脑出血患者急性期窦性心率震荡结果分析

目的:观察首次脑出血(intracerebral hemorrhage,ICH)患者急性期窦性心率震荡(heart rate turbulence,HRT)的变化特点.方法:从44例脑出血患者选择20例符合HRT分析条件的患者为脑出血组,选择无心脑器质性疾病且符合HRT分析条件的20例患者作为对照组.所有患者发病5天内行24小时动态心电图监测,计算并分析HRT指标震荡初始(turbulence onset,TO)、震荡斜率(turbulence slope,TS),同时收集患者临床资料.结果:与对照组TO、TS比较,脑出血组TO值升高有统计学意义(P＜0.05),TS值降低无显著性意义(P＞0.05).不同部位脑出血患者TO及TS差异无统计学意义(渐进显著性＞0.01).结论:脑出血组患者急性期的HRT减弱,自主神经功能受到损害,推测脑出血患者急性期心脏意外发生可能性大.左右半球、蛛网膜下腔出血时自主神经损害程度是否存在差异仍待探讨.     

Adrenomedullin Is a Diagnostic and Prognostic Biomarker for Acute Intracerebral Hemorrhage

Hemorrhagic stroke remains an important health challenge. Adrenomedullin (AM) is a vasoactive peptide with an important role in cardiovascular diseases, including stroke. Serum AM and nitrate–nitrite and S-nitroso compounds (NOx) levels were measured and compared between healthy volunteers (n = 50) and acute hemorrhagic stroke patients (n = 64). Blood samples were taken at admission (d0), 24 h later (d1), and after 7 days or at the time of hospital discharge (d7). Neurological severity (NIHSS) and functional prognosis (mRankin) were measured as clinical outcomes. AM levels were higher in stroke patients at all times when compared with healthy controls (p < 0.0001). A receiving operating characteristic curve analysis identified that AM levels at admission > 69.0 pg/mL had a great value as a diagnostic biomarker (area under the curve = 0.89, sensitivity = 80.0%, specificity = 100%). Furthermore, patients with a favorable outcome (NIHSS ≤ 3; mRankin ≤ 2) experienced an increase in AM levels from d0 to d1, and a decrease from d1 to d7, whereas patients with unfavorable outcome had no significant changes over time. NOx levels were lower in patients at d0 (p = 0.04) and d1 (p < 0.001) than in healthy controls. In conclusion, AM levels may constitute a new diagnostic and prognostic biomarker for this disease, and identify AM as a positive mediator for hemorrhagic stroke resolution.     

Mechanical Ventilation for Comatose Patients with Inoperative Acute Intracerebral Hemorrhage: Possible Futility of Treatment

Background

Comatose patients with acute intracerebral hemorrhage (ICH) diagnosed as inoperative due to their severe comorbidity will be treated differently between countries. In certain countries including Japan, aggressive medical care may be performed according to the patients'' family requests although the effects on the outcome are obscure. For respiratory distress in comatose patients with inoperative acute ICH, the role of mechanical ventilation on the outcome is unknown. We speculated that the efficacy of a ventilator in such a specific condition is limited and possibly futile.

Methods

We retrospectively evaluated the in-hospital mortality and further outcome of 65 comatose patients with inoperative ICH. Among the patients, 56 manifested respiratory distress, and the effect of the ventilator was evaluated by comparing the patients treated with and without the ventilator.

Results

The in-hospital mortality was calculated as 80%. A statistically significant parameter affecting the mortality independently was the motor subset on the Glasgow Coma Scale (P = 0.015). Among the patients who manifested respiratory distress, 7.7% of patients treated with a ventilator and 14.0% of patients not treated with a ventilator survived; an outcome is not significantly different. The mean survival duration of patients treated with a ventilator was significantly longer than the mean survival duration of patients not treated with a ventilator (P = 0.021). Among the surviving 13 patients, 7 patients died 5 to 29 months after onset without significant consciousness recovery. Another 6 patients suffered continuous disablement due to prolonged severe consciousness disturbances.

Conclusion

The current results indicate that treating comatose patients resulting from inoperative acute ICH may be futile. In particular, treating these patients with a ventilator only has the effect of prolonging unresponsive life, and the treatment may be criticized from the perspective of the appropriate use of public medical resources.     

