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Objective:To explore the value of single nucleotide polymorphism for molecular warning of hypertensive intracerebral hemorrhage in Li Nationality in Hainan.Methods:Totally 56 patients with hypertensive intracerebral hemorrhage of Li Nationality in Hainan Province, 100 healthy controls of Li nationality and 203 healthy controls of Han nationality in Hainan Province from January 2019 to October 2020 were selected as the research subjects.After genomic DNA was extracted, rs2494739, rs2494744 and rs2498794 of AKT1 gene were genotyped and analyzed by SPSS 25.0 to explore the differences between Han and Li Nationality, and between Li healthy population and intracerebral hemorrhage population.Results:There was no difference in the frequencies of rs2498794, rs2494739 and rs2494744 polymorphisms of AKT1 gene among Han and Li healthy controls ( P>0.05). The rates of AA, AG and GG at rs2498794 locus in Li Nationality patients with intracerebral hemorrhage (14.28%, 39.29% and 46.43%) were significantly different from those of Li control group (44.00%, 47.00% and 9.00%)( P<0.05). The distribution rates of AA, AG and GG of rs2494744 in Li Nationlity patients with intracerebral hemorrhage were 57.14%, 37.50% and 5.36%, respectively, which were statistically significant compared with the control group (20.00%, 44.00% and 36.00%) ( P<0.05). The incidence of CC, CT and TT at rs2494739 locus in Hainan Li Nationality patients were 14.28%, 46.43% and 39.29% respectively, which were also significantly different from those in Li control group(34.00%, 41.00% and 25.00%) ( P<0.05). The incidence of rs2494744-A in intracerebral hemorrhage group (75.89%) was much higher than that in Li control group (42.00%), and the OR value of rs2494744-A was 4.35.The incidence of rs2498794-G in intracerebral hemorrhage group and control group were 66.07% and 32.50%, respectively, and the OR was 4.04.Alleles rs2494744-A and rs2498794-G were moderately associated with the incidence of intracerebral hemorrhage ( P<0.05). Conclusion:rs2494744-AA, rs2498794-GG and alleles rs2494744-A and rs2498794-G are the risk factors of HICH in Li nationality, which is of great value to the construction of its molecular early warning system.
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Objective:To investigate the application of continuous intracranial pressure (ICP) combined with regional cerebral oxygen saturation (rScO 2) monitoring in patients with hypertensive intracerebral hemorrhage before and after operation of the removal hematoma through small bone window and the effect on the prognosis of patients. Methods:The clinical data of 37 patients with supratentorial hypertensive intracerebral hemorrhage admitted to the neurosurgical intensive care unit of the people′s Hospital of Inner Mongolia Autonomous Region from April 2018 to October 2020 were retrospectively analyzed.ICP monitoring and near infrared spectroscopy (NIRS) were used to monitor the intracranial pressure and rScO 2 concentration before and after the operation, and the changes of intracranial pressure and rScO 2 before and after the operation were analyzed.According to Glasgow Outcome Score (GOS), patients with GOS score>3 were classified as good prognosis group (21 cases), and those with GOS score ≤3 were classified as poor prognosis group (16 cases). Results:The postoperative intracranial pressure((15.80±6.70) mmHg)of patientswith hypertensive intracerebral hemorrhage was lower than that before operation((20.40±5.80) mmHg), and the difference was statistically significant( t=3.226, P=0.002). The postoperative rScO 2 ((62.31±3.85)% )of patientswith hypertensive intracerebral hemorrhage was higher than that before operation((59.73±3.13)%), and the difference was statistically significant( t=3.171, P=0.002). The decrease of intracranial pressure in patients with good prognosis((6.53±2.21) mmHg)was more obvious than that in patients with poor prognosis((4.24±2.30) mmHg). The concentration of rScO 2 increased in both groups.But in the group with good prognosis, the rScO 2 increased((3.99±2.34)%)was significantly higher than that in poor prognosis group((2.32±2.25)%). Six months after operation, there were significant differences in preoperative and postoperative intracranial pressure and rScO 2 between good prognosis group and poor prognosis group, and the difference was statistically significant( t=3.090, 2.176; P=0.004, 0.036). Conclusion:Small bone window evacuation of intracerebral hematoma can significantly reduce the concentration of intracranial pressure and increase the concentration of rScO 2 in patients with intracerebral hemorrhage.The changes of intracranial pressure and rScO 2 before and after operation have potential value in judging the prognosis of patients.
