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Objective@#To explore the effects of minimally invasive intracranial hematoma removal in the treatment of cerebral hemorrhage, and its influence on neurological functional recovery, serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-8(IL-8), tumor necrosis factor-alpha (TNF-α).@*Methods@#From January 2016 to December 2017, 100 patients with cerebral hemorrhage admitted to Zhejiang Xin'an International Hospital were selected and randomly divided into two groups according to the digital table, with 50 cases in each group.The control group was given routine symptomatic treatment, the observation group received minimally invasive intracranial hematoma removal combined with conventional treatment.The curative effect, restoration of nerve function, the levels of hs-CRP, IL-6, IL-8 and TNF- were observed in the two groups.@*Results@#After treatment, the blood loss and edema volume around the hematoma in the two groups were declined significantly (t=5.74, 9.32, 7.41, 9.32, all P<0.05), and the improvements of the observation group was better than those of the control group (t=8.29, 5.28, all P<0.05). The excellent and good rate of the observation group was 90%(45/50), which was significantly higher than 72%(36/50) of the control group (χ2=3.62, P<0.05). After treatment, the NDS scores of the two group were significantly lower than those before treatment (t=4.64, 5.75, all P<0.05), the GCS scores of the two groups were significantly improved (t=5.41, 7.86, all P<0.05). The NDS score of the observation group was significantly lower than that of the control group (t=5.31, P<0.05), the GCS score of the observation group was significantly higher than that of the control group(t=3.84, P<0.05). After treatment, the levels of inflammatory factors in the two groups were significantly reduced compared with those before treatment (t=3.27, 3.75, 3.38, 3.61, 5.74, 4.39, 6.52, 8.26, all P<0.05), the levels of inflammatory factors in the observation group were significantly lower than those in the control group (t=4.37, 3.92, 8.52, 4.28, all P<0.05).@*Conclusion@#Minimally invasive removal of intracranial hematoma combined with conventional treatment in the treatment of patients with cerebral hemorrhage can obtain satisfactory clinical effect, can promote neural functional recovery, improve inflammatory factor levels (hs-CRP, IL-6, IL-8, TNF alpha), it is worthy of application.
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Objective To explore the clinical effect of targeted soft channel intracranial hematoma drainage combined with urokinase and autologous serum on hypertensive cerebral hemorrhage.Methods Form October 2016 to October 2017,120 patients with hypertensive cerebral hemorrhage were selected as the research objects in Handan First Hospital.In accordance with the principle of random number rule,they were divided into two groups,60 cases in each group,the study group was given directional soft channel with autologous serum treatment,the control group was given directional soft channel joint urokinase for treatment of intracranial hematoma drainage,and then nerve function,clinical curative effect,inflammatory factors and endothelial function of two groups were compared.Results Before treatment,the National Institutes of HealthStroke Scale (NIHSS) score of the study group and the control group were (4.70±0.99) and (4.71 ± 1.02),after treatment were (9.57± 1.54) and (6.63 ± 1.35),respectively.The difference between the two groups before treatment was not statistically significant (t =0.054,P =0.957).After treatment,the NIHSS scores of patients in both groups were significantly higher than those before treatment (Study group t =20.605,P=0.000,Control group t =8.790,P =0.000),The NIHSS score of the study group was significantly higher than that of the control group and the difference was statistically significant (t=11.120,P=0.000).Before treatment,Interleukin-6 (I1-6) in the study group and the control group were(45.61 ±4.13) ng/L and (44.98±2.19) ng/L,after treatment were (13.72±2.19) ng/L and (26.17±2.51) ng/L,respectively,and the two groups before treatment showed no significant difference (t =0.065,P =0.948).After treatment,IL-6 in both the study group and the control group decreased significantly (Studygroup t =52.841,P =0.000,Control group t =43.740,P =0.000),and IL-6 in the study group was significantly lower than that in the control group (t =28.951,P=0.000).Before treatment,the Tumor necrosis factor-α (TNF-αt) of the study group and