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Objective:To investigate the efficacy of Compound Musk combined with nimodipine combined with minimally invasive surgery in the treatment of hypertensive cerebral hemorrhage and the effects on serum inflammation, stress and apoptosis.Methods:Prospective research methods was used. A total of 118 patients with hypertensive intracerebral hemorrhage who received treatment in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from March 2017 to January 2021 were randomly divided into control group and Compound Musk group (59 cases in each group). After minimally invasive surgery, patients in the control group were treated with nimodipine on the basis of conventional treatment, while patients in the Compound Musk group were treated with compound musk on the basis of the control group. After 2 weeks, the efficacy was evaluated and the levels of serum inflammatory indexes, oxidative stress indexes and apoptosis indexes were measured.Results:The total effective rate in Compound Musk group was higher than that in control group: 98.3% (58/59) vs. 88.1% (52/59), and the difference was statistically significant ( P<0.05). After 2 weeks of treatment, serum inflammatory indexes including nuclear factor-κB (NF-κB), interleukin-1β (IL-1β), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9); apoptosis indexes including soluble Fas receptor (sFas), soluble Fas ligand (sFAS-L); oxidative stress indexes including advanced oxidation protein products (AOPP), malondialdehyde (MDA) decreased, and some oxidative stress indexes including glutathione peroxidase (GSH-Px), catalase (CAT) increased. The levels of the above inflammatory indexes, apoptosis indexes and oxidative stress indexes in Compound Musk group were lower than those in control group, NF-κB: (18.96 ± 2.17) ng/L vs. (24.10 ± 3.23) ng/L, IL-1β: (12.88 ± 1.74) ng/L vs. (15.19 ± 1.63) ng/L, MMP-3: (5.62 ± 0.95) ng/L vs. (7.97 ± 0.86) ng/L, MMP-9: (7.07 ± 0.86) ng/L vs. (9.26 ± 1.13) ng/L, sFas: (3.24 ± 0.38) μg/L vs. (4.19 ± 0.53) μg/L, sFas-L: (209.17 ± 24.39) ng/L vs. (288.54 ± 37.61) ng/L, AOPP: (10.76 ± 1.84) μg/L vs. (13.51 ± 2.09) μg/L, MDA: (2.87 ± 0.32) μmol/L vs. (3.45 ± 0.34) μmol/L, and the differences were statistically significant ( P<0.05). Some of the above oxidative stress indexes were higher than those in control group, GSH-Px: (3 274.91 ± 376.09) U/L vs. (2 854.19 ± 325.22) U/L, CAT: (60.82 ± 7.43) U/L vs. (52.17 ± 6.48) U/L, the differences were statistically significant ( P<0.05). During treatment, there was no significant difference in the incidence of rash, diarrhea, drug-induced liver and myocardial injury between two groups ( P>0.05). Conclusions:Compound Musk has a positive effect on improving the curative effect and internal environment of patients with hypertensive intracerebral hemorrhage after minimally invasive surgery, and will not increase the occurrence of serious adverse reactions.
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Objective:To investigate the clinical effect of minimally invasive catheterization based on computer 3D-Slicer software system in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods:Three hundred and fifty patients with HICH treated in People′s Hospital of Lanling County in Shandongfrom June 2019 to June 2020 were selected as the research object. According to the operation method, they were divided into 3D-Slicer group (175 cases) and CT group (175 cases). They were treated with 3D-Slicer software-assisted minimally invasive catheterization and minimally invasive soft-channel drainage under CT localization, respectively. The general conditions of the surgery, hematoma clearance rate and laboratory indexes, oxidative stress index and prognosis were compared between the two groups.Results:The intraoperative blood loss, the hospitalizationtimein the 3D-Slicer group were lower than those in the CT group: (81.42 ± 12.33) ml vs. (101.54 ± 11.71) ml, (15.67 ± 3.71) d vs. (17.22 ± 3.52) d; the success rate of one-time successful puncture to preset position in the 3D-Slicer group was higher than that in the CT group: 100.00%(175/175) vs. 81.14%(142/175), there were statistical differences ( χ 2 = 34.26, P<0.05). The hematoma clearance rate after the surgery for 1, 3 and 7d in the 3D-Slicer group were higher than those in the CT group:(87.93 ± 8.54)% vs. (66.43 ± 7.99)%, (92.48 ± 10.31)% vs. (89.52 ± 11.74)%, (96.37 ± 10.22)% vs. (94.30 ± 9.25)%, there were statistical differences( P<0.05). After the surgery for 7 d, the levels of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT) in the 3D-Slicer group were higher than those in the CT group: (121.36 ± 10.59)U/L vs. (109.14 ± 9.05) U/L, (92.80 ± 8.63) μg/L vs. (81.45 ± 9.11) μg/L, (24.64 ± 5.43) U/L vs. (20.84 ± 3.47) U/L; while the level of malondialdehyde (MDA) was lower than that in the CT group: (4.42 ± 0.57)μmol/L vs. (5.19 ± 0.51) μmol/L, there were statistical differences ( P<0.05). After the surgery for 3 months, the rate of favorable prognosis in the 3D-Slicer group was higher than that in the CT group 73.71%(129/175) vs. 62.29%(199/175), there was statistical difference ( χ2 = 5.25, P<0.05). Conclusions:Minimally invasive catheterization based on 3D-Slicer software system in the treatment of HICH can not only improve the clinical efficacy, but also shorten the hospitalization time, reduce intraoperative blood loss, and improve the prognosis.