Restricted Diffusion in Biophysical Systems: Experiment

The pulsed-gradient spin echo nuclear magnetic resonance (PGSENMR) technique was used to measure restricted diffusion of water in three types of animal tissue: human blood plasma and red cells; rat and rabbit heart; rat and rabbit liver. Characteristic lengths (L) for restriction of diffusion are estimated from dependence on the measuring time. Limitations on the range of observable restrictive lengths (1.5-15 μm) are discussed.

The decrease in diffusivity due to 1 μm alumina powder (volume fraction = 0.18) in glycerin/water mixtures agrees with the Wang theory assuming spherical particles and no hydration. The characteristic length (L 4 μm) is larger than the particle size (1 μm) or separation (1.8 μm). Comparison of the diffusivities in tissues at short diffusion times with the Wang theory indicates some bound or trapped water.

For packed red blood cells, a restriction (L 2.3 μm) was attributed tothe red cell membrane. A permeability p 0.014 cm/s may be estimated from the decrease in diffusivity. Average values of diffusivity ratio in heart were: 0.36 ± 0.02 for rat; and 0.26 ± 0.03 for rabbit; and in liver: 0.25 ± 0.01 for rat; 0.25 ± .04 for 10-day old rabbit; and 0.195 ± 0.03 for 2-yr old rabbit. A restriction (L 2.7 μm) in rat liver probably results from the mitochondria.

     

Hck Promotes Neuronal Apoptosis Following Intracerebral Hemorrhage

The hematopoietic cell kinase (Hck) is a member of the Src family protein kinases which regulates many signal transduction pathways including cell growth, proliferation, differentiation, migration, and apoptosis. However, the expression and function of Hck after intracerebral hemorrhage (ICH) are unknown. Western blot, immunohistochemistry, and immunofluorescence showed that Hck was obviously up-regulation in neurons adjacent to the hematoma after ICH. In addition, the temporary raise of Hck expression was paralleled with the expression of p53, Bax, and active caspase-3, suggesting that Hck was involved in neuronal apoptosis. Hck siRNA dramatically decrease hemin-induced expression of p53, Bax, and active caspase-3 as well as the amount of apoptotic SH-SY5Y cells in vitro. Furthermore, Hck interacted with p53. Hence, Hck might promote neuronal apoptosis via p53 signaling pathway after ICH.     

Verbascoside Attenuates Acute Inflammatory Injury Caused by an Intracerebral Hemorrhage Through the Suppression of NLRP3

Neurochemical Research - Intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with a high mortality rate affecting individuals worldwide. After ICH, persistent inflammation...     

尼莫地平治疗高血压性脑出血疗效观察

目的:尼莫地平治疗高血压性脑出血的临床疗效。方法:90例高血压脑出血患者随机分为实验组(45例)和对照组(45例),对照组仅采用常规治疗,实验组在常规治疗的基础上采用尼莫地平进行治疗,比较两组临床疗效、治疗前后的临床神经功能缺损评分、临床残疾评分以及血肿和水肿带体积改变。结果:实验组和对照组的治疗有效率为73.33%和42.22%,差异具有统计学意义(P<0.05)。实验组和对照组治疗前、后临床神经功能缺损评分分别为(18.58±3.06)、(12.31±2.74)和(18.28±2.97)、(15.22±2.72),实验组和对照组治疗前、后临床残疾评分分别为(38.93±3.37)、(61.57±3.03)和(37.51±4.962)和(43.48±7.19),实验组和对照组治疗前、后的血肿体积分别为(17.23±5.48)cm3、(7.93±3.33)cm3和(17.60±5.46)cm3、(10.97±4.25)cm3,实验组和对照组治疗前、后的水肿带体积分别为(7.73±3.20)cm3、(4.21±1.60)cm3和(7.83±3.19)cm3和(5.67±1.82)cm3,所有患者治疗后各指标均优于治疗前,治疗后两组组间比较均有有显著性(P<0.01)。结论:尼莫地平能够明显的减少血肿体积和水肿带的体积,提高治疗的效果,减少脑出血患者发生神经功能缺损和残疾的可能。     