the control group were (63.01 ± 4.22) μg/L and (62.96 ± ±4.21) μg/L,after treatment were (40.92 ± 3.12) μg/L and (55.67.4.02) μg/L,respectively.The difference between the two groups before treatment was not statistically significant (t =0.065,P =0.948).TNF-α in both the study group and the control group significantly decreased after treatment (Study group t=32.604,P=0.000,Control group t=9.933,P=0.000).TNF-α in the study group was significantly lower than the control group (t =22.453,P=0.000).Before treatment,the nitric oxide of the study group and the control group were (33.46±4.27) μmol/L and(32.97±4.25) μmol/L,after treatment were(54.15±3.11) μmoL/L and (43.17± 3.22) μmol/L.No statistically significant difference was observed between the two groups before treatment (t =0.630,P =0.530).After treatment,nitric oxide was significantly increased in both the study group and the control group (Study group t =30.339,P =0.000,Control group t =14.818,P =0.000).Nitric oxide in the study group was significantly higher than that in the control group (t =18.999,P=0.000).Before treatment,the Endothelin-1 of the study group and the control group before and after treatment were (84.43±4.22) μg/L and (84.51±4.26) μg/L,after treatment were(57.47±5.07) μg/L and (70.14±5.12) μg/L.There was no statistically significant difference between the two groups before the treatment (t =0.335,P =0.738).After the treatment,endothelin-1 in both the study group and the control group was significantly reduced (Study group t =22.889,P =0.000,Control groupt =10.662,P =0.000),and endothelin-1 in the study group was significantly lower than that in the control group (t =9.226,P =0.000).The total effective rate of the study group after treatment was 88.33％ (53/60),significantlyhigher than that of the control group (73.33％) (44/60).The difference between the two groups was statistically significant (x2 =4.357,P =0.037).Conclusion Targeted soft channel intracranial hematoma drainage combined with autologous serum was effective in the treatment of hypertensive cerebral hemorrhage,which is worthy of clinical application.
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Objective To explore the effects of minimally invasive intracranial hematoma removal in the treatment of cerebral hemorrhage,and its influence on neurological functional recovery,serum levels of high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6),interleukin-8 (IL-8),tumor necrosis factor-alpha (TNF-α).Methods From January 2016 to December 2017,100 patients with cerebral hemorrhage admitted to Zhejiang Xin'an International Hospital were selected and randomly divided into two groups according to the digital table,with 50 cases in each group.The control group was given routine symptomatic treatment,the observation group received minimally invasive intracranial hematoma removal combined with conventional treatment.The curative effect,restoration of nerve function,the levels of hs-CRP,IL-6,IL-8 and TNF-were observed in the two groups.Results After treatment,the blood loss and edema volume around the hematoma in the two groups were declined significantly (t =5.74,9.32,7.41,9.32,all P ＜ 0.05),and the improvements of the observation group was better than those of the control group (t =8.29,5.28,all P ＜ 0.05).The excellent and good rate of the observation group was 90％ (45/50),which was significantly higher than 72％ (36/50) of the control group (x2 =3.62,P ＜ 0.05).After treatment,the NDS scores of the two group were significantly lower than those before treatment (t =4.64,5.75,all P ＜ 0.05),the GCS scores of the two groups were significantly improved (t =5.41,7.86,all P ＜ 0.05).The NDS score of the observation group was significantly lower than that of the control group (t =5.31,P ＜ 0.05),the GCS score of the observation group was significantly higher than that of the control group (t =3.84,P ＜ 0.05).After treatment,the levels of inflammatory factors in the two groups were significantly reduced compared with those before treatment (t =3.27,3.75,3.38,3.61,5.74,4.39,6.52,8.26,all P ＜ 0.05),the levels of inflammatory factors in the observation group were significantly lower than those in the control group (t =4.37,3.92,8.52,4.28,all P ＜0.05).Conclusion Minimally invasive removal of intracranial hematoma combined with conventional treatment in the treatment of patients with cerebral hemorrhage can obtain satisfactory clinical effect,can promote neural functional recovery,improve inflammatory factor levels (hs-CRP,IL-6,IL-8,TNF alpha),it is worthy of application.
