BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHOD...BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.展开更多
BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to th...BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.展开更多
One disadvantage of direct anticoagulant drug is the lack of an antidote, which may become relevant in patients with traumatic brain in- jury. A 77-years old man with atrial fibrillation and syncope received dabigatra...One disadvantage of direct anticoagulant drug is the lack of an antidote, which may become relevant in patients with traumatic brain in- jury. A 77-years old man with atrial fibrillation and syncope received dabigatran despite recurrent falls. Due to a ground-level-fall, he suffered from subarachnoidal and intraparenchymal hemorrhages, subdural hematoma and brain edema with a midline shift. Despite osteoelast/c trepanation and hematoma-evacuation he remained comatose and died seven days later without regaining consciousness. Most probably, decreased dabigatran clearance due to increased age might have contributed to the fatal course. We suggest withholding anticoagulant therapy in patients with unexplained falls. If anticoagulant therapy is deemed necessary, vitamin-K-antagonists with their potential for laboratory monitoring and reversal of anticoagulant activity should be preferred.展开更多
Objective: To study the changes between cerebral oxygen (O 2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was...Objective: To study the changes between cerebral oxygen (O 2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was made, followed by open cardiopulmonary resuscitation, reperfusion with normal or high mean arterial pressure (MAP), and controlled ventilation to 4 h. Animals were randomly assigned into Group NT (normotensive reperfusion, n=6) and Group HT (hypertensive reperfusion, n=6). Cerebral arteriovenous (sagittal sinus) O 2 content difference (Ca-ssO 2) and venous (sagittal sinus) PO 2 (PssO 2) were determined before cardiac arrest (CA) and 30, 60, 120, and 240 min after CA. Results: In Group NT, Ca-ssO 2 was lower at 30 min (P<0.05) but higher at 240 min (P<0.01) after CA than that before CA. In Group HT, Ca-ssO 2 was not significantly different from that in Group NT before CA but was lower than that in Group NT at 30 min after CA (P<0.01). Ca-ssO 2 was not significantly different in Group NT and HT thereafter. In both groups, PssO 2 was both higher at 30 min after reperfusion (P<0.01) and at 240 min after reperfusion lower (P<0.05) than those before CA .At 30 min after reperfusion, PssO 2 was higher (P<0.01) in Group HT than that in Group NT, with insignificant difference between two groups. Conclusion: Cerebral O 2 delivery and uptake are mismatched after CA and resuscitation. Hypertensive reperfusion improves oxygen delivery to the brain early after CA.展开更多
Patients with headache constitute up to 4.5% of emergency department （ED） visits.~11 Cerebral venous thrombosis （CVT） is an important cause of the headache that is more common than once suspected. The diagnosis of...Patients with headache constitute up to 4.5% of emergency department （ED） visits.~11 Cerebral venous thrombosis （CVT） is an important cause of the headache that is more common than once suspected. The diagnosis of CVT is often missed or delayed because of non- specific clinical manifestations, and brain computerized tomography （CT） may easily be misinterpreted.展开更多
A model of cerebral vasospasm (CVS) associated with subarachnoid hemorrhage (SAH) was prepared on male Sprague-Dawley rats by a single intracisternal injection (i. c.) of 150 μl autologous fresh blood directly to Wil...A model of cerebral vasospasm (CVS) associated with subarachnoid hemorrhage (SAH) was prepared on male Sprague-Dawley rats by a single intracisternal injection (i. c.) of 150 μl autologous fresh blood directly to Willis circle.The process of CVS was monit展开更多