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To systematically review the efficacy and safety of acupuncture combined with minimally invasive surgery or basic the-rapy in treating hypertensive intracerebral hemorrhage(HICH) patients compared with minimally invasive surgery or basic treatment. In this study, the four Chinese databases, the four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, all above were systematically and comprehensively retrieved from the time of database establishment to September 10, 2020. Rando-mized controlled trials(RCTs) were screened out according to inclusion criteria and exclusion criteria established in advanced. The methodological quality of included studies was evaluated by the tool named "Cochrane bias risk assessment 6.1". Meta-analysis of the included studies was performed using RevMan 5.4, and the quality of outcome indicators was evaluated by the GRADE system. Finally, 17 studies were included, involving 1 852 patients with HICH, and the overall quality of the included studies was not high. According to Meta-analysis,(1)CSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-3.50,95%CI[-4.39,-2.61],P<0.000 01);(2)NIHSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.78,95%CI[-5.55,-4.00],P<0.000 01);(3)the cerebral hematoma volume of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.44,95%CI[-5.83,-3.04],P<0.000 01);(4)ADL score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=20.81,95%CI[17.25,24.37],P<0.000 01);(5)the GCS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=2.41,95%CI[1.90,2.91],P<0.000 01). The GRADE system showed an extremely low level of evidence for the above outcome indicators. Adverse reactions were mentioned only in two literatures, with no adverse reactions reported. The available evidence showed that acupuncture combined with minimally invasive surgery or basic therapy had a certain efficacy in patients of HICH compared with minimally invasive surgery or basic therapy. However, due to the high risk of bias in the included studies, its true efficacy needs to be verified by more high-quality studies in the future.
Subject(s)
Humans , Acupuncture Therapy , Intracranial Hemorrhage, Hypertensive/therapy , Treatment OutcomeABSTRACT
The study aims to analyze the outcome indicators of randomized controlled trial(RCT) of traditional Chinese medicine(TCM) in the treatment of hypertensive intracerebral hemorrhage(HICH) in recent three years, and thus provide suggestions for the future studies in this field. Four English databases, four Chinese databases and two online registration websites of clinical trials were searched. The RCTs published between January 2018 and September 2020 were screened. The risk of bias was assessed and outcome measures were classified. A total of 151 839 articles were retrieved, of which 44 RCTs were included for analysis after screening. The outcome measures of the included RCTs were classified into 7 categories, among which the symptoms/signs category showed the highest reporting rate. National Institute of Health stroke scale(72.73%) was the most frequently reported outcome indicator, while the vo-lume of intracerebral hemorrhage determined by computerized tomography(36.36%) was the most frequently reported lab test outcome. Most studies collect the outcomes at the end of treatment, while 9 studies reported long-term outcomes 3 months or more after onset. Compared with those of international clinical trials, the application of some of the outcomes was reasonable, focusing on patients' symptoms, quality of life and objective outcomes. However, there were still several problems: unclear primary and secondary outcome measures, insufficient attention to long-term prognosis, insufficient attention to social function, few TCM outcomes, lack of measurement blindness and the use of unreasonable composite outcomes. It is recommended that researchers should rationally design the outcome indicators of clinical trials and develop the core outcome set.