脑出血患者脑脊液Abeta水平检测及其临床意义

目的:探讨脑出血患者脑脊液中amylid-beta(Aβ)40和Aβ42水平及其与出血量以及血肿周围低密体积相关性。方法:采集73例脑出血患者及72例健康对照的脑脊液标本,采用酶联免疫吸附法(Elisa)检测脑脊液中的Aβ40和Aβ42的水平,分析其与出血量和血肿周围低密度体积的相关性。结果:(1)脑出血患者脑脊液Aβ40和Aβ42水平显著高于健康对照组(P0.01)。(2)脑出血患者脑脊液Aβ40(r=0.549,P0.01;r=0.791,P0.01)和Aβ42(r=0.450,P0.01;r=0.440,P0.01)水平与出血量及血肿周围低密度体积呈正相关。结论:Aβ40和Aβ42水平为神经元损害的标志物,本研究提示脑脊液Aβ40和Aβ42水平对于判断脑出血严重程度具有临床参考价值。     

Modeling Intracerebral Hemorrhage Growth and Response to Anticoagulation

The mechanism for hemorrhage enlargement in the brain, a key determinant of patient outcome following hemorrhagic stroke, is unknown. We performed computer-based stochastic simulation of one proposed mechanism, in which hemorrhages grow in “domino” fashion via secondary shearing of neighboring vessel segments. Hemorrhages were simulated by creating an initial site of primary bleeding and an associated risk of secondary rupture at adjacent sites that decayed over time. Under particular combinations of parameters for likelihood of secondary rupture and time-dependent decay, a subset of lesions expanded, creating a bimodal distribution of microbleeds and macrobleeds. Systematic variation of the model to simulate anticoagulation yielded increases in both macrobleed occurrence (26.9%, 53.2%, and 70.0% of all hemorrhagic events under conditions simulating no, low-level, and high-level anticoagulation) and final hemorrhage size (median volumes 111, 276, and 412 under the same three conditions), consistent with data from patients with anticoagulant-related brain hemorrhages. Reversal from simulated high-level anticoagulation to normal coagulation was able to reduce final hemorrhage size only if applied relatively early in the course of hemorrhage expansion. These findings suggest that a model based on a secondary shearing mechanism can account for some of the clinically observed properties of intracerebral hemorrhage, including the bimodal distribution of volumes and the enhanced hemorrhage growth seen with anticoagulation. Future iterations of this model may be useful for elucidating the effects of hemorrhage growth of factors related to secondary shearing (such as small vessel pathology) or time-dependent decay (such as hemostatic agents).     

Protective Effect of Granulocyte Colony-stimulating Factor on Intracerebral Hemorrhage in Rat

Granulocyte colony-stimulating factor (G-CSF) is a member of the cytokine family of growth factors that can protect the neurons from focal cerebral ischemia-induced injuries. The intracerebral hemorrhage (ICH) has been widely observed in the clinic; however, the protective effect of G-CSF on ICH is still elusive. We found in the present study that the intraperitoneal injection of G-CSF for 5 days could improve the ICH-induced neuronal behavioral impairment measured by limb placement assay. We also observed that injection of G-CSF could increase the number of stem cells in the specific zone of the hemorrhagic areas, demonstrated by the enhanced expression of nestin. Additionally, G-CSF could also promote the mobilization of circulating hemopoietic stem cells (HSCs) to the damaged brain areas and activate the astrocytes. Our results reveal that G-CSF is also protective for the ICH with the mechanisms involving proliferation of neural stem cells, the migration of HSCs and the activation of astrocytes.     