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Objective To analyze the safety and effectiveness of ultra-early microsurgical treatment of ruptured anterior communicating artery aneurysm (ACoAA) with intracranial hematoma. Methods The clinical and imaging data of 47 ACoAA with intracranial hematoma patients treated with ultra-early (within 24 h after onset) microsurgery were retrospectively analyzed from September 2008 to September 2018 in the Department of Neurosurgery, General Hospital of the Eastern War Zone. All patients received head CT and CT angiography (CTA) or DSA before operation, and underwent microsurgery via pterional lateral cerebral fissure approach. The glasgow coma scale (GCS) was used to evaluate the consciousness state of patients before and after operation. The Glasgow outcome scale (GOS) was used to evaluate the prognosis of patients. The clinical and imaging(CTA or DSA) follow-ups were regularly performed every 3 months after procedure. Results All cases of aneurysms were completely clipped. Of the 47 patients, the hematoma of 33 cases were completely cleared and the hematoma of 14 cases were partially cleared;25 cases underwent decompressive craniectomy and 26 cases underwent extraventricular drainage. Postoperative complications occurred in 10 patients (21.3%), including 3 cases with intracranial rehemorrhage (1 case died),2 cases with hypothalamic dysfunction,2 cases with hydrocephalus, 1 case with frontotemporal lobe infarction, 1 case with intracranial infection, and 1 case with malignant brain swelling; the remaining patients had no obvious postoperative complications and were observed varying degrees of clinical symptoms improvement compared with preoperative status. Of the 47 patients, except 1 patient died, no aneurysm was found in CTA or DSA in the remaining 46 patients after operation. At discharge, COS score showed 5 points in 2 cases,4 points in 9 cases,3 points in 21 cases and 2 points in 14 cases. 11 cases had good prognosis and 35 cases had poor prognosis. The postoperative (17 ± 4) d GCS score of these 46 patients showed that the consciousness state was improved (the preoperative and postoperative scores were; 5 ± 1 and 7 ±2 Respectively,t = 7. 607,P <0. 01). Of these 46 patients,29 patients were followed up (3 month to 6years,median time 9 [6, 18] months) without recurrence. Conclusion Ultra-early microsurgery is a safe and effective method for the treatment of ruptured ACoAA with intracranial hematoma, and it is very important for the improvement of the consciousness state of patients.
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Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH):YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation.Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed.The differences in demographics,length of operation time,costs and length of hospital stay,Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients.Results There were no significant differences in the gender (male 58.33％ vs.63.64％,femal 41.67％ vs.36.36％),age (65.5±11.8 years vs.56.8±10.1 years),preoperative GCS (6.83±3.93 vs.5.82±3.40),intracranial hematoma volume (50.52±23.07 mL vs.68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs.22.45±18.37 days) (P＞0.05);There were statistically significant differences in length of operation time (0.73±0.21 h vs.3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs.79 857.90±34 916.48 yuan of RMB) between two groups (P＜0.05);Follow-up 3 months,there were no significant differences in rate of good recovery 33.3％ vs.18.1％,severe disability rate (25.0％ vs.27.3％) and mortality rate (41.7％ vs.54.6％) between two groups (P＞0.05).Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time,more accurate hematoma localization,lower risk of injury,and lower hospitalization costs.In particular,the procedure is suitable for elderly,frail,and poor general condition patients.It can also be applied as emergency treatment for HICH.