To clarify whether the endothelin A (ETA)-receptor antagonist BQ-123 can prevent the development of cerebral vasospasm (CVS) induced by endothelin (ET-1) and subarachnoid hemorrhage (SAH), which has been controversia1...To clarify whether the endothelin A (ETA)-receptor antagonist BQ-123 can prevent the development of cerebral vasospasm (CVS) induced by endothelin (ET-1) and subarachnoid hemorrhage (SAH), which has been controversia11y reported by various authors. We have performed investigations in anesthetized Sprague-Dawley rats- Intracisternal injection (i. c. ) of ET-l (10-11, 10-10, 10-9 mol/kg) could induce acute dose-dependent CVS, furthermore, the highest dose of ET-l (lO-’ mo1/kg) had a biphasic response in CVS of a 24-hour duration. However, the CVS by ET-1 (10-9 mol/kg) could be prevented effectively by previous i. c. of BQ-123 in a dose-dependent manner (10-9, 10-8, 10-7 mol/kg), of which the i. c- of BQ-123 (10-7mol/kg) could abolish the CVS completely. i. c. of BQ-123 (10-7 mol/kg) before SAH induced by a single i. c, of 150 pl autologous fresh blood directly to the Willis circle cou1d prevent the following CVS largely, which was a biphasic response and long-lasting (duration of 72 h). We conclude that subarachnoid application of ETA-receptor antagonist can effecti vely prevent CVS induced by ET-1 and SAH, and ET-1 may be the major mediator responsible for the CVS following SAH.展开更多
目的探讨氢气吸入辅助治疗对老年脑出血患者术后神经功能恢复的影响。方法选取2021年1月至2023年2月邢台市中心医院神经外科接受手术治疗的脑出血患者100例,随机分为观察组(氢气吸入辅助治疗)和对照组(常规治疗),每组50例。比较2组格拉...目的探讨氢气吸入辅助治疗对老年脑出血患者术后神经功能恢复的影响。方法选取2021年1月至2023年2月邢台市中心医院神经外科接受手术治疗的脑出血患者100例,随机分为观察组(氢气吸入辅助治疗)和对照组(常规治疗),每组50例。比较2组格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、36项简明健康调查问卷(short from 36-item questionnaire,SF-36)评分和血清脑源性神经营养因子(brain derived neurotrophic facor,BDNF)、胰岛素样生长因子1(insulin-like growth factor 1,IGF-1)、降钙素基因相关肽(calcitonin gene related peptide,CGRP)水平及并发症发生率。结果观察组治疗后4周及8周GCS评分、SF-36评分明显高于对照组,NIHSS评分明显低于对照组,差异有统计学意义(P<0.01)。观察组治疗后8周血清BDNF、IGF-1及CGRP水平明显高于对照组,差异有统计学意义(P<0.01)。2组并发症发生率比较,差异无统计学意义(6.00%vs 10.00%,P>0.05)。结论氢气吸入辅助治疗能够明显改善脑出血患者神经功能恢复和生活质量,提高血清神经功能指标水平。展开更多
目的探索立体定向神经内镜血肿清除术对老年高血压性脑出血患者的影响。方法收集2020年1月至2023年12月唐山市工人医院神经外二科就诊的基底节区高血压性脑出血患者220例,根据手术方式分为观察组100例和对照组120例,观察组给予立体定向...目的探索立体定向神经内镜血肿清除术对老年高血压性脑出血患者的影响。方法收集2020年1月至2023年12月唐山市工人医院神经外二科就诊的基底节区高血压性脑出血患者220例,根据手术方式分为观察组100例和对照组120例,观察组给予立体定向神经内镜血肿清除术,对照组给予开颅血肿清除术,比较2组患者术后康复情况。结果观察组手术时间与对照组比较,差异无统计学意义[(94.56±14.75)min vs(94.03±14.50)min,t=0.268,P=0.789]。2组术前美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分比较,差异无统计学意义(P=0.058)。与对照组比较,观察组术后3、6个月NIHSS评分显著降低[(5.90±4.02)分vs(9.23±3.47)分,P=0.000;(4.54±2.56)分vs(6.50±3.07)分,P=0.000]。2组患者格拉斯哥预后评分和术后并发症发生率比较,差异无统计学意义(P>0.05)。结论立体定向神经内镜血肿清除术可改善高血压性脑出血患者术后神经功能。展开更多
基金supported by a grant from Shanghai Pudong New Area(PWZxkq2011-01)
文摘BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.
文摘BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.
文摘One disadvantage of direct anticoagulant drug is the lack of an antidote, which may become relevant in patients with traumatic brain in- jury. A 77-years old man with atrial fibrillation and syncope received dabigatran despite recurrent falls. Due to a ground-level-fall, he suffered from subarachnoidal and intraparenchymal hemorrhages, subdural hematoma and brain edema with a midline shift. Despite osteoelast/c trepanation and hematoma-evacuation he remained comatose and died seven days later without regaining consciousness. Most probably, decreased dabigatran clearance due to increased age might have contributed to the fatal course. We suggest withholding anticoagulant therapy in patients with unexplained falls. If anticoagulant therapy is deemed necessary, vitamin-K-antagonists with their potential for laboratory monitoring and reversal of anticoagulant activity should be preferred.
文摘Objective: To study the changes between cerebral oxygen (O 2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was made, followed by open cardiopulmonary resuscitation, reperfusion with normal or high mean arterial pressure (MAP), and controlled ventilation to 4 h. Animals were randomly assigned into Group NT (normotensive reperfusion, n=6) and Group HT (hypertensive reperfusion, n=6). Cerebral arteriovenous (sagittal sinus) O 2 content difference (Ca-ssO 2) and venous (sagittal sinus) PO 2 (PssO 2) were determined before cardiac arrest (CA) and 30, 60, 120, and 240 min after CA. Results: In Group NT, Ca-ssO 2 was lower at 30 min (P<0.05) but higher at 240 min (P<0.01) after CA than that before CA. In Group HT, Ca-ssO 2 was not significantly different from that in Group NT before CA but was lower than that in Group NT at 30 min after CA (P<0.01). Ca-ssO 2 was not significantly different in Group NT and HT thereafter. In both groups, PssO 2 was both higher at 30 min after reperfusion (P<0.01) and at 240 min after reperfusion lower (P<0.05) than those before CA .At 30 min after reperfusion, PssO 2 was higher (P<0.01) in Group HT than that in Group NT, with insignificant difference between two groups. Conclusion: Cerebral O 2 delivery and uptake are mismatched after CA and resuscitation. Hypertensive reperfusion improves oxygen delivery to the brain early after CA.
