早期康复治疗对高血压脑出血患者预后影响的临床观察

目的:观察早期康复治疗对高血压性脑出血患者预后的影响,探讨改善高血压性脑出血患者预后的治疗方案。方法:选择高血压性脑出血患者130例,随机均分为对照组与观察组,对照组采取常规治疗,观察组在常规治疗基础上,在病情48h内不再进展即行早期康复治疗,比较两组患者治疗2周后NIHSS评分和Fugl-Meyer积分、治疗4周后临床疗效及治疗3个月后日常生活能力。结果:两组患者在治疗2周后NIHSS评分和Fugl-Meyer积分、治疗4周后临床疗效及治疗3个月后日常生活能力方面比较,具有(高度)统计学意义(P0.01,P0.05)。结论:临床治疗高血压脑出血患者时,应尽可能施行早期康复治疗,可显著提高临床疗效、改善患者预后。     

入院时血清钙水平与高血压性脑出血血肿体积、神经功能及预后的关系研究

摘要 目的：探讨入院时血清钙水平与高血压性脑出血血肿体积、神经功能及预后的关系。方法：选择2018年9月-2020年4月我院收治的高血压性脑出血患者102例,根据患者入院时血清钙水平将其分为低血钙组（血清钙<2.1 mmol/L, n=34）、正常血钙组（2.1 mol/L≤血清钙≤2.7 mmol/L, n=39）和高血钙组（血清钙>2.7 mmol/L, n=29）,比较各组性别、血肿体积、入院美国国立卫生研究院卒中量表（NIHSS）评分等临床资料。所有患者随访1年,观察患者格拉斯哥预后量表（GOS）评分,根据患者预后情况将患者分为预后良好组（n=84）和预后不良组（n=18）,比较两组血清钙、血肿体积、入院NIHSS评分、GOS评分。应用受试者工作特征（ROC）曲线分析血清钙水平对患者预后的预测价值。结果：三组血肿体积、入院NIHSS评分、GOS评分、1年病死率、1年再出血率、总预后不良率比较有统计学差异（P<0.05）。预后不良组血清钙水平、GOS评分显著低于预后良好组,血肿体积、入院NIHSS评分显著高于预后良好组（P<0.05）。Pearson相关性分析显示：高血压性脑出血患者入院时血清钙水平与脑出血血肿体积、入院NIHSS评分呈负相关,与GOS评分呈正相关（P＜0.05）。ROC曲线分析显示入院时血清钙预测高血压脑出血不良预后的曲线下面积为0.129（95%CI：0.073~0.179）。结论：高血压性脑出血患者入院时血清钙水平与血肿体积、神经功能及预后存在一定关联,且入院时血清钙对高血压性脑出血不良预后具有一定预测价值。     

老年高血压性脑出血相关预后影响因素回顾性分析

目的：回顾性分析高血压性脑出血患者影响预后的各因素之间的关系的相关性,以及各因素对脑出血患者预后的影响。方法：回顾性分析我院2009年1月-2012年7月间接受治疗的老年高血压性脑出血患者147例,其中男：86例,女：61例;年龄60．83岁,平均（69．6±5．7）岁;高血压病程8-23年,平均（9．7±1．6）年。分析老年高血压性脑出血患者发病至就诊时间、入院就诊时的临床表现、患者的意识状态、出血位置及出血量、语言功能障碍、肢体运动功能障碍,以及患者的预后转归等因素与预后的相关性。结果：老年高血压性脑出血治疗后,总有效率为67．7％;在诸多预后因素中：意识状态、出血量、出血位置,以及是否破入脑室等因素与预后具有相关性,具有统计学意义（P〈0．05）。结论：老年高血压性脑出血的预后与意识状态、出血量、出血位置相关,根据临床症状对脑出血患者采取积极的治疗措施,对脑出血患者的预后有重要的意义。     

