ABSTRACT
Objective@#To assess the risk factors associated with nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage (ICH) in the acute phase to provide evidence for prevention and intervention of nosocomial infections.@*Methods@#Clinical data of 224 patients with non-surgical basal ganglia ICH from January 2014 to December 2018 in the Shenzhen People′s Hospital were analyzed. Patients were divided into 2 groups based on the presence or absence of infection. Clinical data between the two groups were compared including gender, age, past medical history, bleeding volume, hematoma growth rate, systolic blood pressure, diastolic blood pressure, GCS, NIHSS, WBC, RBC, FBI, PLT, CR, BUN, GLU, CRP, UA, CHOL, TG, LDL, HCY. Multivariate Logistic regression analysis and the area under the ROC curve were performed on meaningful variables (P<0.05) to determine the early independent predictors of risk factors for nosocomial infections.@*ResuIts@#Nosocomial infection occurred in 47 of 224 patients, with an infection rate of 20.98%. Compared with infected group, non-infected group had a higher value of age [(63.91 ± 12.37) years vs. (58.66 ± 12.37) years, P=0.010], bleeding volume [(10.33 ± 7.94) ml vs. (7.61 ± 6.58) ml, P=0.034], hematoma growth rate [(7.34 ± 9.17) ml/h vs. (4.33 ± 6.77) ml/h, P=0.040], systolic blood pressure [(177.94 ± 25.28) mmHg (1 mmHg=0.133 kPa) vs. (164.85 ± 22.34) mmHg, P=0.001], NIHSS score [(7.89 ± 4.92) scores vs. (4.84 ± 4.59) scores, P<0.01], WBC [(9.50 ± 3.23) × 109/L vs. (8.25 ± 2.28) × 109/L, P=0.015], FBI [(3.44 ± 0.95) g/L vs. (3.03 ± 0.63) g/L, P=0.007], BUN [(7.01 ± 5.84) mmol/L vs. (4.95 ± 1.93) mmol/L, P=0.021], GLU [(7.27 ± 2.84) mmol/L vs. (5.96 ± 1.75), P=0.004] and CRP [(11.94 ± 21.4) mg/L vs. (4.39 ± 6.41) mg/L, P=0.021]. Multivariate Logistic regression analysis showed that systolic blood pressure (OR=1.021, 95% CI 1.005 -1.037, P=0.012), NIHSS score (OR=1.143, 95% CI 1.056 - 1.237, P=0.001), BUN (OR=1.174, 95% CI 1.025 - 1.344, P=0.020), CRP (OR=1.063, 95% CI 1.016 - 1.112, P=0.008) and age (OR=1.053, 95%CI 1.019 -1.089, P=0.002) was an independent risk factor for nosocomial infection in non-surgical basal ganglia ICH patients in the acute phase. The Area Under Curve (AUC) of the above independent risk factors was calculated, and the results showed that systolic blood pressure (AUC=0.653, 95% CI 0.564 -0.741, P=0.001), NIHSS score (AUC=0.679, 95% CI 0.592 - 0.767, P=0.000), BUN (AUC=0.617, 95% CI 0.526 - 0.708, P=0.014), CRP (AUC=0.691, 95% CI 0.614 - 0.768, P=0.000) and age (AUC=0.643, 95% CI 0.557 - 0.728, P=0.003) had an early predictive value for the occurrence of nosocomial infection in non-operative basal ganglia ICH patients in the acute stage.@*Conclusions@#The occurrence of nosocomial infections has identifiable and early predictive risk factors in patients with non-surgical basal ganglia ICH during acute phase. Therefore, controllable risk factors need to be controlled to reduce the incidence of nosocomial infections.
ABSTRACT
Objective:To introduce some rare clinical features of the variant Guillain-barre syndrome (GBS) and to explore its possible pathogenesis for the early diagnosis.Methods:The clinical data, laboratory data and treatment outcomes of four patients, who admitted to Shenzhen People′s Hospital from October 2017 to June 2018 and diagnosed with variant GBS were analyzed and summarized.Results:All the four patients presented limb weakness as a first manifestation. However, they all had clinical features that were inconsistent with typical GBS, and the clinical features were shown differently in each patient. One patient showed asymmetrical limb paralysis. The first manifestation of one patient was severe and persistent back pain accompanied by paraplegia. One patient was accompanied by obvious headache and positive meningeal irritation. One patients had the plane of sensory obstacles, paraplegia, and positive pathological sign. Cerebrospinal fluid examination showed protein cell dissociation in four patients. Electromyogram was consistent with peripheral neurogenic damage. Magnetic resonance imaging (MRI) of the brain and the spinal cord showed no obvious abnormalities. The four patients with obvious improvement in symptoms were treated with gamma globulin and glucocorticoid.Conclusions:Variant GBS is rare and clinical symptoms are various. Patients with atypical clinical symptoms should still be diagnosed by relevant auxiliary examinations to avoid delayed illness.
