Curative effect of minimally invasive puncture and drainage assisted with alteplase on treatment of acute intracerebral hemorrhage

Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.

Aggressive Blood Pressure Control in Intracerebral Hemorrhage (the Abc-Ich Study)—A Pilot Study

Spontaneous intracerebral hemorrhage (ICH) accounts for one fifth of all strokes and is associated with an extremely high rate of morbidity and mortality. Affecting greater than 1 million people a year, ICH will leave the majority of its’ patients significantly disabled or dead. An initially high systolic blood pressure upon presentation is associated with hematoma expansion, peri-hema- toma expansion, and increased mortality. The relationship between blood pressure, the degree of blood pressure control and hematoma expansion has yet to be defined, but the literature has ob- served a relationship between tightly controlled blood pressures and decreased hematoma expansion. There have been many proposed mechanisms to explain this effect. Larger initial hematomas may lend greater hydrostatic forces and this could result in greater total hematoma volume, and greater surrounding edema. Recent literature has suggested that blood pressure reductions in acute ICH may be tolerated because of reduced metabolism, and preserved autoreguation in the peri-hematoma region. The volume of the hematoma is a critical determinant of mortality and functional outcome after intracerebral hemorrhage, and early hematoma growth is an important cause of neurologic deterioration. An increase in volume of more than thirty-three percent is detectable on repeated computed tomography (CT) in thirty-eight percent of patients initially scanned within the first three hours of onset of symptoms;in two thirds of these cases this change is noticeable on CT within the first hour. This supports the hypothesis that early aggressive blood pressure optimization would decrease hematoma size and edema. This is further supported by the fact that patients with high blood pressure and acute intracerebral hemorrhage have worse outcomes than their counterparts. We hypothesize that prompt and aggressive, early blood pressure reduction in emergency department patients with acute spontaneous intracerebral hemorrhage will result in a reduction of early hematoma growth. The study institution is a large urban emergency department and tertiary care stoke center, with over 55,000 emergency department visits per year. This prospective cohort study compared the results and outcomes observed within the enrolled prospective study population, to the results and outcomes of a matched historical cohort population (future patients with intracranial hemorrhage that did not receive the ABC-ICH protocol). Methods and Material: A nicardipine infusion was administered to optimize blood pressure in all patients presenting with intracerebral hemorrhage with a target mean arterial pressure (MAP) of 80 - 110. Hematoma volume (primary outcome measure) was measured on cat scans at time of presentation and at twenty-four hours. The hematoma volume in the enrolled prospective study population was compared to those of a matched cohort (patients with intracranial hemorrhage that did not receive the ABC-ICH protocol following the conclusion of the study). Results: One hundred total patients were enrolled into the study. Fifty patients were enrolled prospectively in the study and matched to a similar group of fifty cohort patients. The difference in the mean change of hematoma volume at twenty-four hours was 7.29 ml (control) and 2.84 ml (study). The result was an absolute decrease in hematoma size of 4.45 ml in the group treated aggressively with nicardapine for blood pressure reduction within one hour of their initial presentation. Conclusions: These results support the previous research suggesting that aggressive blood pressure control in intracerebral hemorrhage reduces hematoma growth, however the clinical benefit of such a reduction will have to be evaluated in ongoing research.

Seasonal Changes of Hemorheology in Patients with Intracerebral Hemorrhage in Acute Phase

Objective.To explore the seasonal changes of hemorheology in patients with intracerebral hemorrhage in acute phase.Methods.The hemorheology indexes were detected in 100 acute cerebral hemorrhage patients and 30 normal persons.The observed group were divided into summer group,transition season group and winter group according to traditional solar terms,then the hemorheology indexes of different groups were compared.Results.Compared with control group,the whole blood viscosity increased with statistical significance(P<0.05).The whole blood viscosity of four cut blood rates and plasma viscosity were further compared in summer group,transition season group and winter group,and the indexes were the highest in winter group.Compared with transition season group,the erythrocyte aggregation index and erythrocyte transformation index acute intracerebral hemorrhage patients were decreased in winter group and summer group.The whole blood viscosity,plasma viscosity and erythrocyte sedimentation rate(ESR)compared in each group were increased with statistical significance.There were no significant statistical differences in hematocrit(HCT)among each groups(P>0.05).Conclusion.The hemorheology indexes in acute intracerebral hemorrhage patients are influenced by changes of different seasons and The blood of acute cerebral hemorrhage patients shows a concentrated tendency.The whole blood viscosity and plasma viscosity of acute cerebral hemorrhage patients were increased more obviously in winter group,which may be a pathophysiological basis of high incidence of acute cerebral hemorrhage in cold season and increase of severe cases.