颅内静脉系统血栓形成合并脑出血的临床特点、危险因素、诊断方法以及治疗方案分析

目的:探讨颅内静脉系统血栓形成(CVST)合并脑出血的临床特点、危险因素、诊断方法以及治疗方案。方法:选择我院于2002年2月到2017年5月收治的CVST确诊患者38例为研究对象,按照是否合并脑出血分为脑出血组16例与对照组22例,比较两组患者的临床特点、危险因素、诊断方法、治疗方案与预后。结果:脑出血患者MRI显示受累横窦8例、海绵窦6例、乙状窦2例;对照组显示受累横窦10例、海绵窦8例、乙状窦4例。脑出血组的头痛、意识改变、运动障碍等临床症状发生率明显高于对照组(P0.05),两组感觉障碍、视力下降与痫性发作比例对比差异无统计学意义(P0.05)。二分类变量Logistic回归分析显示脑膜炎、贫血、先天性凝血酶原疾病为导致CVST合并脑出血发生的主要独立危险因素(P0.05)。所有患者均给予脱水降颅压及支持对症治疗,脑出血组预后不良8例,不良率为50.0%;对照组预后不良4例,不良率为18.2%,脑出血组的预后不良率明显高于对照组(P0.05)。结论:CVST合并脑出血在临床上比较常见,多表现为头痛、意识改变、运动障碍等,MRI诊断有很好的效果,脑膜炎、贫血、先天性凝血酶原疾病为导致CVST合并脑出血发生的危险因素,抗凝、溶栓等治疗能取得较好的效果。     

顶部跨上矢状窦硬膜外血肿的外科治疗策略探讨

目的:探讨顶部跨上矢状窦硬膜外血肿的诊断和外科治疗策略,提高其临床治疗效果。方法:回顾分析2002年1月～2011年10月我院收治的27例颅脑创伤后发生的跨上矢状窦硬膜外血肿病例的临床资料、手术方法,总结分析其治疗效果。结果:按GOS治疗结果评定,保守治疗的15例患者均恢复良好;开颅手术的12例患者中,7例恢复良好,1例中残,1例重残,1例植物生存,2例死亡。全组病人均经头颅X线或CT检查提示血肿区域有骨折或冠状缝或矢状缝分离,并经手术证实,其中伴有上矢状窦破裂2例。单纯骨折不伴有矢状窦损伤者手术效果较好,而伴有矢状窦撕裂者预后较差。结论:顶叶跨上矢状窦硬膜外血肿临床少见,病情变化快,正确掌握顶部跨上矢状窦硬膜外血肿的诊断和把握手术指征,有助于改善其预后。     

组织扩张器辅助神经内镜治疗高血压脑出血的临床应用价值分析

目的:探讨组织扩张器辅助神经内镜治疗高血压脑出血的临床效果,为高血压脑出血的治疗提供依据。方法:选择我院2017年2月至2018年1月收治的高血压脑出血患者108例,其中应用组织扩张器辅助神经内镜治疗的高血压脑出血患者52例作为研究组,应用传统开颅血肿清除术治疗的高血压脑出血患者56例作为对照组。比较两组手术出血量、血肿清除率、手术时间、术后再出血率、术后并发症发生情况及术后3个月、术后6个月格拉斯哥预后评分(GOS)情况。结果:研究组手术时间短于对照组,研究组手术出血量、术后再出血率均低于对照组,血肿清除率高于对照组(P0.05)。研究组肺部感染、尿路感染发生率低于对照组(P0.05);两组消化道出血、深静脉血栓发生率比较差异无统计学意义(P0.05)。两组术后6个月GOS评分分布优于术后3个月,术后3个月、术后6个月研究组GOS评分分布优于对照组(P0.05)。结论:组织扩张器辅助神经内镜治疗高血压脑出血能有效缩短手术时间和减少术中出血量,其血肿清除率也更高,且患者术后并发症发生率较低,预后较好。     