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Objective:To observe the efficacy of 3D printing-assisted hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage and to explore the factors affecting postoperative brain dysfunction.Methods:A retrospective Case-control study was conducted to select 168 hypertensive intracerebral hemorrhage patients who were treated with 3D printing assisted hematoma puncture and drainage in the People′s Hospital of Yuechi County from January 2020 to September 2022 as the observation group, and 125 hypertensive intracerebral hemorrhage patients who were treated with CT guided hematoma puncture and drainage in the People′s Hospital of Yuechi County at the same time as the control group. The clinical efficacy of the two groups of patients was compared. According to the occurrence of postoperative brain dysfunction, the patients in the observation group were divided into normal brain function group ( n=121) and brain dysfunction group ( n=47). The clinical data of age, preoperative cerebral hernia, blood loss, ventilator-assisted ventilation, postoperative Glasgow coma index score (GCS) and postoperative complications were compared between the two groups. Multivariate Logistic regression was used to analyze the factors affecting postoperative brain dysfunction in the observation group, and a line chart model was constructed and its predictive efficiency was evaluated. The measurement data of normal distribution is expressed as mean ± standard deviation ( ± s), and independent sample t-test is used for inter group comparison. Chi-square test was used for comparison between count data groups. Results:The proportion of the drainage tube in the hematoma, hematoma clearance rate at 3 and 7 days after surgery, total effective rate of treatment, and GCS score at 1 week after surgery in the observation group were 88.69%(149/168), 54.17%(91/168), 96.43%(162/168), 92.86%(156/168), and 10.72±3.45, respectively, the control group was 75.20%(94/125), 36.80%(46/125), 81.60%(102/125), 76.80%(96/125), and 9.08±3.22, respectively, the difference between the two groups was statistically significant ( P<0.05). Advanced age ( OR=1.983, 95% CI: 1.169-2.732, P=0.017), preoperative cerebral hernia ( OR=1.532, 95% CI: 1.113-2.139, P=0.029), bleeding volume ≥ 50 mL ( OR=2.538, 95% CI: 1.802-3.347, P=0.003), postoperative GCS score 3-5 ( OR=2.874, 95% CI: 2.265-3.449, P<0.001), postoperative hypoxemia ( OR=2.251, 95% CI: 1.673-2.842, P=0.010) and postoperative chronic hydrocephalus ( OR=1.642, 95% CI: 1.214-2.021, P=0.022) were risk factors for postoperative brain dysfunction, while ventilator-assisted ventilation ( OR=0.656, 95% CI: 0.132-0.828, P=0.038) was protective factors. The internal verification of the line chart model by Bootstrap resampling method shows that the model has high differentiation, accuracy and validity. Conclusion:The application of 3D printing-assisted localization in hematoma puncture and drainage can improve the puncture condition and the hematoma clearance rate and clinical effect of patients with hypertensive intracerebral hemorrhage. Advanced age, preoperative cerebral hernia and bleeding volume are related to postoperative brain dysfunction. Clinical attention should be paid to patients with risk indicators of postoperative brain dysfunction.
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Objective:To investigate the effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage.Methods:A total of 112 patients with basal ganglia region hypertensive cerebral hemorrhage admitted to Lanling County People′s Hospital from May 2017 to February 2020 were selected as the research objects, and 56 patients performed traditional craniotomy(craniotomy group), and 56 patients used spinal CT to locate the hematoma area and puncture point before the surgery, and performed drilling and drainage according the scanning results (drilling group). The operation conditions, hematoma volume changes and hematoma clearance rate in two groups were compared. The levels of neuron-specific enolase (NSE), specific protein S100B, interleukin(IL)-17, IL-1β and C-reactive protein (CRP) in two groups before and after the treatment for 1 month were compared. The scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index Scale(BI) in two groups before and after the treatment for 3 months were compared.Results:The operative time, intraoperative blood loss, postoperative drainage volume in the drilling group were lower than those in the craniotomy group: (1.21 ± 0.28) h vs. (2.43 ± 0.37) h, (131.98 ± 39.51) ml vs. (231.64 ± 47.65) ml, (41.05 ± 5.68) ml vs. (62.93 ± 7.83) ml; the hematoma clearance rate in the drilling group was higher than that in the craniotomy group: (89.57 ± 6.15)% vs. (77.95 ± 5.92)%, there were statistical differences ( P<0.05). After treatment for 1 month, the levels of S100B, NES, IL-17, IL-1β, CRP in the drilling group were lower than those in the craniotomy group: (0.49 ± 0.18) μg/L vs. (0.67 ± 0.24) μg/L, (15.32 ± 1.67) μg/L vs. (17.61 ± 1.59) μg/L, (147.38 ± 14.86) ng/L vs. (172.59 ± 12.94) ng/L, (84.17 ± 10.48) ng/L vs. (107.43 ± 9.35) ng/L, (33.78 ± 4.77) mg/L vs. (47.01 ± 4.15) mg/L, there were statistical differences ( P<0.05). After treatment for 3 months, the scores of NIHSS in the drilling group was lower than that in the craniotomy group and the scores of BI in thedrilling group was higher than that in the craniotomy group: (3.57 ± 2.13) scores vs. (7.83 ± 2.96) scores, (84.56 ± 8.16) scores vs. (67.43 ± 6.95) scores, there were statistical differences ( P<0.05). The complication rate in the two groups had no statistically differences ( P>0.05). Conclusions:Compared with traditional craniotomy, the drilling and drainage based on spiral CT-guided on hematoma clearance has the advantages of shorter operation time, less injury, better regulation of inflammation and better improvement of neurological function.
