Function prognosis promotion and relative factor analysis of subhypothermia therapy to hypertension cerebral hemorrhage patients

Objective To study the effect of sub-hypotherm ia on hypertension cerebral hemorrh age and content of serum endothelin(ET).Method87hypertension cerebral hemorrhage cases were divided into subhypothermia group and control group randoml y,patients in subhy-pothermia group received subhypoth ermia therapy in NICU 6hours after operation or hospitalization.We tested serum ET content with specific radioimmunoassay method 24hours,72hours and 3weeks after therapy,and compared them with control group.Result ET content of two groups increased apparently after 24hours,ET of subhypothermia group was lower than that of control group(P <0.01);it recovered 3weeks after therapy.Conclusion Subhypothermia techniques can appa rently improve prognosis of hyperte nsion cerebral hemorrhage patients,serum ET level may be one important index to evaluate severity of hypertension cerebral hemorrhage.

Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery.Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group.Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage, and contribute to the neurological function recovery. TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage, but also has a certain value in evaluating the prognosis of neurological function.

Therapeutic potential of stem cells in subarachnoid hemorrhage

Aneurysm rupture can result in subarachnoid hemorrhage,a condition with potentially severe consequences,such as disability and death.In the acute stage,early brain injury manifests as intracranial pressure elevation,global cerebral ischemia,acute hydrocephalus,and direct blood–brain contact due to aneurysm rupture.This may subsequently cause delayed cerebral infarction,often with cerebral vasospasm,significantly affecting patient outcomes.Chronic complications such as brain volume loss and chronic hydrocephalus can further impact outcomes.Investigating the mechanisms of subarachnoid hemorrhage-induced brain injury is paramount for identifying effective treatments.Stem cell therapy,with its multipotent differentiation capacity and anti-inflammatory effects,has emerged as a promising approach for treating previously deemed incurable conditions.This review focuses on the potential application of stem cells in subarachnoid hemorrhage pathology and explores their role in neurogenesis and as a therapeutic intervention in preclinical and clinical subarachnoid hemorrhage studies.

EFFECT OF ACUPUNCTURE ON NEUROLOGICAL DEFECTS AND DAILY LIFE ABILITY IN PATIENTS WITH ACUTE CEREBRAL HEMORRHAGE

Objective: To observe the effect of acupuncture of Shuigou (GV 26), Neiguan (PC 6), Zusanli (ST 36), etc. on neurological defects and daily life ability in patients with acute cerebral hemorrhage. Methods: Fifty eight cases of acute cerebral hemorrhage patients were randomized into control group (n=28) and treatment group (n=30). Patients of two groups were both treated with intravenous infusion of Mannitol and other expectant medicines. In addition, patients of treatment group were also treated with acupuncture therapy, once daily and continuously for one month. Before and after treatment, the scores of neurological defects and daily life ability (Barthel Index) were given for assessing the therapeutic effect. Results: Following treatment, both scores of neurological defects of two groups decreased significantly (P<0.05), and the score of treatment group was strikingly lower than that of control group (P<0.05). After treatment, values of Barthel Index (BI) of two groups increased considerably in comparison with pre treatment (P<0.01), and the value of BI of treatment group was bigger than that of control group (P<0.05). Conclusion: Acupuncture can improve acute cerebral hemorrhage patients’ nervous function and daily life ability.

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.

ADVANCES IN CLINICAL AND EXPERIMENTAL STUDIES ON ACUPUNCTURE TREATMENT OF ACUTE CEREBRAL HEMORRHAGE

In the present paper, the authors review recent advances in clinical and experimental studies on acupuncture treatment of cerebral hemorrhage(CH). Regarding clinical studies, the resuscitation-inducing needling maneuver, and main points of Shuigou(水沟GV 26),Baihui(百会 GV 20) and scalp-points Motor Area(MS 6), Sensory Area(MS 7), etc. are often involved. Concerning experimental studies, the underlying mechanisms of acupuncture of GV-26+“Neiguan”(内关 PC 6), GV-20,GV-26+GV-20, etc. in improving acute CH are introduced. In a word, acupuncture therapy works well in improving clinical symptoms and signs of CH patients, and acupuncture stimulation induced ameilioration of cerebral blood flow, favorable modulation of some bioactive substances as excitatory and inhibitory amino acids, endothelin, CGRP, heat shock protein 70, etc. and neuro-endocrine-immune network may contribute to the effect of acupuncture on CH. In addition, acupuncture combined with medicine and earlier application of acupuncture therapy in the acute stage of CH are recommended in clinical practice.

