Establishment and verification of a predictive model for hyponatremia after craniocerebral trauma / 国际外科学杂志

Objective:Based on clinical data, establish and verify the prediction model of hyponatremia after craniocerebral trauma.Methods:Through retrospective analysis of 226 patients with traumatic brain injury who were eligible for inclusion in Department of Neurosurgery, Qingpu Branch, Zhongshan Hospital, Fudan University from June 2019 to January 2021. After 6 months of follow-up, the patients were divided into the hyponatremia group ( n=81) and the normal group ( n=145) according to their blood sodium level. Various factors that may be related to the occurrence of hyponatremia were analyzed. Logistic multivariate regression was used to analyze the independent risk factors of patients with hyponatremia, the best cut-off point of was determined by the characteristic curve (ROC), and the nomogram prediction model was established and verified based on the independent risk factors of patients with hyponatremia. Results:Patients in the normal blood sodium group were(40.33±15.32) years old, 87 cases (60.00%) of cerebral contusion, 3 cases (2.07%) of intraventricular hemorrhage, 15 cases (10.34%) of cerebral hernia, 35 cases (24.14%) of GCS score <6 and 110 cases (75.86%) of GCS score ≥6; In the hyponatremia group, patients were (47.17±16.03) years old, with 65 cases (80.25%) of cerebral contusion, 7 cases (8.64%) of intraventricular hemorrhage, 19 cases (23.46%) of cerebral hernia, 44 cases (54.32%) of GCS score <6 and 37 cases (45.68%) of GCS score ≥6, the difference between the two groups was statistically significant ( P<0.05). Logistic multivariate regression analysis found that increasing age, ventricular hemorrhage, cerebral herniation, elevated ADH and GCS score <6 were all independent risk factors for patients with hyponatremia( OR=2.287, 2.531, 1.344, 1.387, 1.582; 95% CI: 1.945-2.628, 1.338-3.723, 1.256-1.431, 1.013-1.761, 1.233-1.931; P<0.05). The GCS score predicts that the area under the ROC curve for patients with hyponatremia was 0.795, the cut-off point was 6 points, the sensitivity was 95.00%, and the specificity was 64.30%. A nomogram model was constructed to predict patients with hyponatremia based on independent risk factors, in which the C-index calculation result and ROC curve AUC were 0.798 (95% CI: 0.751-0.842) and 0.815 (95% CI: 0.767-0.877), respectively, indicating a good degree of discrimination; Calibration curve evaluation results showed that the model has good consistency. Conclusion:GCS score is an independent risk factor that affects whether patients with craniocerebral trauma are complicated by hyponatremia. It has a good predictive value for whether this type of patients is complicated by hyponatremia, which is conducive to early identification and intervention of patients.

Serum alkaline phosphatase can evaluate the severity of acute spontaneous intracerebral hemorrhage / 中华检验医学杂志

Objective:To investigate the change and clinical significance of serum alkaline phosphatase (ALP) level in patients with acute spontaneous intracerebral hemorrhage(AICH).Methods:81 patients with AICH admitted to the Neurosurgery Department of Tianjin Third Central Hospital from January 2019 to October 2020 were retrospectively analyzed. 81 patients with non cerebral hemorrhage who came from the health examination center or complained of dizziness and had no hepatobiliary and skeletal diseases were selected as the control group. The clinical data of all the patients were recorded, including gender, age, Glasgow Coma Scale (GCS) score, hemorrhage location, liver function indexes, the history of hypertension, diabetes, heart disease, smoking, drinking, and so on. The differences in clinical data between the two groups were compared. Pearson correlation was used to analyze the correlation between liver function indexes and GCS score. The independent risk factors for AICH were screened by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of serum ALP in predicting intracerebral hemorrhage.Results:Serum ALP level in AICH group was significantly higher than that in the control group [85.0(70.0, 103.0) U/L vs 65.0(54.5, 71.5)U/L, Z=6.740, P<0.001]. Pearson correlation analysis showed that serum ALP had a negative correlation with GCS score ( r=0.255, P=0.022). Binary logistic regression analysis showed that hypertension ( OR=20.440, 95% CI 8.572-48.737) and ALP ( OR=1.077, 95% CI 1.049-1.105) were risk factors for intracerebral hemorrhage. Serum ALP level was an independent risk factor ( OR=1.069, 95% CI 1.038-1.101) for AICH after adjusting for confounding variables including age, AST, history of hypertension. ROC curve showed that the area under the curve (AUC) of serum ALP in predicting intracerebral hemorrhage was 0.807 (95% CI 0.740-0.873, P<0.001), with sensitivity of 67.9% and specificity of 81.5%. Conclusions:Serum ALP level may be related to the occurrence and severity of AICH. Therefore, serum ALP level can be used as a reference index to evaluate the occurrence, severity of patients with AICH.