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Objective?To compare the clinical efficacy and prognosis of neural endoscopic intracranial hematoma evacuation (NEIHE) and soft channel puncture drainage (SCPD) in treatment of hypertensive intracerebral hemorrhage (HICH).?Methods?106 HICH cases from January 2015 to December 2016 were divided into endoscopic group (51 cases, NEIHE scheme) and drainage group (55 cases, SCPD scheme) according to random number, operation and complications indicators were recorded, variations on peripheral inflammatory factors and NIHSS neurological deficit score were compared, meanwhile, clinical efficacies were determined.?Results?Though the endoscopic group with operative time (108.5 ± 33.8 vs 85.8 ± 25.4) min and intraoperative blood loss (54.2 ± 17.7 vs 42.6 ± 14.5) ml were significantly higher than drainage group (P < 0.05), the endoscopic group associated with a higher hematoma clearance 48 h post operation (85.8 ± 7.8 vs 74.7 ± 9.2) % (P < 0.05) and lower overall complication rate (13.7% vs 29.1%) (P < 0.05). After 14 d, the endoscopic group with the decreased value of peripheral blood TNF-α (129.5 ± 33.7 vs 107.8 ± 29.5) pg/ml, IL-6 (74.3 ± 22.8 vs 56.7 ± 18.2) pg/ml, hs-CRP (32.6 ± 7.5 vs 27.2 ± 6.6) mg/L were all significantly higher than the drainage group (P < 0.05). After 14 d, endoscopic group with decreased value of NIHSS score was significantly higher than the drainage group (13.0 ± 3.8 vs 10.3 ± 3.5) (P < 0.05). 6 months after operation, the increased Barthel index in the survivors of endoscopic group was significantly higher than the drainage group (44.8 ± 9.7 vs 39.5 ± 11.2) (P < 0.05).?Conclusion?Though the NEIHE is more complicated than SCPD in treatment of HICH, the hematoma clearance is more complete, the complications are less, and the short-term efficacy and prognosis with obvious advantages.
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Objective To investigate clinical effect of mild hypothermia therapy assisted intracranial hematoma evacuation in treatment of cerebral hemorrhage.Methods One hundred and ten patients with cerebral hemorrhage were selected in Affiliated Hospital of North China University of Science and Technology from December 2011 to December 2013,and were randomly divided into two groups.Fifty-five patients treated intracranial hematoma evacuation as control group.Another 55 patients treated mild hypothermia therapy assisted intracranial hematoma evacuation as observation group.Treatment effect was compared between two groups.Results Serum S100β,neuron specific enolization (NSE) enzyme,tumor necrosis factor α (TNF-α),creactive protein(CRP),cognitive function score,daily life ability score,neurological function defect score before and after treatment in control group were (0.82±0.12) μg/L and (0.53±0.09) μg/L,(19.42±2.30) μg/L and (10.36±1.07) μg/L,(3.62±0.57) mg/L and (1.54±0.30) mg/L,(29.43±4.36) g/L and (10.25± 1.07) g/L,(13.42± 1.58) points and (25.03± 1.19) points,(21.45± 3.27) points and (37.92 ± 5.83)points,(13.27± 1.35) points and (4.84 ± 1.08) points,the differences were significant (t =8.471,11.834,17.026,22.539,12.230,10.619,25.531,P ＜ 0.05).Serum S100β,NSE,TNF-α,CRP,cognitive function score,daily life ability score,neurological function defect score before and after treatment in observation group were (0.84±0.13)μg/L and (0.41±0.10) μg/L,(19.48±1.76) μg/L and (8.75±0.84) μg/L,(3.64± ±0.61) mg/Land (1.17±0.29) mg/L,(29.58±3.62) g/L and (6.02±1.18) g/L,(13.29±1.34) points and (27.58± 1.27) points,(21.68±4.02) points and (48.26±7.14) points,(13.46± 1.21) points and (3.57±0.85) points,the differences were significant(t=13.498,16.739,25.728,41.836,13.769,15.857,36.352,P＜0.05).Compared with serum S100β,NSE,TNF-α,CRP,cognitive function score,daily life ability score,neurological function defect score before treatment,there were no difference between two groups (P ＞0.05).Serum S100β,NSE,TNF-α,CRP,neurological function defect score after treatment in observation group were lower than control group(t =5.926,4.839,6.162,10.054,6.714,P＜0.05).Cognitive function score,daily life ability score after treatment in observation group were higher than control group (t =4.008,5.973,P ＜0.05).Postoperative Glasgow prognosis classification in observation group (14 cases of grade Ⅰ,27 cases of grade Ⅱ,11 cases of grade Ⅲ,2 cases of grade Ⅳ,1 case of grade Ⅴ) was better than control group(8 cases of grade Ⅰ,12 cases of grade Ⅱ,23 cases of grade Ⅲ,7 cases of grade Ⅳ,5 cases of grade Ⅴ),the differences were significant between the two groups (Z=17.085,P =0.002).Total effective rate in observation group 94.5％ (52/55) was higher than control group 78.2％ (43/55),the differences were significant between the two groups (Z =6.253,P=0.012).Conclusion Mild hypothermia therapy assisted intracranial hematoma evacuation in treatment of cerebral hemorrhage,can significantly reduce inflammatory factor and S100βlevel,improve neurological function,has significant effect and good prognosis.It is worthy of clinical use.