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Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.
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Objective:To investigate the clinical efficacy of 3D printed guide plate-assisted hematoma puncture and catheter drainage in the treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia.Methods:The clinical data of 42 patients with a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia who received treatment with 3D printed guide plate-assisted hematoma puncture and catheter drainage in Dazhu Hospital of North Sichuan Medical College from January 2016 to January 2021 were retrospectively analyzed. In the traditional puncture group, there were 19 patients who received traditional punctures according to preoperative cranial CT findings (traditional puncture group). In the 3D printed guide plate puncture group, there were 23 patients who received hematoma puncture and catheter drainage assisted by a 3D printed guide plate. Preoperative preparation time (from admission to operation), operative time, the number of hematoma punctures, hematoma clearance rate, postoperative indwelling time of drainage tube, residual hematoma rate, the occurrence of puncture canal bleeding, intracranial infection, Glasgow Coma Scale score measured at 3 and 7 days after surgery, and Glasgow Outcome Scale score measured at 1, 3 and 6 months after surgery were compared between the two groups.Results:There were no significant differences in preoperative preparation time and operative time between the two groups ( t = 0.25, 0.40, both P > 0.05). 3D-printed guide plate-assisted hematoma puncture reduced the probability of reveiving one more hematoma puncture during the surgery. There was no significant difference in the number of hematoma puncture between the two groups ( χ2= 0.48, P > 0.05). There were no significant differences in the probabilities of puncture canal bleeding and intracranial infection between the two groups ( χ2 = 0.05, 0.03, both P > 0.05). Postoperative indwelling time of the drainage tube in the 3D printed guide plate puncture group was significantly shorter than that in the traditional puncture group [(3.10 ± 0.38) vs. (3.46 ± 0.52) days, t = 2.65, P < 0.05]. The residual hematoma rate in the 3D printed guide plate puncture group was significantly lower than that in the traditional puncture group [(32.04 ± 5.33)% vs. (37.37 ± 5.51)%, χ2 = 3.20, P < 0.05]. There were significant differences in Glasgow Coma Scale score measured at 3 and 7 days after surgery between the two groups [(12.04 ± 1.19) points vs. (11.26 ± 0.93) points, (13.65 ± 0.88) points vs. (12.94 ± 0.97) points, t = 2.33, 2.46, both P < 0.05]. Glasgow Outcome Scale score measured at 1, 3, and 6 months after surgery in the 3D printed guide plate puncture group was 18, 21, and 22 points, respectively, which was significantly higher than 9, 11, and 12 points in the traditional puncture group ( χ2 = 4.34, 4.69, 5.17, all P < 0.05). Conclusion:3D printed guide plate assisted hematoma puncture and catheter drainage for treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia can increase the accuracy of puncture, decrease hematoma residual rate, improve short- and long-term prognosis, does not prolong preoperative preparation time. Moreover, it costs low, is safe, and is easy to learn.