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.

Recovery of a degenerated corticospinal tract after injury in a patient with intracerebral hemorrhage:confirmed by diffusion tensor tractography imaging

The corticospinal tract （CST） is a major neuronal tract of motor function in the human brain （York, 1987; Davidoff, 1990; Jang, 2014）. Recovery of an injured CST is one of the motor recovery mechanisms in stroke patients （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, and transcra- nial magnetic stimulation （TMS） have been widely used in demonstrating the recovery of an injured CST （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Pannek et al., 2009; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. DTT has the advan- tage of enabling visualization of the architecture and integ- rity of the CST at the subcortical level in three dimensions （Mori et al., 1999; Kunimatsu et al., 2004）.

Protective Effects of α-Tocopherol against Brain Tissue Damage Induced by Intracerebral Hemorrhage in SD Rats

Lipid peroxidation mediated by oxygen radical is one of the main mechanisms underlying secondary brain injury. Among all vitamin E compounds, α-tocopherol shows the most prominent antioxidative effects. It plays an important role in cell aging and injury. However, there has been no report regarding the effects of α-tocopherol on changes in brain tissue morphology after intracerebral hemorrhage (ICH), cerebral edema, or the expression of Bax and Bcl-2 proteins. We use SD rats to carry out the related studies;based on the atlas of SD rats, the caudate nucleus was positioned using a stereotaxic apparatus, and 50 μl autologous tail artery blood was injected to caudate nucleus in the ICH and α-tocopherol groups to establish ICH model. Rats in the sham surgery group received the same volume of saline in the caudate nucleus. Rats in the α-tocopherol group received intraperitoneal injections of α-tocopherol at 600 mg/kg every day. Rats in the ICH group and sham surgery group received the same amount of saline at the same times as those in the α-tocopherol group. We observed some interesting results: comparisons of brain tissue sections of rats from different groups showed that brain tissue damage and functional neurological deficits among rats from the α-tocopherol group were less pronounced than in the ICH group. Wet weight/ dry weight measurement showed that rats from the α-tocopherol group exhibited less cerebral edema than those in the ICH group. Rats from the α-tocopherol group showed less Bax expression and more Bcl-2 expression than those in the ICH group.

Treatment of Intracerebral Hemorrhage

Intra-cerebral hem-orrhage(ICH)refers tospontaneous intra-cerebral parenchyma bleeding.A series of patho-logical alterations woulddevelop in patients withICH,including,besideshematoma occupyingeffect,secondary cerebral edema and reductionof cerebral blood flow in

Changes in hemeoxygenase-1 and superoxide dismutase in the peri-hematomal brain tissues of rats following intracerebral hemorrhage