Temporal Evolution of MRI Characteristics in Dogs with Collagenase-Induced Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is one of the most lethal types of stroke. Neuroimaging techniques, particularly MRI, have improved the diagnostic accuracy of ICH. The MRI characteristics of the evolving stages of ICH in humans—but not those in dogs—have been described. In this study, we document the temporal MRI characteristics in a canine model of collagenase-induced ICH. Specifically, ICH was induced in 5 healthy beagles by injecting 500 U of bacterial collagenase from Clostridium histolyticum, which was delivered into the parietal lobe over 5 min by using a microinfusion pump. T1- and T2-weighted, fluid-attenuated inversion recovery, gradient-echo (GRE), and diffusion-weighted (DWI) imaging and measurement of the apparent diffusion coefficient (ADC) were performed serially at 6 different time points (before and 12 h, 3 d, 5 d, 10 d and 24 d after hemorrhage) by using a 3-T MR system. The temporal changes of T1 signal intensity (SI) corresponded well with the reported human data. The temporal changes of T2 and GRE sequences, with the exception of T2 and GRE hyperintensities at the early subacute stage, also matched. ADC measurements were high at the early subacute stage, and DWI-SI positively correlated with T2- and GRE-SI from the early subacute stage onward. In conclusion, MRI is an ideal method for characterizing the temporal evolution of parenchymal alterations after ICH in dogs. These data might be useful for differentiating clinical stages of ICH in dogs.Abbreviations: ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; FLAIR, fluid attenuation inversion recovery; GRE, gradient echo; ICH, intracerebral hemorrhage; ROI, region of interest; SIR, signal intensity ratio; WI, weighted imagingIntracerebral hemorrhage (ICH) occurs in 15% to 20% of all stroke patients.¹⁰ In comparison with ischemic stroke, patients with ICH are at higher risk of death and long-term functional disability.¹⁰ Most survivors remain disabled, owing to the hematoma within the brain parenchyma, which can cause severe neurologic deficits.Because of the rapid progression of brain damage during the first hours after ICH, quick recognition and diagnosis are key. Clinical signs are helpful for early diagnosis but are insufficient for the differentiation of ICH from other stroke subtypes. Brain imaging techniques, including CT and MRI, have helped improve the accuracy of diagnosis, which is necessary for the appropriate treatment of acute cerebrovascular accidents.⁵ Previously, MRI was considered unsuitable for detecting early-stage hemorrhage. However, MRI recently was shown to have high sensitivity for detecting hyperacute ICH, superior even to CT.²¹ MRI is now considered the ideal imaging modality for characterizing the temporal and spatial evolution of parenchymal changes after ICH.³⁰The MRI characteristics of ICH vary with the duration of the hematoma, the type of MRI sequence, and various biologic factors.¹⁷ The several forms of hemoglobin (oxyhemoglobin, deoxyhemoglobin, and methemoglobin), which have different magnetic properties, are observed at different times points during hemorrhage, depending on whether they contain unpaired electrons.²⁸ The MR signal intensity (SI) of hemorrhage has been reported for various animal models, from in vitro studies, and during clinical observations.^2,6,12,24 Reflecting the breakdown products of hemoglobin, the MRI features of 5 distinctive stages of ICH have been reported in humans: hyperacute (within 24 h of hemorrhage; intracellular oxyhemoglobin; long T1 and T2 values; iso- to hypointense on T1-weighted images [WI], hyperintense on T2WI); acute (1 to 3 d; intracellular deoxyhemoglobin; long T1, short T2 values; hypointense on T1WI, hypointense on T2WI); early subacute (3 to 7 d; intracellular methemoglobin with intact erythrocyte; short T1 and T2 values; hyperintense on T1WI, hypointense on T2WI); late subacute (7 to 14 d; extracellular methemoglobin with erythrocyte lysis; short T1, long T2 values; hyperintense on T1WI and T2WI); and chronic (after 14 d; ferritin and hemosiderin; long T1, short T2 values; hypointense on T1WI and T2WI).⁴So far, very few clinical studies have assessed the time-dependent evaluation of MRI patterns beyond 24 h in dogs.²³ The clinical setting presents several difficulties to the study of ICH. Because ICH patients are often critically ill, requiring physiologic support, most patients with ICH are unsuitable for MRI due to their medical instability.¹⁵ In dogs, it is frequently impossible to ascertain the precise interval between hemorrhage and MRI scanning. An animal model offers several advantages for studying ICH: histologic analysis in survivors of ICH, the initial testing of novel interventions, homogeneous experimental groups, and a predictable onset of ICH.²⁷An experimental animal model used in human medicine should exhibit certain characteristics, such as ease of standardization and reproducibility, and representation of the principal mechanisms associated with the particular condition in humans.⁸ Small-animal (for example, mice, rats, gerbils) and large-animal (for example, cats, dogs, pigs, sheep, monkeys) models that demonstrate these characteristics have been developed. Although small animals are often more cost-effective and allow for relatively simpler genetic manipulation and management, the use of large-animal models is important in preclinical studies of ICH because these animals have gyrencephalic brains with well-developed white matter that are structurally and functionally similar to human brains.¹⁶ Notably, numerous experimental treatment strategies have been evaluated successfully in rodent models and in vitro, but the vast majority of such modalities subsequently have failed in clinical trials.¹⁸ For all of these reasons, the Stroke Therapy Academic Industry Roundtable strongly recommends the use of appropriate large-animal models of stroke.¹⁹ Among large animals, dogs are readily and economically available, easy to care for, and have predictable intercurrent diseases.Presently, MRI of the brain is extremely useful in confirming stroke, determining the extent of the lesion, and distinguishing between ischemic and hemorrhagic stroke. However, MRI findings of canine ICH are largely based on results from human studies, given the paucity of relevant canine studies. A previous study demonstrated that the time course of ICH stages is much faster in rats than in humans.³ Therefore, we hypothesized that the temporal MRI characteristics of evolving stages of canine ICH differ from those of ICH in humans.Advanced MRI techniques may enable clarification of mechanisms that mediate injury after ICH. Diffusion-weighted imaging (DWI) has already proven useful in the diagnosis and investigation of the natural history of ischemic stroke.⁷ However, the usefulness of those techniques to assess mechanisms of neuronal injury after ICH remains a topic of debate, both in humans and in dogs. Therefore, the purpose of the current study was to evaluate the utility of advanced MRI techniques, including DWI, in the diagnosis of canine ICH, by monitoring the temporal changes in MR images relative to the stage of hematoma in affected dogs.     