甲状腺癌诊断及预后相关分子标志物的研究进展

甲状腺结节是最常见的疾病之一,其精确诊断对于患者的有效临床管理十分重要。分子标志物是一项非常有效的诊断和预后评估工具,尤其在细胞学不确定的甲状腺癌结节。近年来,分子标志物的临床应用发展已经取得显著的进步。随着新一代基因检测技术的发展,能够同时检测多个基因,这不仅可为甲状腺癌的诊断提供依据,而且也可为预测甲状腺癌患者的预后提供参考,本文就甲状腺癌的诊断及预后相关的分子标志物进行综述。     

小骨窗微创手术治疗高血压脑出血患者的疗效

目的:分析小骨窗微创手术在高血压脑出血患者的临床效果。方法:选取我院收治的高血压脑出血患者200例,按照治疗方式的不同分为观察组100例,对照组100例,观察组采用小骨窗微创手术治疗,对照组采用传统开颅手术治疗,对两组疗效及预后进行对比。结果:两组患者的术后残留血肿量较术前明显减少,差异有统计学意义(P0.05),观察组术后残留血肿量(10.3±2.8)m L,对照组术后残留血肿量(11.1±3.0)m L,两组之间术后血肿残留量比较,差异无统计学意义(P0.05)。观察组手术时间(92.8±15.5)分钟,对照组手术时间(125.4±16.1)分钟,观察组手术时间明显短于对照组,差异有统计学意义(P0.05)。观察组住院时间(15.8±5.2)天,对照组住院时间(24.1±5.8)天,观察组住院时间明显短于对照组,差异有统计学意义(P0.05)。再出血率比较:观察组治疗后再出血率3.0%,对照组治疗后再出血率8.0%,观察组出血率明显低于对照组,差异有统计学意义(P0.05)。NDS及ADL比较:两组治疗后NDS及ADL均优于治疗前,差异有统计学意义(P0.05)。观察组NDS及ADL均显著优于对照组,差异有统计学意义(P0.05)。GCS比较:两组评分差异无统计学意义(P0.05)。结论:小骨窗微创手术可以改善患者的预后,可显著提高高血压脑出血治疗效果。     

56例脑出血的诊断与治疗体会

1992～ 1 997年 1 2月我院收治 56例脑出血患者 ,现将诊断和治疗体会报告如下。1　临床资料1 .1　一般资料　 56例脑出血患者男 37例 ,女 1 9例 ,年龄 40～ 79岁。有高血压病史者 48例。出血部位 :全部患者均经头颅 CT检查确诊。左右侧基底节出血 42例 ,脑干桥脑出血 5例 ,小脑出血 2例 ,脑叶出血 7例。出血量按多田公式计算。1 .2　临床分型　按意识及偏瘫程度分 ～ 级 [1] ,其中 级 30例 , 级 1 3例 , 级 8例 , 级 5例。1 .3　治疗　内科治疗 44例 ,均采用速尿或甘露醇降低颅内压 ,控制高血压 ,维持液体酸碱平衡等治疗方案 ,外科治疗 …     

颅内压监测在高血压脑出血患者治疗中的指导价值及术后再出血的危险因素分析

摘要 目的：探讨颅内压监测在高血压脑出血患者治疗中的指导价值,并分析术后再出血的危险因素。方法：选取我院于2017年2月~2020年7月期间收治的70例高血压脑出血患者的临床资料进行回顾性分析,根据有无颅内压监测将患者分为对照组31例和监测组39例。对比对照组、监测组围术期指标情况,对比对照组、监测组术后并发症发生情况,采用单因素及多因素Logistic回归分析患者术后再出血的影响因素。结果：监测组甘露醇使用剂量少于对照组,重症监护室（ICU）住院时间、甘露醇使用天数短于对照组（P<0.05）。监测组术后并发症总发生率低于对照组（P<0.05）。本次研究纳入的70例高血压脑出血患者中,13例发生术后再出血纳为再出血组,再出血发生率为18.57%（13/70）;剩余的57例未再出血患者纳为未出血组。单因素分析结果可知,高血压脑出血患者术后再出血与发病至手术时间、凝血机制、术前血肿量、入院时收缩压（SBP）有关（P<0.05）。多因素Logistic回归分析结果显示,发病至手术时间≤6 h、凝血机制异常、术前血肿量>60 mL、入院时SBP≥200 mmHg均是高血压脑出血患者术后再出血的危险因素（P<0.05）。结论：颅内压监测在高血压脑出血患者治疗中的指导价值较高,高血压脑出血患者术后再出血与发病至手术时间、凝血机制、术前血肿量、入院时SBP相关,临床应给予高度重视并积极干预,以降低术后再出血发生率。     