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Objective To evaluate the therapeutic efficacy and safety of micro-invasive craniopuncture scavenging technique (MPST) for treatment of intracranial hematoma in patients with hypertensive cerebral hemorrhage (HICH).Methods All the clinical randomized controlled trial (RCT) studies published on MPST and internal medicine conservative treatment of HICH were searched via computer screening of databases including Cochrane clinical trials database, the Chinese biomedical literature database (CBM), Chinese periodical network full-text special topic database, Chinese science and technology periodical database and electronic periodicals database of Wanfang from January 2006 to January 2017. The study group was given the MPST plus basic treatment, and the control group was given conservative treatment. The studies collected meeting the eligible criteria were sorted and analyzed by the software RevMan 5.0, the differences in therapeutic effect and mortality were compared between the two groups, and a funnel chart was plotted to analyze the potential publication bias.Results A total of 13 RCTs published studies consistent with the eligible criteria were found, including1556 patients. The Meta-analysis showed that the effective rate in the study group was significantly higher than that in the control group [odds ratio (OR) = 4.29, 95% confidence interval (95%CI) 3.33 - 5.53,P < 0.01]; the fatality rate was markedly lower than that of the control group (OR = 0.25, 95%CI 0.19 - 0.35,P < 0.01). The funnel graph showed that each study had asymmetrical scatter plot of the variable quantity of research results, indicating a publication bias being present, which might be related to the subjectivity of the researchers in publishing their results.Conclusions Using MPST to treat HICH can significantly improve the therapeutic efficiency and reduce deterioration rate. However, due to the low quality of clinical research, it is necessary to carry out rigorous andmulti-center randomized controlled studies to further confirm the results.
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Objective To investigate the clinical effect and safety of the treatment of cerebral hemorrhage of basal ganglia regionin middle volume with minimally invasive surgery combined with alteplase .Methods Sixty-three patients with moderate amount of cerebral basilar hemorrhage and their GCS scores were between 8 to 10 in our hospital from 2012 to 2016 were divided into experimental group and control group .The experimental group were taken by minimally invasive surgery for intracranial hematoma combined with alteplase , otherwise, the patients in the control group were treated by medical conservative treatment .GCS,NIHSS,activities of daily living ( ADL), mRS were used to evaluated the efficacy ,the results were compared .Results The amount of bleeding in two groups had no significant difference before treatment .However, the experimental group of hematoma was neaely clear up or almost all absorped , the control group was not significantly reduced after treatment according to review of CT , there was statistical significance between the two groups (P<0.05).In the experimental group, NIHSS score was significantly decreased after treatment than before treatment ( P<0.05 ) , while there was no statistically significant difference in the control group .In the experimental group , GCS score was significantly decreased after treatment than before treatment(P<0.05).Three months after discharge, the ADL score of the experimental group was significantly higher than that of the control group ( P<0.05 ) , the mRS score of the experimental group after 3 months was significantly lower than that of the control group ( P<0.05 ) .Conclusion Treatment to basal ganglia cerebral hemorrhage of minimally invasive surgery combined with alteplase is more safe and effective by removing intracranial hematoma quickly , reducing brain damage caused by hematoma compression and thereby deseasing morbidity and mortality.
