【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.
Objective To investigate the clinical manifestations, CT and prognosis of pontine hemorrhage. Methods Analyze the summarized clinical data of 21 patients with pontine hemorrhage retrospectively. Results The period of 46-70 years old was vulnerable to pontine hemorrhage,and hypertension was the major risky factor of it. The death rate of pontine hemorrhage inceases when the bleeding beyond 5 ml. Nine of the 21 patients survived. Conclution The prognosis was highly related to the bleeding amount, the position of bleeding and the complication.
目的:探讨幕上高血压脑出血手术治疗近期预后的影响因素。方法:回顾经手术治疗的73例幕上高血压脑出血患者的临床资料,分析患者性别、年龄、术前GCS评分、出血部位、术前瞳孔有无散大、出血是否破入脑室、出血量、手术时机8个因素对患者预后的影响。评定患者日常生活能力(ADL)分级,将ADL 1-3级划为预后良好组,ADL 4-6级划为预后差组。结果:预后良好组和预后差组在术前GCS评分、出血量、出血是否破入脑室、术前瞳孔有无散大及手术时机上在统计学上有显著性差异(Plt;0.05),而患者的年龄、性别及出血部位则在统计学上未见显著性差异(Pgt;0.05)。Logistic回归分析,术前GCS评分、出血量、出血是否破入脑室与预后ADL分级相关(Plt;0.05)。其相关系数分别为:-0.456、0.124、0.341。结论:术前GCS评分、出血量、出血是否破入脑室是估计患者手术治疗近期预后有意义的指标,术前瞳孔有无散大、手术时机对评价患者预后有一定的参考价值。了解影响高血压脑出血预后的因素可以更有效的制定治疗方案,估计预后。
Objective To explore an approach of evidence-based treatment for acute hypertensive cerebral hemorrhage. Methods (1) Thoroughly evaluating the patient’s condition. (2) Formulating clinical problems. (3) We searched The Cochrane Library (Issue 1, 2006), Ovid EBM REVIEWS (2001 to 2006), MEDLINE (1980 to 2006) and CNKI (1994 to 2006) for evidence. (4) Assessing evidence. (5) Applying evidence. Results Total 13 relevant studies were retrieved. Results indicated that all kinds of interventions for the treatment of hypertensive cerebral hemorrhage showed different degrees of efficacy, including the Stroke Unit, blood pressure control, mannitol, hemostyptic and neuroprotective agents, promotion of blood circulation and resolving of blood stasis, stereotactic aspiration etc. However, the effects of other interventions need further validation except Stroke Units which had higher quality evidence. Based on the patient’ specific conditions, we recommended the following evidence-based treatment plan: immediate transfer to the Stroke Unit; sequential application of reptilase (within 6 h), citicoline (within 24 h), mannitol and Compound Danshen Injection (after 24 h); temporary withhold of enalapril meleate; monitoring of blood pressure, ECG, renal function and electrolytes; and if intracranial hemorrhage occurs again during the treatment, stereotactic aspiration should be applied. Conclusions Through evidence-based method, an individualized treatment plan could obviously improve the treatment effectiveness and reduce the incidence of adverse effects in patients with hypertensive cerebral hemorrhage.
Cerebral hemorrhage is a common clinical critical disease, and venous thromboembolism is one of its common complications. How to diagnose and treat venous thromboembolism early is still the main problem in the management of patients with cerebral hemorrhage. This article reviews the concept, pathogenesis, risk factors, evaluation tools, prevention and treatment of venous thromboembolism in patients with cerebral hemorrhage. Suggestions are put forward on the development of evaluation tools and improvement of prevention and treatment, in order to provide reference for clinical management and related research of patients with cerebral hemorrhage complicated with venous thromboembolism.
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。
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:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.