MRI-Based Analysis of Intracerebral Hemorrhage in Mice Reveals Relationship between Hematoma Expansion and the Severity of Symptoms

Intracerebral hemorrhage (ICH) is featured by poor prognosis such as high mortality rate and severe neurological dysfunction. In humans, several valuables including hematoma volume and ventricular expansion of hemorrhage are known to correlate with the extent of mortality and neurological dysfunction. However, relationship between hematoma conditions and the severity of symptoms in animal ICH models has not been clarified. Here we addressed this issue by using 7-tesla magnetic resonance imaging (MRI) on collagenase-induced ICH model in mice. We found that the mortality rate and the performance in behavioral tests did not correlate well with the volume of hematoma. In contrast, when hemorrhage invaded the internal capsule, mice exhibited high mortality and showed poor sensorimotor performance. High mortality rate and poor performance in behavioral tests were also observed when hemorrhage invaded the lateral ventricle, although worsened symptoms associated with ventricular hemorrhage were apparent only during early phase of the disease. These results clearly indicate that invasion of the internal capsule or the lateral ventricle by hematoma is a critical determinant of poor prognosis in experimental ICH model in mice as well as in human ICH patients. MRI assessment may be a powerful tool to refine investigations of pathogenic mechanisms and evaluations of drug effects in animal models of ICH.     

一组有或无CT 脑灌注" 点征"的自发性脑内出血患者临床效果观察

目的:观察有或无CT脑灌注"点征"自发性脑内出血(sICH)患者的临床疗效。方法:以本院2013年5月~2015年5月就诊的100例s ICH,均接受基线CT脑灌注检查,依据是否有"点征"将患者分为观察组(有"点征")与对照组(无"点征"),24内行CT平扫复查,比较两组影像学结果及临床结果。并通过Logistic多因素分析影响s ICH患者预后不良(死亡)危险因素。结果:观察组24h内CT平扫复查血肿增长6 mL以上、血肿增长相对值33%及以上比率均明显高于对照组(P0.05);观察组血肿进展发生率、3个月内死亡率分别为63.04%、36.96%,显著高于对照组的14.81%、7.41%(P0.05)。Logistic回归分析发现sICH患者预后不良独立危险因素包括基线血肿体积、"点征"。结论:有或无CT脑灌注"点征"自发性脑内出血患者血肿进展、预后不同,基线血肿体积、"点征"为sICH患者预后不良的独立危险因素。     

老年高血压脑出血手术治疗预后的影响因素分析

目的分析老年人高血压脑出血手术治疗预后的各种影响因素,以提高手术疗效。方法回顾105例老年人（≥60岁）高血压脑出血手术治疗临床资料,分析GCS评分、出血量、手术时机、年龄对预后的影响。结果患者术前GCS评分越高预后越好,血肿量较小者（≤50m l）预后较好,年龄越大者预后差,患者在6小时内及6-24小时内手术则较24小时后手术预后好。结论患者术前GCS评分是H ICH预后的重要指标,不同的出血量有不同的预后,超早期和早期手术疗效好,高龄患者（〉80岁）手术风险大,预后差。     