The Effect of Zhu Yu Hua Tan Tang on IntracranialPressure in Case of Acute Cerebral Hemorrhage

The therapeutic effect of Zhu Yu Hua Tan Tang (逐瘀化痰汤Decoction for removing blood stasis and resolving phlegm) plus general and modern treatment on acute cerebral hemorrhage in 44 cases, and the pressure-lowering effect of Zhu Yu Hua Tan Tang and mannitol in 20 cases of acute cerebral hemorrhage in the basilar region, and in rabbits with experimental encephaledema induced by injection of olive oil into the common carotid artery were observed in this study. The results showed that Zhu Yu Hua Tan Tang plus general treatment can better improved the conscious state of the patients than western medicine, and it can make the intracranial pressure drop clinically by 40.44%. The intracranial pressure-lowering effect of Zhu Yu Hua Tan Tang, though slow, is smooth and long-lasting without any rebound phenomenon, as compared to those of mannitol. Similar results were found in animal experiments, but the intracranial pressure-lowering amplitude of Zhu Yu Hua Tan Tang was stronger than that of mannitol. The difference between the clinical and experimental results needs to be further studied.

New Developments in Drug Therapy and Research of Cerebral Vasospasm

In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vaso-spasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Current research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.

INFLUENCE OF DIFFERENT NEEDLE-RETAINING DURATION ON CEREBRAL HEMODYNAMICS OF CEREBRAL PARALYSIS CHILDREN

Objective: To investigate the effects of different needle-retaining duration on cerebral hemodynamics in cerebral paralysis (CP) children. Methods: A total of 20 cases of CP children were subjected into this study. Changes of systolic peak value (Vs), blood flow velocity at the end-diastolic phase (Ved), mean velocity (Vm), pulsation index (PI) and resistance index (RI) of the cerebral hemodynamics before and after performing JIN’s Three-Needling Therapy with the needles retained for 30 min (group A) and 5 min (group B) were observed by using transcranial Doppler ultrasonography (TCD). Results: After acupuncture, the blood flow in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) was accelerated, and the resistance of blood vessels decreased. The effect of needle-retaining-30 min was better than that of needle-retaining-5 min. Conclusion: In treating cerebral paralysis by using JIN’s Three-Needling Therapy, sufficient stimulation provided by needle remaining is an important factor for achieving satisfactory therapeutic effects.

Clinical Study on 28 Cases of Acute Cerebral Hemorrhage Treated by Scalp Acupuncture plus Rehabilitation Therapy

Objective： To evaluate the clinical efficacy of scalp penetrating technique plus rehabilitation therapy in treating acute cerebral hemorrhage. Methods： The patients were allocated randomly by computer into scalp acupuncture plus rehabilitation group （A）, rehabilitation group （B） and Western medication control group （C）. Results： The total effective rate and the curative and remarkable effective rate were 92.9% and 75.0% respectively in Group A, and 84.6% and 69.2% respectively in Group B and 75.9% and 37.9% respectively in Group C. There was a very significant difference in comparison of Group A and Group B with Group C （P〈0.01, P〈0.05）. There was no significant difference between Group A and Group B （P〉0.05）. But the total effective rate was significantly higher in Group A than in Group B. Conclusion： Scalp acupuncture plus rehabilitation therapy can obviously enhance the clinical effect in cerebral hemorrhage, reduce the neural deficit due to acute cerebral hemorrhage and improve the ability in daily life.