BACKGROUND: The mechanism of intracerebral hemorrhage (ICH)-induced hemorrhagic brain injury is very complicated, involving the position-occupying effect of cephalophyma, ischemic factors, the toxic effect of hematoma components, the destruction of blood-brain barrier, etc. The expression and effect of hemeoxygenase-1 (HO-1) in the cerebrovascular disease has been paid close attention. OBJECTIVE: To observe the expression of HO-1 and change of superoxide dismutase (SOD) in the peri-hematomal brain tissue of rats following ICH. DESIGN: Randomized controlled animal experiment. SETTING: Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College. MATERIALS: Forty healthy male SD rats, of clean grade, weighing from 250 to 300 g, were provided by Qinglongshan Animal Farm of Nanjing. The involved 40 rats were randomized into sham-operation group (n =5) and ICH group (n =35), and ICH group was divided into 7 subgroups with 5 rats in each: ICH 6, 12, 24, 48, 72, 100 and 168 hours groups. Rabbit anti-rat HO-1 immunohistochemial kit ( Boster Co., Ltd., Wuhan) and SOD kit (Jiancheng Bioengineering Institute, Nanjing)were used in this experiment. METHODS: This experiment was carried out in the Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College Between April and July 2005. In the ICH group: Autologous blood of rats was injected into the head of caudate nucleus to create ICH animal models. In the sham-operation group, the same amount of normal saline was injected into the head of caudate nucleus of rats. The brains of rats in each group were harvested at different time points. The hematoma-side brain tissue was cut open in the coronal plane taking hematomal region as center, and the posterior part was fixed with 100 g/L neutral formaldehyde. 100 mg brain tissue was taken from anterior part. The number of positive cells in HO-1 and SOD activity in peri-hematomal brain tissue at different time after ICH were detected by immunohistochemical method and xanthine oxidation method respectively. MAIN OUTCOME MEASURES: ① The expression of HO-1 in the peri-hematomal brain tissue of rats in two groups following ICH.② The expression of SOD activity in the peri-hematomal brain tissue of rats in two groups following ICH. RESULTS: ①The number of HO-1 positive cells in the peri-hematomal brain tissue of rats in two groups following ICH 6, 12, 24, 48, 72, 120 and 168 hours was (11.03±2.01),(16.47±2.98),(25.50±5.65),(51.57±7.05),(47.33±4.73),(26.57±5.12),(7.63±2.17) cells/high-fold visual field , respectively; The number of HO-1 positive cells in the ICH 12-120 hours groups was significantly higher than that of sham-operation group [(6.07±1.85)cells/high-fold visual field, P < 0.01]; The HO-1 positive cells were the most in the ICH 48 hours group and were still expressed a little in the ICH 168 hours group. ② The SOD in the brain tissue of rats at ICH 6, 12, 24, 48, 72, 120 and 168 hours was (404.46±8.14),(396.84±10.97),(387.74±5.32),(356.21±9.27),(307.95±10.15),(357.48±11.28) and (402.98±7.23) kNU/g, respectively; The SOD activity of ICH 12 to 120 hours groups was significantly lower than that of sham-operation group [(415.47±11.44) kNU/g,P < 0.01], and that of ICH 72 hours group was the lowest. There was no significant difference of SOD activity between ICH 168 hours group and sham-operation group (P > 0.05). CONCLUSION: Following ICH, the expression of HO-1 in peri-hematomal brain tissue of rats in two groups is obviously increased, but the antioxidant ability of brain tissue is decreased. The changes of both maybe play an important role in the formation of ICH-induced hemorrhagic brain injury.

Construction of a model of autologous blood intracerebral hemorrhage in rats with a double injection and double needle withdrawal and the characteristics of the operative technique