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Objective:To investigate the efficacy of different surgical treatments for hypertensive cerebral hemorrhage in older adult patients and their effects on traumatic stress and cerebral edema.Methods:A total of 100 older adult patients with hypertensive cerebral hemorrhage who received treatment in Zhejiang Xin'an International Hospital from January 2018 to June 2020 were included in this study. They underwent either craniotomy (craniotomy group, n = 50) or hard channel minimally invasive puncture drainage (minimally invasive puncture group, n = 50) according to the willingness of patients and their close relatives. Perioperative indexes, Barthel index after treatment, nerve injury indexes before and after treatment, prognosis related indexes, trauma stress indexes and brain edema were compared between the two groups. Results:Operative time, intraoperative blood loss and postoperative hospital stay in the craniotomy group were (147.21 ± 31.35) minutes, (289.74 ± 22.75) mL and (42.74 ± 6.82 ) days, respectively, which were significantly longer or greater than (41.88 ± 7.19) minutes, (4.62 ± 0.88) mL and (16.27 ± 4.02) days in the minimally invasive puncture group ( t = 38.73, 62.17, 23.17, all P < 0.001). Barthel index at 1 and 3 months after treatment in the minimally invasive puncture group was (63.11± 9.64) and (93.51 ± 11.38), respectively, which was significantly greater than (44.78 ± 8.85) and (81.29 ± 10.37) in the craniotomy group ( t = 3.17, 6.21, both P < 0.05). Before treatment, there were no significant differences in nerve injury index, prognosis index, trauma stress index and brain edema between the two groups (all P > 0.05). At different time points after treatment, each indicator in the minimally invasive puncture group was significantly superior to that in the craniotomy group (all P < 0.05). Conclusion:Hard channel minimally invasive puncture drainage exhibits advantages over traditional craniotomy in the treatment of hypertensive cerebral hemorrhage in older adult patients. Hard channel minimally invasive puncture drainage can more greatly reduce injury to brain tissue, better control nerve injury and brain edema, and more remarkably improve patient's quality of life than traditional craniotomy.
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Objective:To investigate the relationship between serum 25 hydroxyvitamin-D3, soluble advanced glycation end product receptor (sRAGE), nucleotide binding oligomerization domain like receptor 3 (NLRP3) mRNA and cognitive impairment in hypertensive intracerebral hemorrhage (HICH).Methods:143 patients with HICH treated in the Affiliated Hospital of Guangdong Medical University from July 2016 to July 2019 were selected as the research objects. Among the 143 patients with HICH, there were 68 patients with cognitive impairment (cognitive impairment group) and 75 patients without cognitive impairment (control group). The age, gender, amount of intracerebral hemorrhage, bleeding site, blood pressure, blood glucose and blood lipid of the two groups were counted, and the mRNA levels of 25 hydroxyvitamin-D3, sRAGE and NLRP3 were detected. Multivariate logistic regression analysis was used to analyze the risk factors of cognitive impairment in patients with HICH.Results:There were no significant differences in age, gender, smoking, education, bleeding site, diabetes rate, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) between cognitive dysfunction group and control group ( P>0.05); There were significant differences in bleeding volume and neurological function defect score (NIHSS) score between cognitive impairment group and control group ( P<0.05); The level of 25 hydroxyvitamin-D3 in cognitive impairment group was lower than that in control group ( P<0.05), and the expression level of NLRP3 mRNA was higher than that in control group ( P<0.05). There was no significant difference in sRAGE between the two groups ( P>0.05); Logistic regression analysis showed that the decrease of 25-hydroxyvitamin-D3 level, the increase of bleeding volume and NIHSS score were independent risk factors for cognitive impairment in HICH patients ( P<0.05). Conclusions:Decreased serum 25 hydroxyvitamin-D3 levels may increase the risk of cognitive impairment in patients with HICH.
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Objective:To investigate the efficacy and safety of short-term deep sedation after conventional decompressive craniotomy with hematoma removal in patients with hypertensive intracerebral hemorrhage.Methods:Sixty patients with hypertensive intracerebral hemorrhage who underwent conventional decompressive craniotomy with hematoma removal in the People′s Hospital of Yueqing, China between March 2018 and May 2019 were included in this study. They were randomly divided into deep sedation and light sedation groups ( n = 30/group). The deep sedation group was administered propofol (0.6-1.2 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to Richmond Agitation-Sedation Scale (RASS) -3 to -4 points and to the level of pain to Critical Care Pain Observation Tool (CPOT) 0-1 point. The duration of sedation and analgesia was for 48 hours. The light sedation group was administered propofol (0.2-0.5 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to RASS -1 to -2 points and to the level of pain to CPOT 0-1 point. The duration of sedation and analgesia was rehemorrhage for 48 hours. Patients in the two groups were intravenously administered Urapidil to control blood pressure to be 120-160/60-90 mmHg. In addition, all patients were subjected to mechanical ventilation, dehydration, reduction of intracranial pressure, anti-infection and symptomatic treatment. At 0, 6, 12, 24 and 48 hours after surgery, heart rate, mean arterial pressure, intracranial pressure, recurrence of hemorrhage, ventilator-associated pneumonia, lower extremity deep venous thrombosis, and gastrointestinal bleeding were monitored. Results:At 6, 12, 24 and 48 hours after surgery, the heart rate, mean arterial pressure, and intracranial pressure in the deep sedation group were significantly lower than those in the light sedation group ( P < 0.05 or P < 0.01). The recurrence of rehemorrhage and the incidence of gastrointestinal bleeding in the deep sedation group were 3.33% (1/30) and 6.67% (2/30), respectively, which were significantly lower than those in the light sedation group [10.00% (3/30), 20.00% (6/30), χ2 = 1.071, 2.307, both P < 0.05). There were no significant incidences in ventilator-associated pneumonia [30.00% (9/30) vs. 23.30% (7/30), χ2 = 0.340, P > 0.05] and lower extremity deep venous thrombosis [10.00% (3/30) vs. 6.67% (2/30), χ2 = 0.340, P > 0.05]. Conclusion:Short-term deep sedation after conventional decompressive craniotomy with hematoma removal can lower the heart beat, mean arterial pressure, intracranial pressure, the postoperative recurrence of hemorrhage, and the incidence of gastrointestinal bleeding in patients with hypertensive cerebral hemorrhage.