微创颅内血肿清除术对高血压脑出血患者的治疗作用及TCD评价

目的:探讨微创颅内血肿清除术对高血压脑出血患者的治疗作用,及动态TCD监测对患者神经功能恢复的预测价值。方法:选取我院收治的高血压脑出血患者70例,依据治疗方案不同分为微创组及保守组各35例;两组入院后均接受药物保守治疗,微创组同时行尿激酶联合YL-1型血肿穿刺针微创治疗,于治疗前及治疗后第1d、5d、10d和21d行TCD检测,计算血肿及水肿体积变化,并于各时间段行神经功能障碍评分(NIHSS)以评价神经功能恢复情况。结果:微创组治疗后各时间点TCD检测参数Vs、Vd、Vm逐渐升高,PI逐渐降低;保守组治疗后Vs、Vd、Vm先降低后升高,PI先升高后减低,且在治疗后第10d达到低点/峰值;治疗后5d、10d、21d微创组Vs、Vd、Vm高于保守组,PI低于保守组(P<0.05)。治疗后两组脑血肿及水肿体积逐渐降低(P<0.05),微创组各时间点脑血肿及水肿体积明显低于保守组(P<0.05)。治疗后微创组NIHSS评分逐渐下降,保守组NIHSS评分先升高后降低,于治疗后第10d达到峰值,且各时间点均高于微创治疗(P<0.05)。结论:早期微创手术可明显改善高血压脑出血患者血肿周围血流量,利于神经功能恢复,TCD不仅可以用于高血压脑出血患者脑血流量的动态变化监测,对患者神经功能预后具有一定评价价值。

创伤性脑损伤与自发性蛛网膜下腔出血所致脑血管痉挛的TCD临床对比观察

目的探讨经颅多普勒超声（TCD）对创伤性脑损伤（TBI）及自发性蛛网膜下腔出血（SAH）所致脑血管痉挛（CVS）的诊断价值。方法选择381例TBI和216例SAH患者,应用CT、CTA及TCD等确定患者的临床诊断并筛选出存在CVS者,对TCD发现的CVS患者按血管痉挛程度（VmMCA值）分为轻、中、重三组。每天1次行TCD监测。比较两组CVS发生率、开始时间、严重程度及持续时间。结果 381例TBI患者中共发生CVS 210例,发生率为55.12%;CVS发生在伤后2~3 d,持续10~14 d。而216例SAH患者CVS发生151例,发生率为69.91%,发生时间在发病后3~7 d,持续14~21 d。两组CVS发生率、发病高峰及病程比较差异均有统计学意义（P〈0.01）。结论 TCD对CVS能准确进行临床诊断;创伤性脑损伤所致脑血管痉挛发生率低于自发性蛛网膜下腔出血脑血管痉挛,但发生时间早,发生程度轻,持续时间短,预后好。

TCD与CT检测对脑血管淀粉样变脑出血术后预后评估的临床意义

目的探讨脑淀粉样血管病(CAA)相关的脑出血(CAAH)的临床特点及TCD与CT检测对其预后评估的临床意义。方法对10年来收治27例CAAH分为预后良好和预后不良组进行临床资料分析。结果两组患者TCD与CT检测相比较,差异有统计学意义。结论 CAAH以65岁以上老年人多见;出血部位多在脑叶,其中以顶枕最常见,且有多灶、易复发的特点;TCD与CT检测对病情评估及预后判断具有临床意义。