ABSTRACT
Objective To assess the risk factors associated with nosocomial infection in patients with non-surgical basal ganglia intracranial hemorrhage (ICH) in the acute phase to provide evidence for prevention and intervention of nosocomial infections.Methods Clinical data of 224 patients with nonsurgical basal ganglia ICH from January 2014 to December 2018 in the Shenzhen People's Hospital were analyzed.Patients were divided into 2 groups based on the presence or absence of infection.Clinical data between the two groups were compared including gender,age,past medical history,bleeding volume,hematoma growth rate,systolic blood pressure,diastolic blood pressure,GCS,NIHSS,WBC,RBC,FBI,PLT,CR,BUN,GLU,CRP,UA,CHOL,TG,LDL,HCY.Multivariate Logistic regression analysis and the area under the ROC curve were performed on meaningful variables (P ＜ 0.05) to determine the early independent predictors of risk factors for nosocomial infections.ResuIts Nosocomial infection occurred in 47 of 224 patients,with an infection rate of 20.98％.Compared with infected group,non-infected group had a higher value of age [(63.91 ± 12.37) years vs.(58.66 ± 12.37) years,P =0.010],bleeding volume [(10.33 ± 7.94) ml vs.(7.61 ± 6.58) ml,P=0.034],hematoma growth rate [(7.34 ± 9.17) ml/h vs.(4.33 ± 6.77) ml/h,P=0.040],systolic blood pressure [(177.94 ± 25.28) mmHg (1 mmHg=0.133 kPa)vs.(164.85 ± 22.34) mmHg,P=0.001],NIHSS score [(7.89 ± 4.92) scores vs.(4.84 ± 4.59) scores,P＜0.01],WBC [(9.50 ± 3.23) × 109/L vs.(8.25 ± 2.28) × 109/L,p=0.015],FBI [(3.44 ± 0.95) g/L vs.(3.03 ± 0.63) g/L,P =0.007],BUN [(7.01 ± 5.84) mmol/L vs.(4.95 ± 1.93) mmol/L,P =0.021],GLU [(7.27 ± 2.84) mmol/L vs.(5.96 ± 1.75),P =0.004] and CRP [(11.94 ± 21.4) mg/L vs.(4.39 ± 6.41) mg/L,P=0.021].Multivariate Logistic regression analysis showed that systolic blood pressure (OR=1.021,95％ CI 1.005-1.037,P=0.012),NIHSS score (OR=1.143,95％ CI 1.056-1.237,P=0.001),BUN (OR=1.174,95％ CI 1.025-1.344,P=0.020),CRP (OR=1.063,95％ CI 1.016-1.112,P=0.008) and age (OR=1.053,95％CI 1.019-1.089,P=0.002) was an independent risk factor for nosocomial infection in non-surgical basal ganglia ICH patients in the acute phase.The Area Under Curve (AUC) of the above independent risk factors was calculated,and the results showed that systolic blood pressure (AUC =0.653,95％ CI 0.564-0.741,P =0.001),NIHSS score (AUC =0.679,95％ CI 0.592-0.767,P =0.000),BUN (AUC =0.617,95％ CI 0.526-0.708,P =0.014),CRP (AUC =0.691,95％ CI 0.614-0.768,P =0.000) and age (AUC =0.643,95％ CI 0.557-0.728,P =0.003) had an early predictive value for the occurrence of nosocomial infection in non-operative basal ganglia ICH patients in the acute stage.Conclusions The occurrence of nosocomial infections has identifiable and early predictive risk factors in patients with non-surgical basal ganglia ICH during acute phase.Therefore,controllable risk factors need to be controlled to reduce the incidence of nosocomial infections.
ABSTRACT
Objective To evaluate the correlation between serum uric acid with cognitive disorder after acute cere?bral infarction by prospective study. Methods Four hundred consecutively enrolled patients of acute cerebral infarction were divided into no cognitive impairment group and cognitive impairment group according to the assess of Montreal Cog?nitive Assessment (MoCA). Univariate analysises were conducted in the potential risk factors of cognitive impairment in?cluding age, sex, smoking, alcohol, hypertension, diabetes, dyslipidemia, level of education, infarction in key parts, atrial fibrillation, serum uric acid, blood homocysteine between two groups. The statistically significant indicators in univariate analysises were used as independent variables and the scores of MoCA were used as the dependent variable to conduct multiple linear regression analysis. The assessment on the risk of cognitive impairment after cerebral infarction were con?ducted according to serum uric acid, sex, age and TOAST classification further. Results Serum uric acid was indepen?dent risk factors of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level and the relative risk was 1.35,95%CI(1.098,1.660). Especially for the young, male or patients with cerebral infarction in classification of small artery occlusion, the risk increased further, and the relative risk was 1.513, 95%CI(1.092, 2.096)1.412, 95%CI (1.125, 1.771)and 1.464, 95%CI(1.128, 1.900)respectively. Conclusion Exaltation of Serum uric acid was indepen?dent risk factor of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level, and especially for the young, male and patients with cerebral infarction in classification of small artery occlusion, the risk increased fur?ther.
