目的:观察脑出血急性期血凝动态变化规律,为治疗提供理论依据。方法:检测36例脑出血患者病后第1天、第3天、第5天、第10天、凝固启动时间(CST)、凝固达峰值时间(MCT)、最大凝固程度(MCE)、凝血酶原(FⅡ)、纤维蛋白原(Fg)和44例健康体检者的相同指标。结果:与对照组比较,脑出血组病后第1天、第3天、第5天,第10天的MCE、Fg、FⅡ增高(Plt;0.05)。结论:脑出血病后10天血凝显著增高,提示脑出血患者急性期应慎用止血剂和清除脑血肿。
The real-time monitoring of cerebral hemorrhage can reduce its disability and fatality rates greatly. On the basis of magnetic induction phase shift, we in this study used filter and amplifier hardware module, NI-PXI data-acquisition system and LabVIEW software to set up an experiment system. We used Band-pass sample method and correlation phase demodulation algorithm in the system. In order to test and evaluate the performance of the system, we carried out saline simulation experiments of brain hemorrhage. We also carried out rabbit cerebral hemorrhage experiments. The results of both saline simulation and animal experiments suggested that our monitoring system had a high phase detection precision, and it needed only about 0.030 4s to finish a single phase shift measurement, and the change of phase shift was directly proportional to the volume of saline or blood. The experimental results were consistent with theory. As a result, this system has the ability of real-time monitoring the progression of cerebral hemorrhage precisely, with many distinguished features, such as low cost, high phase detection precision, high sensitivity of response so that it has showed a good application prospect.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
The main magnetic field, generated by the excitation coil of the magnetic induction phase shift technology detection system, is mostly dispersed field with small field strength, and the offset effect needs to be further improved, which makes the detection signal weak and the detection system difficult to achieve quantitative detection, thus the technology is rarely used in vivo experiments and clinical trials. In order to improve problems mentioned above, a new Helmholtz birdcage sensor was designed. Stimulation experiment was carried out to analyze the main magnetic field in aspects of intensity and magnetic distribution, then different bleeding volume and bleeding rates experiments were conducted to compared with traditional sensors. The results showed that magnetic field intensity in detection region was 2.5 times than that of traditional sensors, cancellation effect of the main magnetic field was achieved, the mean value of phase difference of 10 mL rabbit blood was (–3.34 ± 0.21)°, and exponential fitting adjusted R2 between phase difference and bleeding volumes and bleeding rates were both 0.99. The proposed Helmholtz birdcage sensor has a uniform magnetic field with a higher field strength, enable more accurate quantification of hemorrhage and monitored change of bleeding rates, providing significance in magnetic induced technology research for cerebral hemorrhage detection.
ObjectiveTo analyze the clinical characteristics of cerebral shock after intracerebral emorrhage (ICH) to enhance the understanding of cerebral shock after ICH. MethodsA total of 136 patients with ICH admitted to hospital from February 2010 to December 2011 were enrolled in this study.Barthel index (BI) and NIH Stroke Scale (NIHSS) were finished within 48 hours.All the patients were divided into cerebral shock group and no cerebral shock group.All of the 136 patients were matched to shock group (39 cases) and no shock group (39 cases) by the baseline NIHSS score.After 6 months,we judged the prognosis of stroke patient by mRS and compared the prognosis between the two groups. ResultsIn 136 patients,95 had cerebral shock (69.85%),and 41 didn't.The NIHSS score in the shock group was higher than that in the no shock group,but the BI score was lower in the shock group.Six months later,2 patients died in shock group,in which lost follow up was in 1,good prognosis in 11,and poor prognosis in 25.In no shock group,1 patient died,2 were lost of follow up,and the prognosis was good in 29 and poor in 7.The prognosis in the shock group was poorer than that in the no shock group. ConclusionThere are neurological deficit symptoms and poor self-care ability in ICH patients associated with brain shock.The period of brain shock impact the prognosis of the patients with cerebral hemorrhage;early functional rehabilitation for stroke patients with brain shock is expected to improve the prognosis of patients with cerebral stroke.
Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
【摘要】 目的 分析脑中心疝对脑出血患者预后的影响，明确早期判定的重要性。 方法 回顾分析2005年2月－2010年8月所有因脑出血行手术治疗的173例患者的临床资料，其中并发小脑幕切迹疝48例，并发脑中心疝37例。 结果 173例患者治愈97例，轻残25例，中残30例，持续植物状态2例，死亡19例；死亡原因：脑功能衰竭11例，颅内感染2例，肺功能衰竭2例，肾功能衰竭3例，弥散性血管内凝血1例。脑中心疝患者病死率（27.03%）高于非脑中心疝患者（6.62%），差异有统计学意义（χ2=10.393，P=0.001）。脑中心疝分期与GOS分级呈负相关关系（rs=-0.827，P=0.000），分期越早，GOS分级越高；脑中心疝存活的27例患者日常生活、活动分级与脑中心疝分期呈正相关关系（rs=0.630，P=0.000），分期越早，ADL分级越低。 结论 脑中心疝的早期判定可以减少患者并发症的发生，降低病死率及伤残率。【Abstract】 Objective To Analyze the effect of brain center hernia on the prognosis of cerebral hemorrhage patients, and clarify the importance of early judgment of brain center hernia. Methods The recorded data of 173 patients undergoing surgery for cerebral hemorrhage in our hospital from February 2005 to August 2010 were retrospectively analyzed. Among them, there were 48 cases of combined transtentorial herniation and 37 cases of combined brain center hernia. Results Among the 173 patients, 97 were cured, 25 were slightly disabled, 30 were moderately disabled, 2 were in persistent vegetative state (PVS), and 19 died. In the 19 dead patients, 11 died of brain function failure, 2 of intracranial infection, 2 of lung failure, 3 of renal failure, and 1 of disseminated intravascular coagulation (DIC). The mortality of patients with brain center hernia (27.03%) was significantly higher than that of non-brain center hernia patients (6.62%) (χ2=10.393, P=0.001). The period of brain center hernia was negatively correlated with GOS′s stage (rs=-0.827, P=0.000), and the earlier the period, the higher the GOS stage. The brain center hernia period in the 27 survival patients was positively correlated with their ADL stage (rs=0.630, P=0.000), and the earlier the period, the lower the ADL stage. Conclusion Early judgement of brain center hernia can reduce patients′ complications, their mortality and disability rate.
ObjectiveTo analyze the trends and major risk factors of intracerebral hemorrhage (ICH) disease burden by gender in China and globally from 1990 to 2021, and to predict ICH incidence and mortality in China and globally by gender from 2022 to 2046. MethodsBased on the Global Burden of Disease Study 2021 (GBD 2021), data on ICH in China and globally from 1990 to 2021 were collected. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) were used to assess ICH disease burden and risk factors by gender. Joinpoint regression models were employed to calculate annual percentage change (APC) and average annual percentage change (AAPC) for trend analysis. The Bayesian age-period-cohort (BAPC) model was applied to predict ICH incidence and mortality from 2022 to 2046. ResultsFrom 1990 to 2021, ASIR, ASMR, and ASDR for ICH in China and globally showed declining trends across genders (P<0.05). For males in China and globally, the AAPC for ASIR was −1.63% (95%CI −1.69% to −1.57%) and −1.14% (95%CI −1.20% to −1.07%), respectively. For females in China and globally, the AAPC for ASIR was −2.27% (95%CI −2.35% to −2.18%) and −1.40% (95%CI −1.40% to −1.33%), respectively. The AAPC for ASMR in Chinese and global males was −1.81% (95%CI −2.07% to −1.55%) and −1.29% (95%CI −1.43% to −1.15%), respectively, while for females in China and globally, it was −2.74% (95%CI −2.94% to −2.54%) and −1.69% (95%CI −1.82% to −1.55%), respectively. The AAPC for ASDR in Chinese and global males was −1.91% (95%CI −2.11% to −1.72%) and −1.39% (95%CI −1.52% to −1.26%), respectively, and for females in China and globally, it was −2.93% (95%CI −3.07% to −2.79%) and −1.85% (95%CI −1.96% to −1.74%), respectively. By 2046, the predicted ASIR for ICH in Chinese and global males is projected to be 38.08/100 000 and 44.23/100 000, respectively, and 28.27/100 000 and 29.15/100 000 for Chinese and global females. The ASMR is predicted to reach 37.01/100 000 and 68.57/100 000 for Chinese and global males, and 22.39/100 000 and 29.45/100 000 for Chinese and global females, respectively. ConclusionThe disease burden of ICH in China has demonstrated a declining trend, yet it persistently exceeds global averages and exhibits pronounced gender disparities. There is an urgent need to enhance focus on these gender−specific variations and implement precisely targeted interventions tailored to the distinct risk factor profiles of each gender, in order to achieve further reductions in ICH−related disease burden.