MEKK1 Associated with Neuronal Apoptosis Following Intracerebral Hemorrhage

The JNKs have been implicated in a variety of biological functions in mammalian cells, including apoptosis and the responses to stress. However, the physiological role of these pathways in the intracerebral hemorrhage (ICH) has not been fully elucidated. In this study, we identified a MAPK kinase kinase (MAPKKK), MEKK1, may be involved in neuronal apoptosis in the processes of ICH through the activation of JNKs. From the results of western blot, immunohistochemistry and immunofluorescence, we obtained a significant up-regulation of MEKK1 in neurons adjacent to the hematoma following ICH. Increasing MEKK1 level was found to be accompanied with the up-regulation of p-JNK 3, p53, and c-jun. Besides, MEKK1 co-localized well with p-JNK in neurons, indicating its potential role in neuronal apoptosis. What’s more, our in vitro study, using MEKK1 siRNA interference in PC12 cells, further confirmed that MEKK1 might exert its pro-apoptotic function on neuronal apoptosis through extrinsic pathway. Thus, MEKK1 may play a role in promoting the brain damage following ICH.     

Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population

BackgroundIntracerebral hemorrhage (ICH) accounts for 10–15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population.MethodData for 1,192 patients admitted for ICH were collected over a four-year period. Multivariate logistic regression was used to identify independent predictors and odds ratios were computed for 30-day mortality and Glasgow Outcome Scale (GOS) comparing males and females.ResultMales suffered ICH at a younger age than females (62.2 ± 13.2 years vs. 66.3 ± 15.3 years; P<0.001). The occurrence of ICH was higher among males than females at all ages until 80 years old, beyond which the trend was reversed. Females exhibited increased severity on admission as measured by Glasgow Coma Scale compared to males (10.9 ± 4.03 vs. 11.4 ± 4.04; P = 0.030). No difference was found in 30-day mortality between females and males (F: 30.5% [155/508] vs. M: 27.0% [186/688]), with unadjusted and adjusted odds ratio (F/M) of 1.19 (P = 0.188) and 1.21 (P = 0.300). At discharge, there was a non-statistically significant but potentially clinically relevant morbidity difference between the genders as measured by GOS (dichotomized GOS of 4–5: F: 23.7% [119/503] vs. M: 28.7% [194/677]), with unadjusted and adjusted odds ratio (F/M) of 0.77 (P = 0.055) and 0.87 (P = 0.434).ConclusionIn our multi-ethnic Asian population, males developed ICH at a younger age and were more susceptible to ICH than women at all ages other than the beyond 80-year old age group. In contrast to the Western population, neurological status of female ICH patients at admission was poorer and their 30-day mortality was not reduced. Although the study was not powered to detect significance, female showed a trend toward worse 30-day morbidity at discharge.     