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Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group (66 cases) and control group(66 cases) by double blind random method.The observation group received three-dimensional titanium mesh repair at 24 ～ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ～ 150 d(3 ～ 5 months) after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were (92.5 ± 12.4) min,(354.3 ± 17.5) mL and (13.2 ± 3.1) min,respectively,which were shorter or less than those in the control group [(142.8 ± 15.3) min,(518.3 ± 22.3) mL and (38.3 ± 4.3) min],the differences between the two groups were statistically significant (t=4.745,6.831,4.963,all P ＜ 0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1 ±0.0) and(0.2 ± 0.1),respectively,which were lower than those in the control group [(0.2 ± 0.1),(0.3 ± 0.1)] (t =3.657,2.579,all P ＜0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P ＜0.05).The incidence of treatment complications in the observation group was 10.94％ (7/64),which was significantly lower than that in the control group [38.7％ (24/62)] (x2 =14.094,P ＜ 0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.
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Objective To investigate the clinical effect of minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage (HICH) and its influence on inflammatory factors.Methods From Decem-ber 2015 to December 2018,80 patients with HICH admitted to Linan People's Hospital Affiliated to Hangzhou Medi-cal College were divided into minimally invasive group (40 cases) and control group (40 cases) by random number table method.After admission,the control group was treated with dehydration of intracranial pressure ,blood pressure control,hemostasis,oxygen inhalation and infection prevention.The minimally invasive group was treated with mini-mally invasive intracranial hematoma clearance on the basis of the control group .The degree of neurological deficit (NIHSS) score,ADL score,hemorrhage volume,edema around hematoma and inflammatory factors were compared before and 2 weeks after treatment , and the prognosis after 3 months of treatment was compared between the two groups.Results After 2 weeks of treatment ,the NIHSS score of the minimally invasive group [(6.42 ±1.29)points] was lower than that of the control group [(11.08 ±1.65)points],while the ADL score of the minimally invasive group [(68.39 ±8.97) points] was higher than that of the control group [(54.26 ±7.41) points],the differences were statistically significant between the two groups (t＝14.072,7.681,all P＜0.05).The amount of bleeding [(8.34 ± 1.29)mL] and the amount of edema around the hematoma [(5.78 ±1.09)mL] in the minimally invasive group were lower than those in the control group [(19.67 ±3.29) mL and (8.91 ±1.75) mL] ( t＝20.277,9.602,all P＜0.05).The serum levels of IL-6 [( 12.65 ±3.87 ) ng／L], hs-CRP [( 6.52 ±1.29 ) mg／L] and TNF-α [(35.64 ±4.08) g／L] in the minimally invasive group were lower than those in the control group [(27.38 ± 6.41)ng／L,(10.84 ±2.04)mg／L,(47.34 ±6.23)mg／L] ( t＝12.442,11.320,9.936,all P＜0.05).The rate of recovered well in the minimally invasive group at 3 months after treatment (42.50%) was higher than that in the control group (20.00%) (χ2 ＝4.713,P＜0.05).Conclusion Minimally invasive removal of intracranial hemato-ma has good clinical effect in the treatment of patients with HICH.It can alleviate inflammation,reduce the amount of hemorrhage and edema around the hematoma ,and promote the recovery of nerve function.
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Objective@#To investigate the clinical effect of minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage (HICH) and its influence on inflammatory factors.@*Methods@#From December 2015 to December 2018, 80 patients with HICH admitted to Linan People's Hospital Affiliated to Hangzhou Medical College were divided into minimally invasive group (40 cases) and control group (40 cases) by random number table method.After admission, the control group was treated with dehydration of intracranial pressure, blood pressure control, hemostasis, oxygen inhalation and infection prevention.The minimally invasive group was treated with minimally invasive intracranial hematoma clearance on the basis of the control group.The degree of neurological deficit (NIHSS) score, ADL score, hemorrhage volume, edema around hematoma and inflammatory factors were compared before and 2 weeks after treatment, and the prognosis after 3 months of treatment was compared between the two groups.@*Results@#After 2 weeks of treatment, the NIHSS score of the minimally invasive group[(6.42±1.29)points] was lower than that of the control group[(11.08±1.65)points], while the ADL score of the minimally invasive group[(68.39±8.97)points] was higher than that of the control group[(54.26±7.41)points], the differences were statistically significant between the two groups (t=14.072, 7.681, all P<0.05). The amount of bleeding [(8.34±1.29)mL] and the amount of edema around the hematoma [(5.78±1.09)mL] in the minimally invasive group were lower than those in the control group [(19.67±3.29)mL and (8.91±1.75)mL] (t=20.277, 9.602, all P<0.05). The serum levels of IL-6 [(12.65±3.87)ng/L], hs-CRP [(6.52±1.29)mg/L] and TNF- α[(35.64±4.08)g/L] in the minimally invasive group were lower than those in the control group [(27.38±6.41)ng/L, (10.84±2.04)mg/L, (47.34±6.23)mg/L] (t=12.442, 11.320, 9.936, all P<0.05). The rate of recovered well in the minimally invasive group at 3 months after treatment (42.50%) was higher than that in the control group (20.00%) (χ2=4.713, P<0.05).@*Conclusion@#Minimally invasive removal of intracranial hematoma has good clinical effect in the treatment of patients with HICH.It can alleviate inflammation, reduce the amount of hemorrhage and edema around the hematoma, and promote the recovery of nerve function.
