conclusion In acute intracerebral hemorrhage patients, the perihematoma perfusion typing and CTA spot sign provide more radiological information that might assist in individualizing therapeutic decisions for patients by possibly forecasting perihematomal ischemia and hematoma enlargement.

MODIFIED GRAEB CRITERIA FOR PREDICTING THE POST-HEMORRHAGIC HYDROCEPHALUS IN INTRAVENTRICULAR HEMORRHAGE

Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.

Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage

Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score （GCS） on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatnaent was performed for five patients （9.3%）, external ventricular drainage （EVD） for 20 patients （37.0%）, THD for four patients （7.4%）, and EVD combined with THD for 25 patients （46.3%）. At six months after onset, 21 （38.9%） patients achieved a favorable outcome, while 33 （61.1%） had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admis- sion （P = 0.001）, larger hematoma volume （P 〈 0.001）, midline shift （P = 0.035）, acute hydrocephalus （P = 0.039）, and no THD （P = 0.037）. The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.

Clinical Study on the Needling and Drug Treatment of Acute Cerebral Hemorrhage

Researches in recent years have shown that cellular immune factor plays an important role in the generation and development of cerebral hemorrhage1-3.

Acupuncture plus naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage: a randomized controlled trial

Objective To observe the efficacy of acupuncture combined with naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage and to explore its possible mechanism of action.Methods Seventy-two patients were divided into a control group and an observation group according to the random number table method,with 36 cases in each group.The control group was treated with intravenous naloxone hydrochloride,and the observation group received additional acupuncture treatment.After 1 month of treatment,the awakening rate,Glasgow coma scale(GCS)score,cerebral edema volume,mean velocity(Vm)of the middle cerebral artery,and cerebrospinal fluid Caspase-3,and macrophage migration inhibitory factor(MIF)levels were compared between the two groups.Results During the study,there were 2 cases of shedding in the control group and 34 remaining valid cases;1 case of shedding in the observation group and 35 remaining valid cases.After treatment,the awakening rate was higher in the observation group than in the control group(P<0.05);the GCS score increased in both groups compared with that before treatment(P<0.05),and was higher in the observation group than in the control group(P<0.05);the volume of cerebral edema decreased in both groups(P<0.05),and was smaller in the observation group than in the control group(P<0.05);the middle cerebral artery Vm increased in both groups(P<0.05),and was higher in the observation group than in the control group(P<0.05);the cerebrospinal fluid Caspase-3 and MIF levels decreased significantly in both groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).Conclusion Acupuncture combined with naloxone hydrochloride for the treatment of coma after surgery for cerebral hemorrhage can promote patients’awakening,improve the degree of coma,reduce the volume of cerebral edema,and enhance cerebral blood flow velocity,producing a better effect than naloxone hydrochloride used alone;it may be related to its reduction of cerebrospinal fluid Caspase-3 and MIF levels.

Fatal deterioration of delayed acute subdural hematoma after mild traumatic brain injury： two cases with brief review

Both delayed posttraumatic intracerebral hemorrhage and epidural hematoma have been well described in the neurosurgical literatures. However, delayed posttraumatic acute subdural hematoma which happens more than a week with a rapid progress after mild traumatic brain injury and causes death of patient is rarely reported. We show two such cases and briefly review the literature and discuss the probable pathogenesis of their rapid progress.

Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries

Objective： To detect the influencing factors for posttraumatic hydrocephalus in patients with severe traumatic brain injuries and provide theoretical reference for clinical treatment. Methods ： Retrospective study was made on 139 patients with severe traumatic brain injuries in our hospital. The patients were divided into two groups： hydrocephalus group and non-hydrocephalus group. Single factor analysis and multiple factor analysis were used to determine the related factors and hydrocephalus. Multiple factor analysis was conducted with logistic regression. Results： Posttraumatic hydrocephalus was found in 19.42% of patients. Age （ OR=1.050, 95% CI： 1.012-1. 090 ）, decompressive craniectomy （ OR =4.312, 95 %CI ： 1. 127-16.503 ）, subarachnoid hemorrhage （ OR = 43.421, 95 % CI ： 7. 835-240. 652 ） and continuous lumbar drainage of cerebrospinal fluid （ OR =0.045, 95%CI： 0. 011-0. 175） were screened out from nine factors as the influencing factors for posttraumatic hydrocephalus. Conclusions ： Risk factors for PTH are as follows： age, deeompressive eranieetomy and subaraehnoid hemorrhage （SAH）. Continuous lumbar drainage of eerebrospinal fluid can greatly reduce posttraumatic hydrocephalus.