文摘Patients with headache constitute up to 4.5% of emergency department （ED） visits.~11 Cerebral venous thrombosis （CVT） is an important cause of the headache that is more common than once suspected. The diagnosis of CVT is often missed or delayed because of non- specific clinical manifestations, and brain computerized tomography （CT） may easily be misinterpreted.
文摘A model of cerebral vasospasm (CVS) associated with subarachnoid hemorrhage (SAH) was prepared on male Sprague-Dawley rats by a single intracisternal injection (i. c.) of 150 μl autologous fresh blood directly to Willis circle.The process of CVS was monit
文摘To clarify whether the endothelin A (ETA)-receptor antagonist BQ-123 can prevent the development of cerebral vasospasm (CVS) induced by endothelin (ET-1) and subarachnoid hemorrhage (SAH), which has been controversia11y reported by various authors. We have performed investigations in anesthetized Sprague-Dawley rats- Intracisternal injection (i. c. ) of ET-l (10-11, 10-10, 10-9 mol/kg) could induce acute dose-dependent CVS, furthermore, the highest dose of ET-l (lO-’ mo1/kg) had a biphasic response in CVS of a 24-hour duration. However, the CVS by ET-1 (10-9 mol/kg) could be prevented effectively by previous i. c. of BQ-123 in a dose-dependent manner (10-9, 10-8, 10-7 mol/kg), of which the i. c- of BQ-123 (10-7mol/kg) could abolish the CVS completely. i. c. of BQ-123 (10-7 mol/kg) before SAH induced by a single i. c, of 150 pl autologous fresh blood directly to the Willis circle cou1d prevent the following CVS largely, which was a biphasic response and long-lasting (duration of 72 h). We conclude that subarachnoid application of ETA-receptor antagonist can effecti vely prevent CVS induced by ET-1 and SAH, and ET-1 may be the major mediator responsible for the CVS following SAH.
文摘目的探讨氢气吸入辅助治疗对老年脑出血患者术后神经功能恢复的影响。方法选取2021年1月至2023年2月邢台市中心医院神经外科接受手术治疗的脑出血患者100例,随机分为观察组(氢气吸入辅助治疗)和对照组(常规治疗),每组50例。比较2组格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、36项简明健康调查问卷(short from 36-item questionnaire,SF-36)评分和血清脑源性神经营养因子(brain derived neurotrophic facor,BDNF)、胰岛素样生长因子1(insulin-like growth factor 1,IGF-1)、降钙素基因相关肽(calcitonin gene related peptide,CGRP)水平及并发症发生率。结果观察组治疗后4周及8周GCS评分、SF-36评分明显高于对照组,NIHSS评分明显低于对照组,差异有统计学意义(P<0.01)。观察组治疗后8周血清BDNF、IGF-1及CGRP水平明显高于对照组,差异有统计学意义(P<0.01)。2组并发症发生率比较,差异无统计学意义(6.00%vs 10.00%,P>0.05)。结论氢气吸入辅助治疗能够明显改善脑出血患者神经功能恢复和生活质量,提高血清神经功能指标水平。
文摘目的探索立体定向神经内镜血肿清除术对老年高血压性脑出血患者的影响。方法收集2020年1月至2023年12月唐山市工人医院神经外二科就诊的基底节区高血压性脑出血患者220例,根据手术方式分为观察组100例和对照组120例,观察组给予立体定向神经内镜血肿清除术,对照组给予开颅血肿清除术,比较2组患者术后康复情况。结果观察组手术时间与对照组比较,差异无统计学意义[(94.56±14.75)min vs(94.03±14.50)min,t=0.268,P=0.789]。2组术前美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分比较,差异无统计学意义(P=0.058)。与对照组比较,观察组术后3、6个月NIHSS评分显著降低[(5.90±4.02)分vs(9.23±3.47)分,P=0.000;(4.54±2.56)分vs(6.50±3.07)分,P=0.000]。2组患者格拉斯哥预后评分和术后并发症发生率比较,差异无统计学意义(P>0.05)。结论立体定向神经内镜血肿清除术可改善高血压性脑出血患者术后神经功能。