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Objective@#To study the surgical strategy and clinical efficacy of hypertensive basal ganglia hematomas via transsylvian transinsular approach individually.@*Methods@#The clinical data of 45 patients with hypertensive basal ganglia hematomas underwent microsurgical treatment with different sylvian anatomical points in Jianhu Hospital Affiliated to Nantong University from October 2014 to June 2016 were retrospectively analyzed.@*Results@#The anterior hematomas was dissected through anterior point of lateral fissure, accounted for 66.7%(30 cases), the posterior hematoma was dissected through rolandic points under lateral fissure, accounted for 22.2%(10 cases), the long axis type hematoma was dissected between the anterior point of the lateral fissure and the lower rolandic point, accounted for 11.1%(5 cases). The postoperative CT scan showed that 42 cases were removed the hematomas for more than 90.0%, 3 cases were removed the hematomas for more than 75.0%, there was no postoperative rebleeding.According to GOS score, 14 cases returned to preoperative life status, 20 cases recovered sufficiently to return to family life, 9 cases could ambulate with a crotch but needed assistance, one case showed vegetative survival, one patient died.@*Conclusion@#Transsylvian transinsular approach via individual sylvian anatomical point should be advocated to remove basal ganglia hematomas, and it has the advantages of minimally invasion, high hematoma evacuation rate, low rebleeding rate, good neurological recovery and so on.
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Objective@#To explore the effect of 3D-slicer assisted soft channel drainage on the surgical outcome and prognosis of patients with hypertensive cerebral hemorrhage (HICH).@*Methods@#Seventy-six HICH patients treated in Zhejiang Xin'an International Hospital from January 2016 to December 2018 were randomly divided into the control group and the observation group, with 38 cases in each group. Both groups of patients underwent percutaneous cone cranial soft channel drainage.The control group patients used CT hematoma localization, and the observation group patients used 3D-slicer software hematoma localization. The perioperative related data, surgical results, complications and prognosis of patients in the two groups were observed and compared.@*Results@#The operation time and hospitalization time of patients in observation group were (76.24 ± 11.24) min and (15.21 ± 4.01) d, significantly shorter than those in control group [(103.17 ± 17.43) min and (18.63 ± 4.75) d], and there were significant differences (P < 0.05). The blood loss during operation and hematoma residual amount 7 d after operation in observation group were (77.21 ± 11.35) ml and (4.24 ± 0.87) ml, significantly lower than those in control group [(115.35 ± 21.22) ml and (18.63 ± 4.75) ml], and there were significant differences (P < 0.05). The hematoma clearance of patients 1 d and 3 d after operation in observation group were (83.24 ± 11.21) ml and (92.24 ± 15.63) ml, significantly higher than those in control group [(69.67 ± 10.73) ml and (85.57 ± 13.11) ml], and there were significant differences (P < 0.05). The incidence rates of intracranial rebleeding, intracranial infection and pulmonary infection in observation group were significantly lower than those in control group [2.63%(1/38) vs. 21.05%(8/38), 0 vs. 15.79% (6/38), 2.63%(1/38) vs. 21.05%(8/38)](P < 0.05). After treatment for 3 months, the good prognosis rate in observation group was significantly higher than that in control group [86.84%(33/38) vs. 65.79% (25/38)] (P < 0.05).@*Conclusions@#3D-slicer software based on percutaneous soft-channel puncture and drainage for HICH patients can achieve better surgical results, reduce the incidence of complications and improve the prognosis of patients.