头穴与项穴丛刺治疗脑供血不足性眩晕TCD即时效应对比研究

目的比较头穴丛刺和项穴丛刺对脑供血不足性眩晕患者脑血流即时效应的影响。方法将57例脑供血不足性眩晕患者随机分成治疗组29例和对照组28例。治疗组采用头穴丛刺治疗,对照组采用项穴丛刺治疗。观察两组治疗前后经颅多普勒(transeranial doppler,TCD)所示大脑中动脉(MCA)、颈内动脉(ICA)、基底动脉(BA)、小脑后下动脉(PINCA)、椎动脉(VA)的收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)变化。结果治疗组治疗后各血管(MCA、ICA、BA、PINCA、VA)血流速度(Vs、Vd、Vm)与同组治疗前比较,差异均具有统计学意义(P<0.01,P<0.05)。对照组治疗后MCA、ICA、VA及PINCA血流速度与同组治疗前比较,差异均具有统计学意义(P<0.01)。对照组治疗后BA的Vs与Vm与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后各血管血流速度与对照组比较,差异均无统计学意义(P>0.05)。结论头穴丛刺和项穴丛刺均能即时改善患者大脑各低流速血管的Vs、Vd、Vm,两种刺法对各血管Vs、Vd、Vm改善程度相近。

Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?

AIM: To use perfusion-derived permeability-surface area product maps to predict hemorrhagic transformation following thrombolytic treatment for acute ischemic stroke.METHODS: We retrospectively analyzed our prospectively kept acute stroke database over five consecutive months for patients with symptoms of acute ischemic stroke(AIS) who had computed tomography(CT) perfusion(CTP) done at arrival. Patients included in the analyses also had to have a follow-up CT. The permeability-surface area product maps(PS) was calculated for the side of the ischemia and/or infarction and for the contralateral unaffected side at the same level. The cerebral blood flow map was used to delineate the ischemic territory. Next, a region of interest was drawn at the centre of this territory on the PS parametric map. Finally, a mirror region of interest was created on the contralateral side at the same level. The relative permeability-surface area product maps(r PS) provided an internal control and was calculated as the ratio of the PS on the side of the AIS to the PS on the contralateral side. A student t-test was performed after log conversion of r PS between patients with and without hemorrhagic transformation. Log conversion was used to convert the data into normal distribution to use t-test. For the group of patients who experienced intracranial bleed, a student t-test was performed between those with only petechial hemorrhage and those with more severe parenchymal hematoma with subarachnoid haemorrhage.RESULTS: Of 84 patients with AIS and CTP at admission, only 42 patients had a follow-up CT. The r PSderived using the normal side as the internal control was significantly higher(P = 0.003) for the 15 cases of hemorrhagic transformation(1.71 + 1.64) compared to 27 cases that did not have any(1.07 + 1.30). Patients with values above the overall mean r PS of 1.3 had an increased likelihood of subsequent hemorrhagic transformation. The sensitivity of using this score to predict hemorrhagic transformation was 71.4, the specificity was 78.6, with a positive predictive value of 62.5 and negative predictive value of 84.6. The accuracy was 76.2. The odds ratio of an event occurring with such an r PS was 9.2. Of the 15 cases of hemorrhagic transformation, there was no difference(P = 0.35) in the r PS between the eight cases of petechial and the seven cases of more severe hemorrhagic events.CONCLUSION: Pretreatment PS can predict the occurrence of hemorrhagic transformation on follow-up of AIS patients with relatively high sensitivity, specificity, positive and negative predictive value.

Effect of Tianhuang Granule(田黄冲剂) on Intracranial Pressure and Serum Matrix Metalloproteinase-9 in Patients with Acute Cerebral Hemorrhage