Intrastriatal Injection of Autologous Blood or Clostridial Collagenase as Murine Models of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease and is associated with significant morbidity and mortality. Lack of effective treatment and failure of large clinical trials aimed at hemostasis and clot removal demonstrate the need for further mechanism-driven investigation of ICH. This research may be performed through the framework provided by preclinical models. Two murine models in popular use include intrastriatal (basal ganglia) injection of either autologous whole blood or clostridial collagenase. Since, each model represents distinctly different pathophysiological features related to ICH, use of a particular model may be selected based on what aspect of the disease is to be studied. For example, autologous blood injection most accurately represents the brain''s response to the presence of intraparenchymal blood, and may most closely replicate lobar hemorrhage. Clostridial collagenase injection most accurately represents the small vessel rupture and hematoma evolution characteristic of deep hemorrhages. Thus, each model results in different hematoma formation, neuroinflammatory response, cerebral edema development, and neurobehavioral outcomes. Robustness of a purported therapeutic intervention can be best assessed using both models. In this protocol, induction of ICH using both models, immediate post-operative demonstration of injury, and early post-operative care techniques are demonstrated. Both models result in reproducible injuries, hematoma volumes, and neurobehavioral deficits. Because of the heterogeneity of human ICH, multiple preclinical models are needed to thoroughly explore pathophysiologic mechanisms and test potential therapeutic strategies.     

Tolerated nitrite therapy in experimental intracerebral hemorrhage: Rationale of nitrite therapy in a broad range of hyperacute strokes

Nitrite therapy is more effective in cerebral ischemia when administered earlier. It would be beneficial during the hyperacute stages of stroke if the nitrite effect is demonstrated in intracerebral hemorrhage (ICH). When nitrite is injected intravenously 3 h after ICH induction in rats, most doses of nitrite provided no beneficial effects on behavioral deficits, brain edema and hematoma volumes. A high dose of nitrite, however, decreased hematoma volume, but not brain edema. Peri-hematomal apoptosis and inflammation were similar between the control and nitrite groups. Nitrite therapy may be considered a therapeutic option in hyperacute stroke because nitrite therapy is tolerated in ICH as well.     

Blocking B7-1/CD28 Pathway Diminished Long-Range Brain Damage by Regulating the Immune and Inflammatory Responses in a Mouse Model of Intracerebral Hemorrhage

Acute brain injuries can activate bidirectional crosstalk between the injured brain and the immune system. The immune system, particularly T lymphocytes and cytokines, has been implicated in the progression of brain injury after intracerebral hemorrhage (ICH). Co-stimulatory molecules B7-1 (CD80)/B7-2 (CD86) binding cognate receptor provides a secondary signaling to T cell activation. The aim of our study was to explore the effects of anti-B7-1 antibody on the development and prognosis of cerebral hemorrhage and to investigate the possible underlying mechanism. Mice were inner canthus veniplex administered with anti-B7-1 antibody at 10 min and 24 h after ICH and sacrificed on the third day after ICH. Immune function was assessed via splenocyte proliferation assay and organism index, respectively. IFN-γ and IL-4 were detected by enzyme-linked immuno sorbent assay. The cerebral edema was evaluated via brain water content. The levels of autophagy and apoptosis related proteins were measured by western blotting analysis. In addition, functional outcome was studied with pole-climbing test and morris water maze. The mice were weighed on 0, 1, 3, 14 and 21 days after ICH. The treatment with anti-B7-1 antibody significantly lowered immune function, and reduced the latency of water maze on 18 and 20 days, the ratio of IFN-γ/IL-4 as well as body weight on day 3 after cerebral hemorrhage. Our study suggests that in the cerebral hemorrhage mice brain anti-B7-1 antibody may reduce long-range brain damage by reversing immune imbalance.     

急性脑梗塞后肺部感染的相关因素及预后

目的:分析探讨急性脑梗塞后肺部感染的相关因素及其预后,以有利于进一步预防及治疗。方法:对2009年5月至2011年5月收治的258例脑梗塞急性期患者的临床资料进行回顾性调查分析,根据是否合并肺部感染分为肺部感染组和对照组,分析肺部感染的危险因素和其预后的相关性。结果:258例脑梗塞患者中发生肺部感染45例,感染率为17.4%,其中心源性脑栓塞占67%。与对照组相比,急性脑梗塞后肺部感染患者年龄偏高(分别为74.2±13.2和69.8±12.7,P<0.021),住院过程中的误吸(OR5.513)及住院时的NIHSS评分(OR1.090)是独立性危险因素,而肺部感染是加重病情的独立性危险因素(OR5.838)。结论:对于高龄、入院时NIHSS评分高、误吸和心源性急性脑梗塞患者应及早预防,已发生肺部感染者应当给予积极有效的治疗。     