BACKGROUND ： Experimental animal models of intracerebral hemorrhag （ICH） are greatly needed, so the process of establishment should be ideal in hematoma formation and easy to operate. OBJECTIVE ： To construct model of ICH in rats with double injection of autologous blood taken from the cut tail cut and double withdrawal of the needle （shortened as two-step injection model）, and compare with those induced by single and double injections. DESIGN ： A randomized controlled tria SETTING： Department of Neurology, General Hospital of Military Area Command of Chinese PLA. MATERIALS： Thirty male Wistar rats of 10 to 12 months, weighing （400±25） g, provided by the Experimental Center of Medical Animals, General Hospital of Shenyang Military Area Command of Chinese PLA, were divided randomly into 3 groups with 10 rats in each group： two-step injection group, single injection group, double injection group. METHODS ： The experiment was carried out in the Department of Neurology, General Hospital of Military Area Command of Chinese PLA from March to June in 2004. Autologous blood ICH model in rats were established as follows： In the two-step injection group, 50 μL unclotted autologous blood was taken from the rat tail cut, then injected with microsyringe into the caudate nucleus, 10 μL injected at first, paused for 2 minutes, and then the rest 40 μL injected slowly and continuously within 2 minutes. After the injection, the needle was kept immovable for about 4 minutes, withdrawn 2.0 mm, again kept immovable for about 4 minute, and then removed wholly at a slow speed. In the single injection group, 50 μL unclotted tail blood was injected slowly and continuously all within 2 minutes and the needle was slowly removed;（4） In the double injection group, 10 mL blood was injected at first, paused for 2 minutes, the rest 40 μL injected evenly within 2 minutes, and then the needle was withdrawn slowly and uninterruptedly. Neurologic findings were scored in accordance with Longa＇s five-point scale （0-4 scores, the higher the score, the severer the neurological dysfunction）. The rats were killed to remove and sections were prepared, the morphological features of hematomas were grossly observed, the maximal diameter and size of hematomas in each slice were measured with the imaging analytical system, and the volume was calculated. Meanwhile, the conveniences of the techniques were compared. MAIN OUTCOME MEASURES： The morphological features and volume of hematomas, neurologic deficit score （NDS）, and the convenience of the techniques were compared. RESULTS： All the 30 rats were involved in the analysis of results without deletion. （1） Results of the morphological observation of volume of hematoma： In the two-step injection group, hematomas located in the right caudate nucleus area regularly in circular or analogously circular shape in each slice. The formation rate of hematomas in the single injection group and double injection group were lower than those in the two-step injection group [60% （6/10）, 80% （8/10）, 100% （10/10）, P〈 0.01, 0.05]. The volume of hematomas in the single injection group and double injection group were smaller than those in the two-step injection group [（28.5±14.8）, （33.4±7.4）, （41.6±3.9） mm3, P〈 0.01, 0.05]. （2） NDS results： The NDS scores in the single injection group and double injection group were smaller than that in the two-step injection group （0.90±0.83, 1.30±0.78, 1.90±0.57, P〈 0.05）. （3）Comparison of the convenience of the techniques： The double injection method allowed generating reproducible hematomas in rats with shortcomings that it needed autologous arterial blood from femoral artery, and precision instruments such as microinfusion pump. The two-step injection injected fresh unclotting blood taken directly from the tail cut with microsyringe into the rat brain, and it has the advantages of easy operation, no influence on the activity of thrombase, shorter duration for model establishment, and higher rate of hematoma formation, which could generate ideal and economical models of ICH. The two-step injection induced hemotoma regularly in circular or analogously circular shape in each slice, but those induced by single and double injections were mostly in strip or fusiform shapes and extending along the needle tracks or into the ventricle or subarachnoid space. CONCLUSION ： The autologous blood ICH model induced by the two-step injection method is a reproducible and reliable one in regular shape, which is better than those induced by double and single injections.

Expression of yeast silencing information regulator 2 in secondary injury of intracerebral hemorrhage

Objective:to investigate the expression of yeast silencing information regulator 2(Sirt2)in the secondary injury of intracerebral hemorrhage(ICH).Methods:twelve Sprague Dawley(SD)rats were randomly divided into a sham group and an ICH group,with six rats in each group.A rat model of ICH was established by injecting collagenase type IV into the right striatum of the rats.The expression of Sirt2 was measured by Western blot and immunohistochemistry after ICH.Result:the behavioral score of the ICH rats was the lowest at 48 h after the operation;therefore the rats at 48 h after surgery were selected as the model rats.The expression of Sirt2 was significantly higher in the striatal tissue of the ICH rats compared with the sham group(P<0.05).Conclusion:the expression of Sirt2 around hematoma in ICH rats decreases,and Sirt2 is expected to become a new target for ICH treatment.

126例ICH患者再次出血致使早期血肿扩大与意识水平相关性的探讨分析

目的探讨分析大脑半球自发性脑内出血(ICH)患者意识水平与早期血肿扩大及血肿量的相关性,为血肿扩大的预测提供新指标。方法对126例发病后4 h内CT诊断为大脑半球ICH患者,24 h后复查CT,了解血肿扩大的发生情况,将结果与首诊时格拉斯哥昏迷评分(GCS)和脑实质内血肿量之间的关系进行分析。结果早期血肿扩大发生率为27.0%。经统计分析,在轻、中度意识障碍组(GCS 9～15分)GCS评分与血肿量呈正相关(P<0.05),在重度意识障碍组(GCS 3～8分)GCS评分仅与血肿扩大相关(P<0.05)。结论患者就诊时GCS评分是大脑半球ICH早期血肿扩大的重要预测指标,血肿量不大而意识障碍严重,高度提示血肿进行性生长。