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Objective: To investigate the impact of serum brain-derived neurotrophic factor (BDNF) levels on depression of hypertensive cerebral hemorrhage(HICH) patients with conservative treatment. Methods: From April 2014 to December 2017, a total of 63 patients with HICH hospitalized in the Department of Neurosurgery, Tangshan Gongren Hospital were enrolled. There were 38 males and 25 females patients. All had intracranial hematoma volume within 30 ml and received conservative treatment. Serum BDNF levels were detected using enzyme linked immunosorbent assay. The paralysis grade was assessed using National Institutes of Health Stroke Scale (NIHSS) on admission and the 21 st day after admission. The Zung Depression Self-rating Scale(SDS) was used to evaluate depression 21 days after admission. Patients with SDS score ≥53 were divided into the depression group and with SDS score < 53 were divided into the non-depression group. The differences of serum BDNF levels between the two groups were compared. Risk factors for depression of HICH patients with conservative treatment were analyzed by binary Logistic regression analysis. Results: The SDS score of the depression group (54. 7 ± 1.5) on the 21st day after admission was significantly higher than that of the non-depression group (44. 6 ± 6. 5, 1 =7. 020, P <0. 01). The serum BDNF levels of the depression group was lower than that of the non-depression group(7. 0 ± 1. 4 p, g/L vs. 8. 6 ± 1. 8 p, g/L, t = - 3. 433, P = 0. 001). The paralysis grade of the depression group was higher than that of the non-depression group on the 21st day after admission (5. 4 ± 1. 5 vs. 3. 8 ± 1. 1, t =4. 951, P <0. 01). In the depression group, the serum BDNF level was negatively correlated with SDS score(r = -0. 535, P =0. 013).blood loss(r= - 0. 578, P = 0. 006) and paralysis grade(r= -0. 715, P<0. 01) on the 21st day after admission. In binary Logistic regression analysis, serum BDNF level was a protective factor for depression in HICH patients undergoing conservative treatment(OR, 0. 990, 95% CI 0. 983-0. 997, P = 0. 008). Conclusion: The lower the serum BDNF levels of HICH patients with conservative treatment, the more prone to depression.
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Objective: To investigate and compare the safety and efficacy of neuroendoscopic minimally invasive surgery and craniotomy for supratentorial hypertensive cerebral hemorrhage. Methods: From June 2016 to April 2018, 85 patients with hypertensive intracerebral hemorrhage treated in Department of Neurosurgery, the First Affiliated Hospital of University of South China were recruited. The time from onset to operation was 3-36 h, averaging 14 ± 7 h. All cases were supratentorial cerebral hemorrhage including 42 cases of basal ganglia cerebral hemorrhage, 28 cases of thalamic hemorrhage and 15 cases of cortical hemorrhage. 44 cases of hemorrhage were on the left side and 41 cases on the right side;38 cases of hemorrhage ruptured into ventricle. The blood loss ranged 32-82 ml, with an average of 52 ± 11 ml. Preoperative Glasgow coma scale(GCS) scores ranged from 6 to 12 points, with an average of 8. 2 ± 1. 5 points. According to different treatment methods, 85 patients were divided into two groups;the craniotomy group(n =51) and the endoscopic treatment group(n = 34). Baseline data, operation condition and related complications were recorded and compared between the two groups. The prognosis of the two groups was evaluated three months after the operation. The Glasgow prognostic scale score 4-5 was defined as favorable prognosis, and score 1-3 as unfavorable prognosis. Results: (1) There were no statistically significant differences in male gender, history of hypertension, age, preoperative GCS score, blood loss and bleeding site between the two groups(all P>0. 05). (2) The clearance rate of hematoma in the endoscopic treatment group was higher than that in the craniotomy group ([86. 7 ±2. 2] % vs. [70. 4 ±7. 2] %, t =9. 135), and the operation duration was shorter than that in the craniotomy group([72 ±6] mins vs. [149 ±21] mins, t = -20. 340). All the differences were statistically significant (all P 0.05). (3) The favorable prognosis rate in the endoscopic treatment group was higher than that in the craniotomy group with statistically significant difference (82. 4% [28/34] vs. 60. 8% [31/51] X2 =4.470, P=0.034). Conclusion: For the treatment of supratentorial spontaneous cerebral hemorrhage, hematoma removal by neuroendoscopic minimally invasive surgery is an alternative surgical method compared with craniotomy in terms of safety and efficacy.
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Objective To explore the effect of 3D-slicer assisted soft channel drainage on the surgical outcome and prognosis of patients with hypertensive cerebral hemorrhage (HICH). Methods Seventy-six HICH patients treated in Zhejiang Xin 'an International Hospital from January 2016 to December 2018 were randomly divided into the control group and the observation group, with 38 cases in each group. Both groups of patients underwent percutaneous cone cranial soft channel drainage.The control group patients used CT hematoma localization, and the observation group patients used 3D-slicer software hematoma localization. The perioperative related data, surgical results, complications and prognosis of patients in the two groups were observed and compared. Results The operation time and hospitalization time of patients in observation group were (76.24 ± 11.24) min and (15.21 ± 4.01) d, significantly shorter than those in control group [(103.17 ± 17.43) min and (18.63 ± 4.75) d], and there were significant differences (P < 0.05). The blood loss during operation and hematoma residual amount 7 d after operation in observation group were (77.21 ± 11.35) ml and (4.24 ± 0.87) ml, significantly lower than those in control group [(115.35 ± 21.22) ml and (18.63 ± 4.75) ml], and there were significant differences (P < 0.05). The hematoma clearance of patients 1 d and 3 d after operation in observation group were (83.24 ± 11.21) ml and (92.24 ± 15.63) ml, significantly higher than those in control group [(69.67 ± 10.73) ml and (85.57 ± 13.11) ml], and there were significant differences (P < 0.05). The incidence rates of intracranial rebleeding, intracranial infection and pulmonary infection in observation group were significantly lower than those in control group [2.63%(1/38) vs. 21.05%(8/38), 0 vs. 15.79% (6/38), 2.63%(1/38) vs. 21.05%(8/38)](P<0.05). After treatment for 3 months, the good prognosis rate in observation group was significantly higher than that in control group [86.84% (33/38) vs. 65.79% (25/38)] (P<0.05). Conclusions 3D-slicer software based on percutaneous soft-channel puncture and drainage for HICH patients can achieve better surgical results, reduce the incidence of complications and improve the prognosis of patients.