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Objective To discuss the risk factors of progressive hemorrhagic injury(PHI)in patients with craniocerebral injury.Methods Clinical data of 149 patients with closed craniocerebral injury were retrospectively analyzed,and the patients were divided into PHI group (42 cases)and non -PHI group (107 cases)according to PHI appeared or not.The patients were immediately given CT scan after admitted,the first CT review was given in the non -PHI group within routine 4 -8h after first CT scan,and due to deterioration of clinical symptoms,the PHI group was given CT review in advance.The intracranial hematoma volume changes between first CT and first CT review in the two groups were observed,then clinical symptoms,signs,biochemical indicators and CT performance in the two groups were compared,and analyzed risk factors of PHI.Results The intracranial hematoma volume showed in CT scan,first CT review and increment volume of the PHI group were significantly higher than the non -PHI group [(14.59 ±4.60)mL vs.(7.28 ±2.94)mL,(25.92 ±8.84)mL vs.(8.35 ±3.41)mL,(10.20 ±3.45)mL vs. (2.10 ±0.65)mL],the differences were significant (t =6.796,11.894,9.367,all P 10mL were major risk factors of PHI (P 50 years old,mydriasis,conscious disturbance,intracranial hematoma volume >10mL in first CT scan.
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Objective:To explore the risk factors of delayed traumatic intracranial hematoma (DTICH)followed by unilateral large decompressive craniectomy (LDC)and its influence in the prognosis of the severe traumatic brain injury (sTBI)patients,and to improve the successful rate of the rescue.Methods:The clinical data of 130 sTBI patients underwent unilateral LDC were retrospectively analyzed.The patients were divided into DTICH group (n=42)and non-DTICH group (n=88)according to whether the DTICH occurred after operation.The risk factors of DTICH and its influence were contrastively analyzed.Results:The analysis results of the clinical data of patients in two groups showed that preoperative GCS,time from trauma to operation,skull fracture,midline shift > 1 cm, basal cistern disappear,activated partial prothrombin time (APTT),fibrinogen (FIB),and thrombin time (TT) were significantly correlated with the appearance of DTICH (P<0.05).Multivariable Logistic regression analysis showed that the time from trauma to operation, skull fracture, basal cistern disappearing and FIB were the independent risk factors of DTICH (P<0.05).The analysis results of GOS 3 months after operation of the patients in two groups showed that the prognosis of the patients in DTICH group was significantly worse than that in non-DTICH group (P<0.01 ).Conclusion:For those patients who accompanied with shorter time from trauma to operation,skull fracture,basal cistern disappearing and FIB decrease,the appearance of DTICH should be paid attention.DTICH can affect the prognosis of patients;prevention and early diagnosis are crucial to improve the prognosis of patients.
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Objective To investigate the application effect of drainage of intracranial hematoma in bedside skull soft channel.Methods In the hospital in October 2014 to 2015 years 5 months in the diagnosis and treatment of intracranial he-matoma in patients with selected 20 cases as the research object and the principles were randomly divided into 2 groups, and the observation group ( n=10) the application of bedside cranial awl soft channel drainage in the treatment of , control group (n=10) application of conventional drilling drainage treatment .Two groups patients therapeutic effect and complications in-cidence were compared .Results To observe the surgical treatment group the total effective rate was 90.0%, and complica-tion rate was 10.0%;Observation group , operation treatment , the total effective rate is 60.0%, and complication rate was 40.0%.Two groups of patients with surgical treatment of total efficiency and complication rates between the groups compared with statistical difference (P<0.05).Conclusion The application of bedside cone cranial soft passage drainage in intracra-nial hematoma is effective , can significantly improve the postoperative cognitive function and muscle strength , improve the a-bility to take care of themselves , and less complications .