ICH-FOS量表及糖基化指数评估脑出血后1年预后效果

目的探讨脑出血功能预后评分(ICH-FOS)量表及糖基化指数(HGI)对脑出血后1年预后情况的指导价值。方法对188例脑出血患者进行ICH-FOS量表评价,并根据空腹血糖及GHbA1c计算HGI,按HGI将患者分为低HGI、中HGI及高HGI组。在患者发病后1年进行随访,采用多因素分析HGI结合ICH-FOS量表对评价患者1年预后的效果。结果188例中预后不良共93例,随着ICH-FOS分值增加,预后不良比例也增高;中HGI组血糖偏低,与高HGI组间存在差异[(6.2±1.85)mmol/L vs.(8.0±3.11)mmol/L,P=0.003];低、中、高HGI组的GHbA1c逐渐增大[6.2%vs.6.9%vs.9.3%],差异有统计学意义(P<0.05)。多因素分析显示,ICH-FOS量表中的各项及HGI均与脑出血1年的预后相关(P均<0.05)。结论ICH-FOS量表及HGI有助于指导临床医师评估脑出血患者的预后。

Research progress of localization technique assisted neuroendoscopy for cerebral hemorrhage

Neurosurgeons who perform intracere-bral hemorrhage(ICH)evacuation procedures have lim-ited options for monitoring hematoma evacuation and intraoperatively assessing residual-hematoma burden.In recent years,neuroendoscope-assisted,minimally inva-sive surgery for spontaneous ICH is simple and effective and becoming increasingly common.Many methods are applied in neuronavigation-assisted surgery for ICH evac-uation,such as neuroendoscopy,three-dimensional(3D)reconstruction,intraoperative ultrasound,and stereotac-tic craniotomy.Compared with a traditional craniotomy operation,hematoma removal(using methods of accurate localization)can reduce iatrogenic damage,protect white matter,and shorten patients’recovery time.This paper mainly outlines the treatment of basal ganglia-cerebral hemorrhage with neuroendoscopy assistance using local-ization techniques.

miR-27b、miR-7在AICH患者早期神经功能恶化的诊断价值

目的分析微小RNA-27b (miR-27b)、微小RNA-7 (miR-7)对急性脑出血(AICH)患者早期神经功能恶化(END)的诊断价值。方法选择2017年5月至2020年6月本院收治的256例自发性AICH患者为研究对象,选取同期健康体检对象140例为对照组,根据入院及复评NIHSS评分对AICH患者进行分组,其中END组58例,非END组198例。收集所有受试者一般资料;实时荧光定量PCR(qRTPCR)法检测血清miR-27b、miR-7的表达水平;ROC曲线分析血清miR-27b、miR-7表达水平对AICH患者END的诊断价值;Logistic回归分析AICH患者发生END的危险因素。结果与对照组比较,非END组、END组的高血压史例数、收缩压、舒张压、miR-27b表达显著升高,miR-7表达显著降低(P<0.05);与非END组比较,END组入院NIHSS评分、入院血肿体积、破入脑室例数、miR-27b表达水平均显著升高,miR-7表达显著降低(P<0.05);ROC曲线结果显示,血清miR-27b、miR-7表达诊断END的ROC曲线下面积(AUC)分别为0.812、0.819,联合诊断END的的AUC为0.931,敏感度为86.2%,特异性为89.9%;多因素Logistic回归分析显示入院NIHSS评分、入院血肿体积、破入脑室、miR-27b是END发生的危险因素,miR-7是END发生的保护因素(P <0.05)。结论miR-27b、miR-7可能是AICH患者END诊断的潜在生物标志物,二者血清表达水平结合患者一般资料可能能够为END发生的预测提供一定的理论依据。

Advances in surgical treatment of intraventricular hemorrhage

Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis.The advantages of surgical intervention in patient management are impressive.This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage(EVD)combined with intraventricular fibrinolysis(IVF)and continuous lumbar cistern drainage(LCD),as well as their safety and efficacy,especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.