ABSTRACT
Objective To assess the predictive value of cerebral arteriosclerosis to acute cerebral infarction evaluated by transcranial doppler ultrasound .Methods 170 cases suspected cerebral arteriosclerosis consecutively enrolled were given transcranial doppler ultrasound and were followed up for 6 months,then we assessed the correla-tion between the levels of cerebral arteriosclerosis and acute cerebral infarction within 6 months.Results By Spearman rank correlation analysis ,there was positive correlation between the severity of cerebral arteriosclerosis de-tected by transcranial doppler ultrasound and acute cerebral infarction within 6 months,the correlation coefficient was 0.575(P<0.05).Conclusion Through the detection of transcranial doppler ultrasound ,the higher levels of cere-bral arteriosclerosis,the greater probability of acute cerebral infarction within 6 months.
ABSTRACT
Objective To observe the effect of Tongsaimai Tablets on the leptomeningeal collateral circulation established after acute cerebral infarction by TCD.Methods 50 patients with acute cerebral infarction were randomly divided into control group (received conventional treatment) and treatment group (received Tongsainai Tablets three times a day,1.75g each time,on the basis of conventional treatment).The leptomeningeal collateral circulation of the two groups were observed after 6 months.Results The factors which may affect the leptomeningeal collateral circulation,such as age,the prevalence of hypertension and hyperlipidemia,original compensatory status of cerebral artery between the two groups had no statistically significant differences.The open rate of leptomeningeal collateral circulation in the treatment group was 64.00％,which was significantly higher than that of the control group(32.00％)(P =0.024).Conclusion Tongsaimai Tablets can promote the formation of leptomeningeal collateral circulation in patients with acute cerebral infarction.
ABSTRACT
Objective To observe the evolution process of cerebral blood flow spectrum in brain death by transcranial doppler ultrasound.Methods To detect the blood flow of bilateral middle cerebral artery in brain dead patients by transcranial doppler ultrasound.Results Twenty brain dead patients were collected in the study.The blood flow velocity of middle cerebral artery ranged s from 6 to 37cm/s,and the mean velocity was (12.13 ± 3.15)cm/s.There were three characteristic spectrums which include oscillatory wave (reverse wave in diastolic),nails wave (tip small wave in systolic),no blood flow sign,and they appeared in turn accoerding to worsen of the disease.The heartbeat irreversibly stopped within 8 days after the appearing of oscillatory wave,and ninty percent of the cases had the regular blood flow spectrums of oscillatory wave-nails wave-no blood flow sign.Conclusion The three regularly characteristic transcranial doppler ultrasound blood flow spectrums,which include oscillatory wave,nails wave and no blood flow sign could facilitate the diagnosis of brain death.
ABSTRACT
Objective To observe the influence of Gastrodia data capsule on cerebral blood flow in the treatment of patients with hypertension.Methods A total of 69 patients with hypertension were divided into the treatment group(36 cases) and the control group(33 cases).The treatment group received treatment of Gastrodia clara capsule combined with antihypertensive drug,the control group received treatment of antihypertensive drug only.Two groups received TCD test before and 20 days after treatment,and the changes of blood flow of intracranial vessels before and after treatment were assessed.Results The total effective rate in treatment group was 97.2％,12 cases cured,15 cases of tangible effectiveness,8 cases of effectiveness,1 case of invalidity.The total effective rate in control group was 75.8％,7 cases cured,12 cases of tangible effectiveness,6 cases of effectiveness,8 case of invalidity,The difference of clinical efficacy between the two groups was statistically significant ( Z =2.240,P ＜ 0.05 ).The mean velocity of MCA,ACA,PCA,BA,VA of control group 20 days after treatment was not statistically different compared to those before treatment.The mean velocity of MCA,ACA,PCA,BA,VA of treatment group 20 days after treatment was lower than those before treatment(t =-2.65,-2.44,-3.92,-3.31,-4.68,all P＜0.05).Conclusion The treatment of Gastrodia elata capsule conbined with antihypertensive drug can significantly improve curative effect of patients with hypertension and improve the condition of cerebral blood flow.