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Humans , Drugs, Chinese Herbal/therapeutic use , Intracranial Hemorrhage, Hypertensive/drug therapy , Medicine, Chinese Traditional , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
The effect of oral or nasal feeding with Chinese patent medicine on hypertensive intracerebral hemorrhage was systematically evaluated by using the method of network Meta-analysis. Four Chinese databases(CNKI, VIP, Wanfang, CBM), three English databases(Medline, EMbase, Cochrane Library) and ClinicalTrials.gov were retrieved through computers. According to the inclusion criteria and exclusion criteria, randomized controlled trials(RCTs) of Chinese patent medicine combined with Western medicine in the treatment of hypertensive intracerebral hemorrhage were screened out according to the inclusion criteria and exclusion criteria. The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies, and Stata 16.0 software was used to analyze the outcome indicators. A total of 3 888 literatures were retrieved, and 30 studies involving 6 kinds of Chinese patent medicines were finally included. The total sample size was 2 758 cases, including 1 401 cases in the treatment group and 1 357 cases in the control group. According to the results of network Meta-analysis,(1)in terms of improving the degree of nerve function defect, the order of Chinese patent medicines was conventional Western medicine combined with Xiaoyukang Capsules>combined with Tongxinluo Capsules>combined with Naoxuekang Oral Liquid>combined with Naoxueshu Oral Liquid>combined with Angong Niuhuang Pills>conventional Western medicine;(2)in terms of reducing the amount of residual cerebral hematoma, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined Xiaoyukang Capsules>combined Naoxuekang Oral Liquid>conventional Western medicine;(3)in terms of improving ability of daily living, the order of Chinese patent medicines was conventional Western medicine combined with Shenzhi Huoxue Capsules>combined with Angong Niuhuang Pills>combined with Naoxueshu Oral Liquid>conventional Western medicine;(4)in terms of improving total effective rate, the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined with Xiaoyukang Capsules>combined with Angong Niuhuang Pills=combined with Naoxuekang Oral Liquid>combined Tongxinluo Capsules>conventional Western medicine treatment. The results showed that in addition to conventional Western medicine therapy, the combined use with Chinese patent medicine can improve the clinical efficacy in the treatment of hypertensive intracerebral hemorrhage. However, due to the differences in the number and quality of various Chinese patent medicines included in the studies, and the lack of direct comparison of Chinese patent medicines, the ranking results still need to be verified by multi center, large-sample-size randomized double-blind trials in the future, so as to provide more reliable evidence support for clinical drug use.
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Humans , China , Intracranial Hemorrhage, Hypertensive , Medicine, East Asian Traditional , Network Meta-Analysis , Nonprescription Drugs , Randomized Controlled Trials as TopicABSTRACT
To systematically review the efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage, four Chinese databases, four English databases, clinical trials registration center(ClinicalTrials.gov) and Chinese clinical trial registry were retrieved. The retrieval time was from the establishment of each database to September 9, 2020. According to the set criteria, the randomized controlled trial(RCT) of Naoxueshu Oral Liquid combined with conventional Western medicine was selected. The "Cochrane bias risk assessment" tool was used to evaluate the quality of the included studies. RevMan 5.4.1 was used to conduct Meta-analysis of the included studies and GRADE system was used to evaluate the evidence quality of the outcome indicators. Eleven studies were finally included, with a total sample size of 1 221 cases, 612 cases in the treatment group and 609 cases in the control group. Meta-analysis showed that Naoxueshu Oral Liquid combined with conventional Western medicine had no significant difference compare with conventional Western medicine in reducing National Institute of health stroke scale(NIHSS) after 2 weeks of treatment for hypertensive intracerebral hemorrhage(MD=-1.59,95%CI[-3.46,0.29],P=0.10), but was superior to conventional Western medicine after 30 d of treatment(MD=-1.16,95%CI [-1.39,-0.94],P<0.000 01). Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine in improving Glasgow coma scale(MD=1.00,95%CI[0,2.00],P=0.05) and reducing the incidence of secondary brain insults(RR=0.38,95%CI[0.24,0.59],P<0.000 1), but there was no significant difference in increasing Barthel index(MD=1.00,95%CI[-0.30,2.30],P=0.13). In terms of effective rate, studies using Guideline for clinical trials of new patent Chinese medicines, NHISS or Glasgow outcome scale(GOS) had shown that Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine(RR_(Guideline for clinical trials of new patent Chinese medicines)=1.27,95%CI[1.10,1.46],P=0.001;RR_(NHISS)=1.26,95%CI[1.13,1.40],P<0.000 1;RR_(GOS)=1.54,95%CI[1.22,1.93],P=0.000 2). In reduction of hematoma volume, Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine after 2 and 4 weeks of treatment(MD_(2 week)=-2.31,95%CI[-3.12,-1.49],P<0.000 01;MD_(4 week)=-2.04,95%CI[-2.41,-1.68],P<0.000 01). GRADE system showed that the evidence level of the above outcome indicators was low and extremely low. In terms of adverse reactions, two of the included studies reported mild adverse reactions, and the rest of studies were not mentioned, so this study was not able to make a positive evaluation of the safety of Naoxueshu Oral Liquid. This study showed that compared with conventional Western medicine, combined Naoxueshu Oral Liquid may be better for hypertensive intracerebral hemorrhage. However, due to the high bias risk in the included studies, more large-sample and high-quality RCTs are still needed in the future.