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Objective To investigate the effects of standard large trauma craniotomy on neuron-specific enolase(NSE)inflammatory factors in patients withintracranial hematoma caused by severe trau-matic brain injury(sTBI).Methods A total of 64 cases of sTBI patients were randomly divided into con-ventional surgery group (conventional group)and standard large trauma craniotomy group (standard group),with 32 cases in each group.The postoperative Glasgow Outcome Scale(GOS)score,preoperative and postoperativeserum inflammatory factors(IL-8,IL-6,TNF-α,ICAM-1 ,and IL-1 0),NSE levels,and postoperative complications were compared.Results The GOS score of the standard group was signifi-cantly superior tothe conventional group(P 0.05 ).Conclusion Inflammatory factors and NSE both playimportant roles in sTBI.Standard large trauma craniotomycan control these indicators effectively and reduce the severity of the patient's illness.
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Objective To evaluatethe application value of APACHE Ⅱ on the prognoses in prediction of pin hole multi-directional intracranial hematoma aspiration to cure severe cerebral hemorrhage.Methods APACHE Ⅱ scoring system was conducted in randomly collected 58 severe cerebral hemorrhage patients' data (30 patients underwent surgical treatment,28 patients underwent conservative treatment)to evaluate the disease severity,prognosis and effect of the pin hole multi-directional intracranial hematoma aspiration.Results The APACHE Ⅱ score of treatment group on the first day was 28.00 ± 1.92 and the predicted mortality was 0.86 ±0.03.The score was decreased obviously on the tenth day(8.20 ± 0.76)and the predicted mortality was 0.57 ± 0.05.The actual mortality was 33.33％.Conclusion APACHE Ⅱ scoring system is suitable for judging the disease severity and predicting the prognosis of severe cerebral hemorrhage patients,it proves that surgical treatment effect of the pin hole multi-directional intracranial hematoma aspiration is remarkable.
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Objective To compare and observe the clinical effects of microscopic evacuation of intraeranial hematoma and small bone flap approach mierosurgical operation in treatment of hypertensive cerebral hemorrhage.Methods From June 2008 to June 2010,116 cases of patients with hypertensive cerebral hemorrhage were classified into two groups with 58 cases in each by random digits table.Group A was treated with microscopic evacuation of intracranial hematoma and group B was treated with small bone flap approach microsurgical operation.The clinical efficacy and neurological impairment Scores were observed and compared between the two groups.Results The total effective rate in group A[87.9%(51/58)]was significantly higher than that in group B[72.4%(42,58)](P<0.05).After treatment 14 d and 28 d,the neurological impairment scores in group A were (22.1±6.2).(12.6±3.3)scores and in group B were (23.5±6.7),(18.6±5.1)scores.Compared with pre-treatment[group A:(41.9±8.1)scores;group B (41.7±7.9)scores],after treatment l4 d and 28 d,the neurological impairment scores in two groups were significantly decreased(P<0.05).Moreover,After treatment28 d,the neurological impairment scores in group A were significantly lower than those in group B(P<0.05).Conclusion Both microscopic evacuation of intracranial hematoma and small bone flap approach microsurgical operation are effective methods in hypertensive cerebral hemorrhage,but microscopic evacuation of intracranial hematoma can enhance the effect and improve the neurological function.
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Objective To explore the effective method in treatment of traumatic intracranial hematoma.Methods The measures and effects of traumatic intracranial hematoma treated by combined treatment of traditional Chinese medicine and western medicine were retorspectively analyzed. 62 cases with traumatic intracranial hematoma were taken controlled methods of clinical research: the control group had 30 patients ( received Western medicine),and experimental group had 32 cases ( received Western medicine treatment combined with Chinese medicine Qingkailing or/and Ligustrazine at the same time ), therapeutic effect evaluation was mede after 28 days.Results Clinical results of the experimental group was superior than the control group ( P ＜ 0.05 ); and complications were fewer (P ＜ 0.05). Conclusion Integration of Chinese and western medicine could improve the efficacy of traumatic intracranial hematoma.