老年高血压脑出血的微创治疗分析

目的:探讨微创手术与传统开颅手术治疗高血压脑出血的手术效果。方法:回顾性分析自2005年5月至2009年7月期间开颅手术39例和微创手术治疗44例高血压脑出血的疗效,比较两种方式的优劣。结果:开颅手术组和微创手术组均获得了较好的疗效,两者相比未见有明显的差别。结论:微创手术组和开颅手术比较未见明显的疗效差异,微创手术手术简单,创伤面积小,费用较低,患者耐受性好,值得推广。     

Serum Copper Homeostasis in Hypertensive Intracerebral Hemorrhage and its Clinical Significance

This study was to investigate the alterations of serum copper homeostasis after hypertensive intracerebral hemorrhage (ICH), which is not yet clear. We recruited 85 hypertensive ICH patients and determined their serum levels of total copper (TCu), small molecule copper (SMC), and ceruloplasmin (Cp). Sera from 32 healthy persons and 12 primary hypertension patients were collected and analyzed as well. Serum TCu levels in ICH patients were tested at three time points (on admission, day 3, and day 7) and found to be higher than that in hypertension patients (p?<?0.05). The serum SMC levels in hypertension patients and ICH patients at three time points were higher than that in healthy controls (p?<?0.05). Higher serum SMC levels on days 3 and 7 were associated with death in the hospital. Additionally, higher serum SMC levels on the seventh day were associated with poor outcome at discharge. High serum Cp levels on admission, as well as low serum Cp levels on the seventh day, were associated with death in the hospital (p?=?0.002 and p?=?0.034, respectively). Our findings indicated that declines in serum Cp and increases in serum SMC are correlated with lethal or poor outcome in hypertensive ICH patients, possibly as a result of contributions to secondary injury of brain after hemorrhage due to impairment of iron transport and enhanced oxidative stress.     

Serum Procalcitonin Levels are Associated with Clinical Outcome in Intracerebral Hemorrhage

Procalcitonin (PCT) has emerged as a new prognostic inflammatory marker in a variety of diseases. This study aimed to evaluate whether PCT is associated with increased risk of unfavorable outcome in intracerebral hemorrhage (ICH) patients. During January 2015–December 2016, we conducted a prospective cohort investigation involved 251 primary ICH patients who were admitted within 24 h after the onset of symptoms. We assessed serum PCT levels for all patients at admission. The functional outcome after 3 months was evaluated by modified Rankin Scale (mRS) and dichotomized as favorable (mRS 0–2) and unfavorable (mRS 3–6). The independent risk factors for unfavorable outcome and mortality after 3 months were examined by binary logistic regression. Of 251 ICH patients, the median PCT concentration was 0.053 µg/L (interquartile range 0.035–0.078 µg/L). Unfavorable outcome and mortality at 3 months were observed in 161 (64.1%) and 51 (20.3%) patients, respectively. After adjusting for potential confounders, patients with PCT levels in the top quartile (>0.078 ug/L), compared with the lowest quartile (<0.035 μg/L) were more likely to have a higher risk of poor functional outcome [odds ratio (OR) 7.341; 95% confidence interval (CI) 2.770–21.114; P = 0.001] and mortality (OR 7.483; 95% CI 1.871–24.458, P = 0.006). Furthermore, the area under the receiver operating characteristic curve of PCT showed 0.701 (95% CI 0.635–0.767) for worse functional prognosis, and 0.652 (95% CI 0.569–0.735) for mortality. This study demonstrated that elevated PCT levels at admission were independently associated with unfavorable clinical outcome in ICH patients.     

老年高血压脑出血的微创治疗分析

目的：探讨微创手术与传统开颅手术治疗高血压脑出血的手术效果。方法：回顾性分析自2005年5月至2009年7月期间开颅手术39例和微创手术治疗44例高血压脑出血的疗效,比较两种方式的优劣。结果：开颅手术组和微创手术组均获得了较好的疗效,两者相比未见有明显的差剐。结论：微创手术组和开颅手术比较未见明显的疗效差异,微创手术手术简单,创伤面积小,费用较低,患者耐受性好,值得推广。