Subject(s)
Humans , Drugs, Chinese Herbal/adverse effects , Intracranial Hemorrhage, Hypertensive/drug therapy , Nonprescription Drugs , StrokeABSTRACT
To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated. Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all 0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all >0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all >0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(=0.413). Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.
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Humans , Basal Ganglia , Intracranial Hemorrhage, Hypertensive , Retrospective Studies , Treatment Outcome , Urokinase-Type Plasminogen ActivatorABSTRACT
@#BACKGROUND: The incidence of hypertensive intracerebral hemorrhage (HICH) has been increasing during the recent years in low- and middle-income countries. With high mortality and morbidity rates, it brings huge burden to the families. It lacks evidence regarding the application of intracranial pressure (ICP) monitoring in HICH. In the current study, the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery. METHODS: A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, between 2014 and 2016, was performed. The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis. RESULTS: ICP monitors were inserted into 50 patients. Patients with ICP monitoring had a signifi cantly better outcome (P<0.05). The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring (16.68 days vs. 20.47 days, P<0.05). Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly (16.0% vs. 15.1%, P=0.901). On univariate analysis, age, Glasgow Coma Scale (GCS) on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes. CONCLUSION: ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring. Future study is still needed to confi rm our results and elucidate which subgroup of HICH patients will benefi t most from the minimally invasive surgical intervention and ICP monitoring.
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Objective: To explore the safeties and efficacies of temporal cortex approach, transsulcus or fissure microsurgery and drilling drainage in the treatment of the patients with supratentorial hypertensive intracerebral hemorrhage (SHICH), and to provide the references for choosing the operation methods for the SHICH patients. Methods: Th e clinical materials of 118 patients with SHICH were collected and were divided into temporal cortex approach group (cortex group, n=39), transsulcus or fissure microsurgery group (fissure group, n=31) and drilling drainage group (drilling group, n=48) according to their different operation methods. The age, hematoma volumes, Glasgow Coma Scale Score (GCS), time from onset to operation, hematoma clearance rates, improvement rates 24 h after operation, rebleeding rates after operation, intracranial infection rates, survival rates, and good prognosis rates of the patients in three groups were recorded. Results: The hematoma clearance rate, improvement rate, survival rate and good prognosis rate of the patients in fissure group were significantly higher than those in cortex group (P0. 05). There were no statistically significant differences in the prognosis indexes (hematoma, GCS, survival rate, and good prognosis rate) of the patients between 30-49 mL and 50-69 mL subgroups in fissure group and drilling group. The age of patients in 50-69 mL subgroup in drilling group was significantly higher than that in fissure group (P< 0. 05). Conclusion: The efficacies and prognosis of SHICH patients treated by transsulcus or fissure microsurgery and drilling drainage are better than those by temporal cortex approach. Drilling drainage is more suitable to the old patients with above moderate hematoma; and transsulcus or fissure microsurgery is more suitable to the patients with massive hematoma.
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Objective@#To evaluate the reliability and validity of Chinese version of the Hypertensive Intracerebral Hemorrhage Empowerment Scale-Short Form (C-HICHES-SF).@*Methods@#A total of 207 hypertensive intracerebral hemorrhage patients treated in the Department of Neurology inpatients of a three-grade hospital in Tianjin from August 2017 to January 2018 were selected by convenient sampling method. Chinese Diabetes Empowerment Scale-Short Form (C-DES-SF) was adapted into C-HICHES-SF by expert enquiry and the patients were surveyed. SPSS 24.0 and AMOS 24.0 were used for data processing.@*Results@#C-HICHES-SF contains 8 items. Its Cronbach α was 0.833, Sperman's half-reliability was 0.797, Guttman's half-reliability was 0.742, test-retest reliability was 0.787, content validity was 0.943. one common factor was extracted by exploratory factor analysis, and could explain 52.36% of the variance contribution.the confirmatory factor analysis revealed a good fit of the model to the date based on various fit indices (χ2/df ratio=1.172, GFI=0.997, AGFI= 0.949, NFI= 0.980, CFI=0.980, TLI=0.994, RMSEA=0.029).@*Conclusion@#C-HICHES-SF has fewer articles and easy to use. It has good reliability and validity in patients with hypertensive intracerebral hemorrhage, It can be used as an effective tool to measure empowerment ability.