Mechanisms of transformation of nicotinamide mononucleotides to cerebral infarction hemorrhage based on MCAO model

ObjectiveThe study aims at discussing the effect of nicotinamide mononucleotides on protecting hemorrhagic transformation of cerebral infarction in the middle cerebral artery occlusion (MCAO) model.MethodMale mice aged 4–5 weeks and weighing about 22–35 g in Shanghai Ninth People’s Hospital are divided into three groups: sham group, collagenase intracerebral hemorrhage model (cICH + Vehicle) group and collagenase nicotinamide mononucleotide (cICH + NMN) group. Then, the intervention therapy research is carried out. After 24 h, the neurological function, brain edema, hematoma volume, body weight, hemorrhage volume, RNA expression level, apoptosis, inflammatory factors and reactive oxygen species (ROS) content in surrounding tissues of mice are analyzed comprehensively.ResultsCompared with the other two groups, nicotinamide mononucleotides in MCAO model have significant effects on improving neurological function, brain edema, inflammatory factors, body weight and cell apoptosis in mice, but have no significant effect on hemorrhage volume and hematoma volume in mice.ConclusionNicotinamide mononucleotides can significantly improve the collagenase-induced intracerebral hemorrhage (ICH) model in mice under MCAO model, and they can protect the brain tissue of mice from RNA level to tissue cell level or mouse body weight and volume level.     

Amount of Bleeding and Hematoma Size in the Collagenase-Induced Intracerebral Hemorrhage Rat Model

The aggravated risk on intracerebral hemorrhage (ICH) with drugs used for stroke patients should be estimated carefully. We therefore established sensitive quantification methods and provided a rat ICH model for detection of ICH deterioration. In ICH intrastriatally induced by 0.014-unit, 0.070-unit, and 0.350-unit collagenase, the amount of bleeding was measured using a hemoglobin assay developed in the present study and was compared with the morphologically determined hematoma volume. The blood amounts and hematoma volumes were significantly correlated, and the hematoma induced by 0.014-unit collagenase was adequate to detect ICH deterioration. In ICH induction using 0.014-unit collagenase, heparin enhanced the hematoma volume 3.4-fold over that seen in control ICH animals and the bleeding 7.6-fold. Data suggest that this sensitive hemoglobin assay is useful for ICH detection, and that a model with a small ICH induced with a low-dose collagenase should be used for evaluation of drugs that may affect ICH.     

Circadian variation in clinical features and outcome of intracerebral hemorrhage: The INTERACT studies

Previous studies consistently reported a diurnal variation in the occurrence of intracerebral hemorrhage (ICH), with a morning peak. However, limited knowledge exists on the circadian pattern of ICH severity and outcome. This study aimed to determine possible associations between ICH onset time and admission severity and 90-day outcomes using the combined data set of the pilot and main-phase Intensive blood pressure (BP) reduction in an acute cerebral hemorrhage trial (INTERACT). The ICH onset time was categorized into three groups (1: 00:00–07:59; 2: 08:00–15:59; and 3: 16:00–23:59). We found an association between onset time and low Glasgow Coma Scale score: aOR (time 1: 1.72, 95% CI 1.12–2.66; time 3: 1.95, 95% CI 1.31–2.89, p = 0.003; in comparison to time 2). There was no association between onset time and volume of ICH (adjusted p = 0.354) or 90-day outcomes of death or major disability, and death and major disability separately (all adjusted p > 0.4). The results showed that more severe cases of ICH patients, defined by a reduced level of consciousness, had late afternoon to early morning stroke onset, but this was unrelated to baseline hematoma volume or location. There was no circadian influence on ICH clinical outcome.