急性高血压性脑出血患者的早期血压管理与预后关系的一项前瞻性研究

目的 分析在急性高血压导致的脑出血患者中进行早期积极的血压管理对患者的血压变化、血肿控制和预后生活质量的影响。方法 便利抽样选取2020年1月—12月急诊入住蚌埠三院急诊内科及EICU的符合纳入标准的急性脑出血患者39例作为对照组,给予常规治疗,根据血压水平缓慢降压,即24 h内收缩压(SBP)控制在180 mmHg以内;2021年1月—12月的急性脑出血患者39例作为观察组,给予强化降压,持续泵入药物乌拉地尔,要求24 h SBP控制在130~140 mmHg。比较两组患者血压变化、血肿控制情况和发病90 d后的功能恢复(改良的Rankin量表)和生活自理能力(Barthel Index)。结果 干预前两组患者收缩压、血肿量差异无统计学意义(P>0.05);干预后,观察组SBP在用药10 min、用药60 min均下降,且低于对照组,但差异无统计学意义(P>0.05);用药120 min和用药24 h时差异比较明显,显著低于对照组(P<0.01)。观察组舒张压(DBP)在用药60 min、用药120 min和用药24 h时均低于对照组,差异有统计学意义(P<0.01);观察组90 d预后良好的人数(27人)高于对照组(24人),预后不良的人数(12人)少于对照组(15人),但组间差异无统计学意义(P>0.05),且两组的生活自理能力的差异无统计学意义(P>0.05)。结论 在急性高血压性脑出血患者中使用乌拉地尔进行强化降压(SBP130~140 mmHg),可以达到控制血压和减缓血肿扩大的效果,但对患者的生存率及长期生活自理能力的改善并不明显。

急性自发性脑出血患者脑血管负荷及血清神经丝轻链、钠水平与近期预后的关系

目的 分析急性自发性脑出血(sICH)患者脑血管负荷及血清神经丝轻链(NFL)、钠水平与近期预后的关系。方法 我院收治的129例急性sICH患者,根据其3个月的Rankin量表(mRS)评分分为预后良好组和预后不良组,对比两组临床资料、脑小血管病(CSVD)负荷评分及血清NFL、钠水平差异,分析急性sICH患者不良预后的影响因素以及CSVD总负荷评分、血清NFL、钠水平在急性sICH预后评估中的价值。结果 本组患者预后不良率为35.66%。与预后良好组相比,预后不良组大量脑出血占比、入院时脑出血(ICH)评分、CSVD总负荷评分及血清NFL水平更高,血钠水平、格拉斯哥昏迷量表(GCS)评分更低(P<0.05);入院时GCS评分、CSVD总负荷评分及血清NFL、钠水平是急性sICH患者不良预后的影响因素(P<0.05);CSVD总负荷评分及血清NFL、钠水平单独预测急性sICH患者不良预后的ROC下曲线面积(AUC)分别为0.702、0.805、0.710,三项联合预测的AUC更高(0.906)(P<0.05)。结论 CSVD总负荷评分及血清NFL、钠水平与急性sICH患者近期预后不良之间存在关联,可为急性sICH患者预后评估提供参考,且三项联合效能更高。

MSK1/CREB信号轴的激活与丁苯酞抑制大鼠脑出血后神经元凋亡的相关性

目的:探讨丁苯酞(NBP)通过丝裂原和应激激活激酶-环磷腺苷效应元件结合蛋白(MSK1-CREB)信号轴对脑出血(ICH)后神经元凋亡的抑制机制。方法:通过Ⅶ型胶原酶尾状核内注入法建立大鼠ICH模型,分别设对照组、假手术组(Sham)、ICH+NBP组、ICH+生理盐水(NS)组。使用改良大鼠神经功能缺损评分(mNSS)评估神经功能,采用干-湿重比较法测量脑组织含水率,通过蛋白印迹和免疫荧光分析检测血肿周围组织中半胱氨酸蛋白酶-3(Caspase-3)、B淋巴细胞瘤-2因子(Bcl-2)、环磷腺苷效应元件结合蛋白(CREB)和丝裂原和应激激活激酶1(MSK1)的表达水平。结果:NBP治疗可显著改善脑出血后大鼠的神经功能缺损,减轻脑水肿,同时抑制Caspase-3的表达并增加Bcl-2、CREB和MSK1的表达。结论:丁苯酞可通过MSK1-CREB信号轴抑制大鼠脑出血后神经元凋亡,改善神经功能和减轻脑水肿。