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Objective To evaluate the reliability and validity of Chinese version of the Hypertensive Intracerebral Hemorrhage Empowerment Scale-Short Form (C-HICHES-SF). Methods A total of 207 hypertensive intracerebral hemorrhage patients treated in the Department of Neurology inpatients of a three-grade hospital in Tianjin from August 2017 to January 2018 were selected by convenient sampling method. Chinese Diabetes Empowerment Scale-Short Form(C-DES-SF)was adapted into C-HICHES-SF by expert enquiry and the patients were surveyed. SPSS 24.0 and AMOS 24.0 were used for data processing. Results C-HICHES-SF contains 8 items. Its Cronbach α was 0.833, Sperman's half-reliability was 0.797, Guttman's half-reliability was 0.742, test-retest reliability was 0.787, content validity was 0.943. one common factor was extracted by exploratory factor analysis, and could explain 52.36% of the variance contribution.the confirmatory factor analysis revealed a good fit of the model to the date based on various fit indices ( χ2/df ratio=1.172, GFI=0.997, AGFI=0.949, NFI=0.980, CFI=0.980, TLI=0.994, RMSEA=0.029). Conclusion C-HICHES-SF has fewer articles and easy to use. It has good reliability and validity in patients with hypertensive intracerebral hemorrhage, It can be used as an effective tool to measure empowerment ability.
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OBJECTIVE: Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH.MATERIALS AND METHODS: A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials.RESULTS: Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26–1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28–0.49; P < 0.0001).CONCLUSION: Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.
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Humans , Cerebral Hemorrhage , Craniotomy , Intracranial Hemorrhage, Hypertensive , Mortality , Neuroendoscopy , NeurosurgeonsABSTRACT
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 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 explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.
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Objective To analyze clinical efficacy of operation approach in lateral fissure for patients with hypertensive intracerebral hemorrhage (HICH) in basal ganglia region.Methods Retrospectively analyzed 120 cases of patients with HICH in basal ganglia region in the department of neurosurgery in our hospital from 2012 to 2015.Among them,64 cases of patients were treated by surgery via lateral fissure-insular approach (lateral fissure group),the other 56 cases of patients were treated by surgery via the traditional trans-temporal cortex approach (temporal lobe group).The perioperative indicators and clinical efficacy were compared between the two groups.Results Compared with the temporal lobe group,the operative time in the lateral fissure group was decreased,and the hematoma clearance rate was increased,there were statistically significant differences(P＜0.05).No statistically significant difference was found in postoperative re-bleeding rate and rate of complications between the two groups(P＞0.05).The activity of daily living (ADL) Barthel index scores,1 month,3 months and 6 months after operation,in the lateral fissure group were significantly higher than those in the temporal lobe group(P＜0.05).In the lateral fissure group one patient died and in the temporal lobe group 2 patients died.The proportion of patients with good prognosis in the lateral fissure group (70.31％) was higher than that in the the temporal lobe group(51.78％,P＜0.05).Conclusion Patients with HICH in basal ganglia region treated by operation via lateral fissure-insular approach undergo a shorter operation time,hematoma is evacuated more thoroughly,and have better postoperative prognosis,compared with those patients treated by operation via traditional trans-temporal cortex approach.
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Objective:To study the effect of naoxintong capsules combined with nerve growth factor on the serum levels of interleukin-6 (IL-6),matrix metalloproteinase-9 (MMP-9) and S100B of patients with hypertensive intracerebral hemorrhage.Methods:88 patients with hypertensive intracerebral hemorrhage who were treated in our hospital from August 2015 to July 2016 were selected and randomly divided into the observation group and the control group The patients in the control group were treated with nerve growth factor,while the patients in the observation group were treated with naoxintong capsules combined with nerve growth factor.Then the clinical efficacy,GCS,GOS score,serum levels ofIL-6,MMP-9 and S100B were observed and compared between the two groups.Results:After treatment,the total effective rate in the observation group was significantly higher than that the control group (P＜0.05).After treatment,the GCS and GOS scores of the two groups were significantly higher than before,and the GCS and GOS of the observation group were higher than those of the control group (P＜0.05).After treatment,the serum levels of IL-6,MMP-9 and S100B in the two groups were significantly lower than before,and the observation group were lower than those of the control group (P＜0.05).There was adverse reactions in the two groups.Conclusion:Naoxintong capsule combined with nerve growth factor can reduce the serum levels of IL-6,MMP-9 and S100B in patients with hypertensive intracerebral hemorrhage,with obvious clinical curative effect and high safety.