Objective： To study the effect and mechanism of Tianhuang Granule （田黄冲剂, THG） on hydrocephalus in the patients with acute cerebral hemorrhage （ACH） through intracranial pressure （ICP） monitoring, serum matrix metalloproteinase-9 （MMP-9） level observation, and National Institutes of Health Stroke Scale （NIHSS） scoring （for nerve function deficit）. Methods： Sixty patients with ACH were equally randomized into two groups by lottery, the control group and the THG group; all were treated with conventional therapy, but to the patients in the THG group, THG was given orally in addition for 28 days. Changes of ICP, MMP-9 expression, and NIHSS scores, as well as the degree of cerebral hematoma and hydrocephalus （by cranial CT scanning） in the patients, were estimated and compared. Results： （1） ICP was lowered more significantly in the THG group, showing a significant difference between groups on day 7 （P〈0.05）. （2） MMP-9 expression was down-regulated in the THG group more significantly and earlier than that in the control group. （3） The degrees of cerebral hematoma and hydrocephalus in the THG group on day 7 were reduced significantly as compared with those on day 3 （P〈0.05）, but in the control group, the day of significant reduction was delayed to day 14, and the degrees on day 7 and day 14 in the two groups were significantly different （P〈0.05 and P〈0.01）. （4） NIHSS score was significantly lower in the THG group than that in the control group on day 14 and day 28 （P〈0.05 and P〈0.01）. Conclusion： THG can effectively lower ICP, down-regulate MMP-9 expression, promote the absorption of cerebral hematoma and hydrocephalus, and improve the nerve function, showing a clinical effectiveness than conventional therapy.

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.

TCD诊断对高血压脑出血术后预后的价值

目的:探讨TCD诊断对高血压脑出血术后预后的价值。方法:2004年6月-2012年12月收治高血压脑出血患者75例,血肿量30~80 ml,分为颅内动脉狭窄组(A组)和正常组(B组);各组均行微创或去骨瓣减压术,术后各组均给予脱水、止血、营养支持等治疗;术后3天、7天、15天计算水肿面积,采用ADL分级法评估6个月时神经功能恢复情况。结果:A组3天、7天、15天时水肿体积大于B组,差异有统计学意义(P<0.05);B组术后6个月ADL分级法评估神经功能恢复情况好于A组,差异有统计学意义(P<0.05)。结论:术后颅内血管TCD诊断对预测高血压脑出血预后有一定临床价值。

TCD监测脑出血患者颅内压的临床研究

目的:探讨经颅多普勒超声(TCD)监测脑出血患者的颅内压的临床意义。方法:选取2014年8-10月由本院神经内科收治的64例脑出血患者为研究对象,将脑出血患者作为观察组,并将同时期门诊健康者作为对照组,分别对两组患者行经颅多普勒超声检测颅内压,比较两组患者的颅内压以及各项脑血流动力学参数。结果:对观察组患者共进行了104次TCD和腰穿测压检测,对照组患者共进行了40次检测,频谱结果提示,随着颅内压的升高,平均血流速度与舒张期血流速度逐渐减小,与颅内压成反比例关系,但收缩期血流速度的变化规律不明显,组间比较差异无统计学意义(P>0.05);而搏动指数和阻力指数随着颅内压的增大逐渐增大,各组间比较差异均具有统计学意义(P<0.05)。结论:经颅多普勒超声检测脑出血患者的颅内压,具有无创伤、检测结果安全、可靠等优势,对患者的病情具有一定的指导作用。

早期肠内营养乳剂支持疗法治疗重症脑出血患者的临床研究

目的研究早期肠内营养支持疗法治疗重症脑出血患者的临床疗效及有效性分析。方法选择2021年10月至2023年2月期间于四川大学华西医院住院的108例重症脑出血患者作为研究对象,以随机数字表法分为对照组和观察组,每组各54例。对照组给予一般鼻饲饮食,观察组给予肠内营养乳剂,比较2组营养状况、急性生理与慢性健康评分(APACHEⅡ)、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、肠黏膜屏障功能、免疫指标、并发症发生情况。结果治疗前,2组营养状况[血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)]、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能[二胺氧化酶(DAO)、D-乳酸(D-LAC)、内毒素(ET)]、免疫指标[免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)]水平比较,差异无统计学意义(P>0.05);治疗2周后,观察组营养状况、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能、免疫指标水平较对照组更佳,差异有统计学意义(P<0.05);观察组并发症发生率为7.41%,较对照组的29.63%更低,差异有统计学意义(P<0.05)。结论对重症脑出血患者早期给予肠内营养乳剂,能够改善患者的营养状况、肠黏膜屏障功能,增强免疫力,减少并发症,减轻神经功能缺损,促进患者病情恢复,值得推广。