脑血疏口服液不同用药时点对脑出血急性期大鼠血肿大小及CD36表达的影响

目的:观察脑血疏口服液在不同用药时点对脑出血急性期大鼠血肿大小及CD36表达的影响。方法:采用尾状核注射Ⅶ型胶原酶构建大鼠脑出血模型。将40只SD大鼠随机分为假手术组(A组)、模型组(B组)、预给药组(C组)、造模后6 h给药组(E组)、造模后24 h给药组(G组)。造模前,C组给予脑血疏口服液灌胃,其余各组给予等量生理盐水灌胃,共7 d。造模后,C、E和G组分别于各自时点给予脑血疏口服液灌胃,其余各组给予等量生理盐水,共3 d。运用改良的神经功能缺损评分标准(mNSS)评估大鼠神经功能缺损程度,磁共振成像技术(MRI)检测脑内血肿体积,苏木-伊红染色(HE)观察血肿周围组织形态,透射电镜观察血肿周围组织超微结构,免疫组化(IHC)观察血肿周围组织CD36阳性细胞数,蛋白印迹法(Western Blot)检测CD36蛋白表达。结果:神经功能缺损评分结果显示,各组大鼠在造模后均出现不同程度的神经功能缺损,与B组相比,C组及E组神经功能评分降低(P<0.05)。病理染色结果提示,C、E、G组较B组血肿周围组织坏死面积减少,周围组织疏松减轻,神经元超微结构改善,线粒体数量增多。MRI检测显示,与B组相比,C、E、G组大鼠血肿体积减小(P<0.05),其中,C、E组血肿吸收率显著提高(P<0.05)。Western Blot结果提示,与B组相比,C、E组的CD36表达水平显著升高(P<0.05)。免疫组化结果提示,与B组相比,C、E、G组大鼠的血肿周围组织CD36免疫标记阳性表达染色加深,数量增多,CD36表达水平升高(P<0.05)。结论:脑出血急性期应用脑血疏口服液不会增加血肿扩大风险及再出血风险,在不同时点给药均可改善大鼠神经功能,促进大鼠血肿吸收,减轻神经元结构损害,且在脑出血急性期6 h内给药疗效最佳,其机制可能与上调大鼠脑出血后CD36的表达有关。

高血压脑出血患者早期肾损伤的危险因素研究

目的 探讨高血压脑出血(HICH)患者早期肾损伤(AKI)的危险因素。方法 选取2020年7月至2022年6月江苏省海安市人民医院收治的90例HICH患者作为研究对象,根据患者早期是否发生AKI情况分为AKI组(21例)与非AKI组(69例)。采用单因素及多因素Logistic回归分析评价尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿微量白蛋白与肌酐比值(ACR)及血清同型半胱氨酸(Hcy)是否为影响HICH患者早期AKI发生的独立危险因素,采用受试者操作特征(ROC)曲线评价尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生的预测价值。结果 AKI组输血或使用甘露醇占比及尿NGAL、尿ACR和血清Hcy水平高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,输血或使用甘露醇[OR=3.556,95%CI(1.608~7.864)]、尿NGAL[OR=1.005,95%CI(1.002~1.008)]、尿ACR[OR=1.812,95%CI(1.251~2.625)]及血清Hcy[OR=1.923,95%CI(1.455~2.542)]是影响HICH患者早期AKI发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生均有预测效能(P<0.05),其曲线下面积分别为0.786[95%CI(0.680~0.892)]、0.676[95%CI(0.553~0.799)]和0.737[(95%CI(0.631~0.843)];3项指标联合预测早期AKI发生的曲线下面积为0.914[(95%CI(0.823~1.000)]。结论 尿NGAL、尿ACR及血清Hcy是影响HICH患者早期AKI发生的独立危险因素,对早期AKI发生均有一定的预测价值,且三者联合预测早期AKI发生的价值更高。