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Objective:To explore the clinical effect of mild hypothermia combined with puncture aspiration operation on the hypertensive intracerebral hemorrhage and its effect on the serum TNF-α,IL-6 and CRP levels.Methods:112 cases of patients with hypertensive intracerebral hemorrhage admitted in our hospital from February 2015 to August 2016 were selected as the research objectives and randomly divides into 2 groups with 56 cases in each group.Both groups were treated with minimally puncture aspiration,and mild hypothermia was performed in the observation group additionally,the clinical effect,complication,short-term prognosis,serum TNF-α,IL-6,CRP levels at different time points before and after operation were compared between two groups.Results:The overall effective rate of observation group was 92.86％,which was significantly higher than of the control group(76.79％.P＜0.05).The incidence of MODS and complications were 0％ and 26.79％ respectively,which were significantly lower than those of the control group(P＜0.05).The serum TNF-α,IL-6,CRP levels of observation group were significantly decreased on the 3rd and 7th day postoperation,which were significantly lower than those before operation (P＜0.01).The serum TNF-α,IL-6,CRP levels of control group on the 3rd day postoperation were similar to those before operation (P＞0.05),but the serum TNF-α,IL-6,CRP levels on the 7th day postoperation were significantly decreased (P＜0.01).The serum TNF-α,IL-6,CRP levels on the 3rd,7th day postoperation were significantly lower than those of the control group at same time points (P＜0.01).The favorable prognosis of observation group was 80.36％,which was significantly higher than that of the control group (62.50％,P＜0.05).Conclusion:Mild hypothermia combined with puncture aspiration operation could effectively reduce the neurological deficits,inhibit the inflammatory response and decrease the mortality.
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Objective To observe the influences of Shenzhi Huoxue capsule to prognosis of patients with hypertensive intracerebral hemorrhage after hard channel puncture and drainage.MethodsTo divide 106 patients with hypertensive intracerebral hemorrhage from May 2013 to April 2015 into two groups.The observation group with 53 cases received Shenzhi Huoxue capsule after hard channel puncture and drainage, the control group did not receive Shenzhi Huoxue capsule.To observe the complications rate, the number of deaths during hospitalization, the number of persons with disabilities after treatment, GOS score, BI index, SSS score and NCSE score of two groups.Results(During treatment, the infection, liver and renal dysfunction and rebleeding rates of observation group were lower than control group, and the infection ratio was significant (P<0.05).(During treatment, the proportion of deaths of observation group was 18.87%,lower than control group with 26.42%, but the differences were not statistically significant.The proportion of disabilities of observation group was 26.42%,lower than control group with 45.28%, and the differences were statistically significant (P<0.05).After treatment, GOS score and BI index of two groups were higher than before treatment(P<0.05).GOS score and BI index of the observation group were (12.85±0.81,83.95±4.37)score, higher than the control group with (10.05±0.73,74.95±4.06)score, and the differences all were statistically significant (P<0.05).After treatment, the SSS score and NCSE score of two groups were higher than before treatment(P<0.05),the SSS score and NCSE score of observation group were (47.10±4.18,66.72±3.99)score, higher than the control group with (38.42±3.05,59.34±3.45)score, and the differences were statistically significant (P<0.05).ConclusionAdding Shenzhi Huoxue capsule to patients with hypertensive intracerebral hemorrhage after hard channel puncture and drainage can reduce the number of persons with disabilities and improve life self-care ability and cognitive ability.
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<p><b>OBJECTIVE</b>To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation (TRABC) in treatment of hypertensive intracerebral hemorrhage (HICH).</p><p><b>METHODS</b>This was a multi-center prospective randomized open-label blinded-endpoint (PROBE) trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale (mRS). Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale (NIHSS) scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded.</p><p><b>RESULTS</b>After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups (P<0.01). Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group (P=0.038). Average Barthel scores in the treatment group after treatment was 89.11±19.93, and in the control group 82.18±24.02 (P=0.003). NIHSS scores of the two groups after treatment decreased significantly compared with before treatment (P=0.001). Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment (P<0.05). There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group.</p><p><b>CONCLUSION</b>The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.</p>