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@# Objective To explore the application value of spiral CT angiography in etiological diagnosis of spontaneous intracranial hematoma before surgery. Methods 48 patients with spontaneous intracranial hematoma following surgical indication assessed by CT scan were ascertained etiological diagnosis performed by CT angiography before surgery.Results The causes of intracranial hematoma were cerebral aneurysm(2 patients), arteriocenous malformation (5 patients), hypertension(40 patients), and no image in one patient performed by CT angiography.Conclusion CT angiography has important value in etiological diagnosis of spontaneous intracranial hematoma before surgery.
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Objective To investigate the key procedures of the acute traumatic intracranial hematoma com-bined with herniation and the prognosis factors. Methods 45 cases of acute traumatic intraeranial hematoma com-bined with herniation from February 1997 to June 2008 were admitted in our hospital. Timely establishment of effec-tive ventilation and circulation and pre-operative examination were done to all the eases. Craniotomy hematoma clean was performed in 8 cases, hematoma clean and decompressive craniectomy was canducted in 33 cases and 4 cases were not operatively treated. Results 26 eases (58%) were cured,and 19 cases (42%) died. Conclusions The key procedures of the acute tranmatie intraeranial hematoma combined with herniation is timely establishment of ef-fective ventilation and circulation, and that is effective method to prevent secondary brain injury ; removing hematoma as soon as possible,and lifting the oppression of the brain stem are the keys to rescue patients. Prognosis is closely related to the degree of primary brain injury, eonseious level before operation and the time of herniation appearance.
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Objective To analyze the clinical effect of intracranial hematoma by drilling skull in treatment with hypertensive brain hemorrhage.Methods 188 patients with hypertensive cerebral hemorrhage were classified into control group with 94 cases and traditional group with 94 cases.The control group were treated with conservative medicine and observation group were treated with intracranial hematoma by drilling skull.The clinical efficacy and defection score of nerves function were observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group(P＜0.05) while the death rate in observation group was significantly lower than that in control group (P＜0.05),Compared with pre-treatment,after treatment 2 weeks and 4 weeks,the Barthel index in two groups were significantly increased(P＜0.05).Moreover,after treatment 2 weeks and 4 weeks,the Barthel index in observation group was significantly higher than that in control group(P＜0.05).Conclusion The intracranial hematoma by drilling skull can enhance effective rate,decrease death rate and improve the ADL ability.
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PURPOSE: Cephalhematomas rarely lead to serious complications, such as skull fractures and intracranial hematomas, so CT and/or MRI scans are indicated only in cases in which depressed fractures are suspected or neurologic symptoms develop. Nevertheless, we have experienced several cases of cephalhematomas associated with intracranial hematomas in the absence of remarkable neurologic symptoms. The aim of this study was to evaluate the correlation between cephalhematomas and intracranial hematomas and determine the need for neuroimaging in infants with cephalhematomas. METHODS: Infants who were admitted to the NICU with cephalhematomas and underwent neuroimaging (CT and/or MRI) between January 2002 and July 2006 were evaluated. Neuroimaging was done when the symptoms suggested the development of an intracranial hematoma. RESULTS: Among 54 infants with cephalhematomas, 18 infants underwent neuroimaging. Six of 18 infants (33.3%) had intracranial hematomas, 4 infants had epidural hematomas, and 2 infants had subdural hematomas. Four of these 6 infants had neurologic symptoms or depressed skull fractures; 2 infants had no neurologic symptoms or depressed skull fractures. The neuroimaging was done to evaluate the cause of an excessive elevation of serum bilirubin and unexplained anemia. There were no remarkable differences between the infants with and without intracranial hematomas with respect to gestational age, birth weight, head circumference, diameter of the cephalhematoma, neurologic symptoms, and other clinical signs and symptoms. CONCLUSION: Based on this study, intracranial hematomas are common complications of cephalhematomas, thus more careful inspection and neuroimaging may be needed in cases of cephalhematomas in newborns.