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 ...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.展开更多
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...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.展开更多
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 t...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.展开更多
目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性...目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性卒中静脉溶栓后症状性颅内出血预测模型相关研究信息,检索时限为建库至2022年12月18日。由2位研究员独立筛选文献、提取资料并评价偏倚风险后对纳入模型的基本特征和方法论进行系统评价。结果纳入20项研究,共30个预测模型。纳入模型ROC曲线的AUC值范围为0.42~0.94。24个(80%)预测模型的整体预测性能较好,模型对不同结局的定义和算法的区分度有明显差异。最常见的预测因子包括NIHSS评分、年龄、梗死的影像学征象或评分、血糖、收缩压和抗血小板药物。结论急性缺血性卒中静脉溶栓后症状性颅内出血预测模型呈现出建模算法多样化、模型性能更佳化、预测因素多元化等特点,但总体偏倚风险较高,未来研究还需要进一步校准模型。此外,应更加关注模型的更新与外部验证,提高其外推性及临床效用,从而发挥模型更大的临床价值。展开更多
目的:选取国内外急性脑梗死患者阿替普酶溶栓后颅内出血风险因素的相关证据,并对最佳证据进行总结,为降低急性脑梗死溶栓术后颅内出血风险提供参考。方法:系统检索国内外数据库及相关协会官方网站中关于急性脑梗死患者阿替普酶溶栓颅内...目的:选取国内外急性脑梗死患者阿替普酶溶栓后颅内出血风险因素的相关证据,并对最佳证据进行总结,为降低急性脑梗死溶栓术后颅内出血风险提供参考。方法:系统检索国内外数据库及相关协会官方网站中关于急性脑梗死患者阿替普酶溶栓颅内出血风险因素的所有证据,包括相关指南、最佳临床实践、专家共识、相关证据总结、系统评价及各类标准;检索时限为2010年1月1日~2022年12月;对检索结果进行分析总结。结果:共纳入14篇文献,包括指南6篇、专家共识1篇、系统评价4篇、科学声明3篇。通过对14篇相关文献按照科学步骤进行分析,得出共有8项影响因素与急性脑梗死患者使用阿替普酶静脉溶栓后发生颅内出血相关:时间窗、高血压、高血糖、入院美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、心房颤动、溶栓前中性粒细胞百分比、大面积梗死、溶栓前头颅CT有早期缺血改变。结论:本研究总结了急性脑梗死患者在使用阿替普酶溶栓后发生颅内出血的相关风险因素的最佳证据,为降低其发生率提供了循证依据。展开更多
目的比较临床上常用的5种深静脉血栓(deep venous thrombosis,DVT)风险评估工具在脑出血急性期患者中的应用价值,筛选出当前更适合的工具,助力医护人员精准识别高危人群。方法采用回顾性研究法,随机选取2020年1~12月在温州医科大学附属...目的比较临床上常用的5种深静脉血栓(deep venous thrombosis,DVT)风险评估工具在脑出血急性期患者中的应用价值,筛选出当前更适合的工具,助力医护人员精准识别高危人群。方法采用回顾性研究法,随机选取2020年1~12月在温州医科大学附属第一医院神经内科住院治疗的256例脑出血急性期患者作为研究对象,由研究者分别应用5种DVT风险评估工具(Padua风险评估模型、Caprini风险评估模型、WellsDVT风险评估模型、Autar风险评估模型和急性脑卒中患者DVT风险评估模型)对患者进行评估,用优劣解距离法(technique for order preference by similarity to ideal solution,TOPSIS)对各工具的敏感度、特异性、受试者操作特征(receiveroperatingcharacteristic,ROC)曲线下面积(area under the curve,AUC)、准确率等进行综合比较并排序,筛选出更适合脑出血急性期患者的DVT风险评估工具。结果5种DVT风险评估工具在脑出血急性期患者中的相对接近程度值(Ci)依次为Autar风险评估模型0.681、Padua风险评估模型0.636、Caprini风险评估模型0.385、急性脑卒中患者DVT风险评估模型0.363、Wells DVT风险评估模型0.315。结论通过综合比较发现,在5种DVT风险评估工具中,Autar风险评估模型预测脑出血急性期患者发生DVT风险的效果更优,建议医护人员采用Autar风险评估模型预测脑出血急性期患者发生DVT的风险。展开更多
文摘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.