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Objective To study the surgical strategy and clinical efficacy of hypertensive basal ganglia hematomas via transsylvian transinsular approach individually.Methods The clinical data of 45 patients with hypertensive basal ganglia hematomas underwent microsurgical treatment with different sylvian anatomical points in Jianhu Hospital Affiliated to Nantong University from October 2014 to June 2016 were retrospectively analyzed.Results The anterior hematomas was dissected through anterior point of lateral fissure,accounted for 66.7％ (30 cases),the posterior hematoma was dissected through rolandic points under lateral fissure,accounted for 22.2％ (10 cases),the long axis type hematoma was dissected between the anterior point of the lateral fissure and the lower rolandic point,accounted for 11.1％ (5 cases).The postoperative CT scan showed that 42 cases were removed the hematomas for more than 90.0％,3 cases were removed the hematomas for more than 75.0％,there was no postoperative rebleeding.According to GOS score,14 cases returned to preoperative life status,20 cases recovered sufficiently to return to family life,9 cases could ambulate with a crotch but needed assistance,one case showed vegetative survival,one patient died.Conclusion Transsylvian transinsular approach via individual sylvian anatomical point should be advocated to remove basal ganglia hematomas,and it has the advantages of minimally invasion,high hematoma evacuation rate,low rebleeding rate,good neurological recovery and so on.
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Objective To investigate the relationship between matrix metalloproteinase-9 (MMP-9) gene polymorphism and delayed cerebral edema in patients with hypertensive intracerebral hemorrhage (HICH).Methods 137 HICH patients were recruited to participate in the study.According to whether combined with delayed cerebral edema,they were divided into the case group (42 cases) and the control group (95 cases).Genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-FLP) for MMP-9 gene-1562C/T polymorphism.Clinical data was collected for statistical analysis.Results There was significant difference in age,diabetes,persistent fever,baseline hematoma volume and National Institute of Health Stroke Scale (NIHSS) between the case group and the control group (all P ＜ 0.05).Meanwhile,serum MMP-9 level of the case group was significantly higher than that of the control group [(176.7 ± 50.3) mg/L vs (145.8 ± 41.3) mg/L,P =0.000].There were significant difference in serum MMP-9 level between genotype CC and genotype (CT + TT) [(147.3 ± 45.0) mg/L vs (189.2 ± 59.4)mg/L,P =0.000].Compared with the control group,the distribution frequencies of allele T in the case group was significantly increased (P =0.019).Multivariatc Logistic regression analysis showed that Allele T was a risk factor of delayed cerebral edema for HICH patients (OR =2.612,95％ CI:1.187-6.670,P =0.005).Conclusions For spontaneous HICH patients,MMP-9 gene-1562C/T polymorphism may closely related to delayed cerebral edema.
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Objective To analyze the risk factors between young and middle-aged patients and oldaged patients with hypertensive cerebral hemorrhage in the Kazakhs of Xinjiang.Methods A retrospective analysis of the 127 cases with hypertensive cerebral hemorrhage in the Xinjiang Uygur Autonomous Region people's Hospital.In addition,171 patients with non cerebral hemorrhage were selected as the control group.All the patients were divided into young and middle-aged group and old-aged group.The risk factors of two groups of hypertensive intracerebral hemorrhage were compared,and two groups of risk factors were analyzed by Logistic regression analysis.Results There were significant differences in diabetes,coronary heart disease,alcohol drinking,disease awareness,treatment compliance,systolic pressure,diastolic pressure,low-density lipoprotein (LDL),high-density lipoprotein (HDL),serum homocysteine (Hcy) and carotid atherosclerosis between the two groups (P ＜ 0.05).Logistic regression analysis showed that the independent risk factors of young and middle-aged patients with hypertensive cerebral hemorrhage in the Kazakhs of Xinjiang included alcohol drinking,treatment compliance,systolic pressure,diastolic pressure and Hcy (P ＜ 0.05),but systolic pressure,Hcy and carotid atherosclerosis were the independent risk factors of oldaged patients (P ＜ 0.05).Conclusions There were differences in the risk factors between young and middle-aged patients and old-aged patients with hypertensive cerebral hemorrhage in the Kazakhs of xinjiang,but systolic pressure and Hcy were both the independent risk factors of the two groups.