文摘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.
文摘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.
文摘目的系统评价急性缺血性卒中静脉溶栓后症状性颅内出血预测模型的特征,为静脉溶栓临床决策提供参考。方法检索中国知网、万方数据知识服务平台、维普资讯、PubMed、Embase、Web of Science和The Cochrane Library数据库,收集急性缺血性卒中静脉溶栓后症状性颅内出血预测模型相关研究信息,检索时限为建库至2022年12月18日。由2位研究员独立筛选文献、提取资料并评价偏倚风险后对纳入模型的基本特征和方法论进行系统评价。结果纳入20项研究,共30个预测模型。纳入模型ROC曲线的AUC值范围为0.42~0.94。24个(80%)预测模型的整体预测性能较好,模型对不同结局的定义和算法的区分度有明显差异。最常见的预测因子包括NIHSS评分、年龄、梗死的影像学征象或评分、血糖、收缩压和抗血小板药物。结论急性缺血性卒中静脉溶栓后症状性颅内出血预测模型呈现出建模算法多样化、模型性能更佳化、预测因素多元化等特点,但总体偏倚风险较高,未来研究还需要进一步校准模型。此外,应更加关注模型的更新与外部验证,提高其外推性及临床效用,从而发挥模型更大的临床价值。
文摘目的:选取国内外急性脑梗死患者阿替普酶溶栓后颅内出血风险因素的相关证据,并对最佳证据进行总结,为降低急性脑梗死溶栓术后颅内出血风险提供参考。方法:系统检索国内外数据库及相关协会官方网站中关于急性脑梗死患者阿替普酶溶栓颅内出血风险因素的所有证据,包括相关指南、最佳临床实践、专家共识、相关证据总结、系统评价及各类标准;检索时限为2010年1月1日~2022年12月;对检索结果进行分析总结。结果:共纳入14篇文献,包括指南6篇、专家共识1篇、系统评价4篇、科学声明3篇。通过对14篇相关文献按照科学步骤进行分析,得出共有8项影响因素与急性脑梗死患者使用阿替普酶静脉溶栓后发生颅内出血相关:时间窗、高血压、高血糖、入院美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、心房颤动、溶栓前中性粒细胞百分比、大面积梗死、溶栓前头颅CT有早期缺血改变。结论:本研究总结了急性脑梗死患者在使用阿替普酶溶栓后发生颅内出血的相关风险因素的最佳证据,为降低其发生率提供了循证依据。
文摘目的比较临床上常用的5种深静脉血栓(deep venous thrombosis,DVT)风险评估工具在脑出血急性期患者中的应用价值,筛选出当前更适合的工具,助力医护人员精准识别高危人群。方法采用回顾性研究法,随机选取2020年1~12月在温州医科大学附属第一医院神经内科住院治疗的256例脑出血急性期患者作为研究对象,由研究者分别应用5种DVT风险评估工具(Padua风险评估模型、Caprini风险评估模型、WellsDVT风险评估模型、Autar风险评估模型和急性脑卒中患者DVT风险评估模型)对患者进行评估,用优劣解距离法(technique for order preference by similarity to ideal solution,TOPSIS)对各工具的敏感度、特异性、受试者操作特征(receiveroperatingcharacteristic,ROC)曲线下面积(area under the curve,AUC)、准确率等进行综合比较并排序,筛选出更适合脑出血急性期患者的DVT风险评估工具。结果5种DVT风险评估工具在脑出血急性期患者中的相对接近程度值(Ci)依次为Autar风险评估模型0.681、Padua风险评估模型0.636、Caprini风险评估模型0.385、急性脑卒中患者DVT风险评估模型0.363、Wells DVT风险评估模型0.315。结论通过综合比较发现,在5种DVT风险评估工具中,Autar风险评估模型预测脑出血急性期患者发生DVT风险的效果更优,建议医护人员采用Autar风险评估模型预测脑出血急性期患者发生DVT的风险。