ICH Score and Basal Plasma D-Dimer in Patients with Intracerebral Haemorrhage

Intracerebral haemorrhage constitutes 10-20 % of all strokes & remains without treatment of proven benefit & has higher risk of morbidity & mortality than cerebral infarction or subarachnoid bleed. Thus, these models may accurately predict outcome, and hence the purpose of this study is to define a clinical grading scale for patients with ICH which uses criteria that are predictive of outcome & that can be rapidly & accurately assessed at the time of presentation in emergency/casualty. Estimation of basal plasma D-dimer levels an indicator of systemic activation of coagulative & fibrinolytic system has shown to a powerful predictor of both early neurological worsening & mortality outcome & hence the present study is undertaken.METHODSThe study was carried out in the IPD of Department of General Medicine, Basaveshwara Teaching and General Hospital, Kalaburagi, attached to Mahadevappa Rampure Medical College. It is a cross sectional study conducted among 100 intracerebral bleed patients between November 2018 to November 2019 with simple random sampling procedure. Patients were followed up at the end of 1 month with telephone/letter/email.RESULTSThe mortality among patients who scored 0 of ICH scale was 0%, ICH score of 1 was 13.6 %, ICH score of 5 was 100 %. No patient scored 6. Higher the ICH score, higher is the mortality. Mortality among patients with D-Dimer value between 1500 – 5000 ng/ml is 55.2 %, and > 5000 ng/ml is 92.3 %. Above table indicates that higher the basal level of D-Dimer value higher is the mortality. Mortality among patients of either sex was equal i.e., 50 % between 8 - 15 days, and no deaths were noted between 15 - 30 days.CONCLUSIONSIntracerebral haemorrhage (ICH) has remained a serious disease despite recent improvements in management. So, efforts must be directed towards better understanding and modification of risk factors. The major risk factor in our study was hypertension. The other common risk factors were alcohol consumption and smoking. Thus, measures to ensure adequate control of hypertension/compliance of treatment among hypertensive, abstinence from alcohol and smoking may reduce the incidence of ICH. High initial plasma D-Dimer levels would indicate bad prognosis in ICH. In addition to diagnosis of ICH, CT Scan can also be used as a useful tool in assessing prognostic outcome of ICH, by using radiological parameters like larger volume of haematoma, presence of midline shift, intraventricular extension of haemorrhage and hydrocephalus which indicated bad prognosis i.e., using ICH score, higher the ICH score higher is the mortality.

The prognostic value of bispectral index in patients with acute cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To evaluate the prognostic role of bispectral index (BIS) monitoring in patients after cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU).Methods Thirtythree adult patients after CPR were enrolled and divided into survived group and non - survived group as per 7-day survival.During their stay in the ICU,BIS and SaO2 (saturation of artery oxygen) levels of all the patients were continuously monitored.The neurological status of the patients was measured with Glasgow coma scale (GCS).Acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) was used to evaluate the patient condition. SjO2 (saturation of jugular bulb venous oxygen ) levels of 23 patients were continuously monitored and then the difference in values between SaO2 and SjO2 was calculated to show oxygen metabolism in the brain. The studied variables were compared between the two groups. The correlations between BIS values and GCS scores,and between BIS and APACHE Ⅱ scores were respectively analyzed. Results The BIS values and difference in values between the SaO2 and SjO2 were significantly higher in the patients of survived group than those in the patients of non-survived group (P ＜0.01 ).There were positive correlation between BIS and GCS (r =0.821,P ＜ 0.01 ) and as well as positive correlation between BIS and APACHE- Ⅱ ( r =0.434,P ＜ 0.05 ).Conclusions The BIS may be useful to predict the post - resuscitative outcome of patients after cardiopulmonary resuscitation.

Temporal Lobectomy and Hematoma Removal for Large Hemorrhage of the Basal Ganglia

Severe hemorrhage of the basal ganglia is usually associated with massive surrounding edema, and even after removal of the hematoma, edema persists for as long as several weeks and exerts an additional deleterious effect on the recovery from the ictus. To determine whether the provision of intracranial space will improve the outcome, we performed temporal lobectomy in addition to hematoma removal and compared the result with hematoma removal only. Over a three-year period from January 1993 to March 1996, we encountered 476 cases of spontaneous intracerebral hemorrhage and of these, 52 with severe hemorrhage of the basal ganglia were selected for this study. On admission, the neurological status of these 52 patients was very poor or progressively deteriorating, and all underwent surgical intervention. They were divided into two groups according to the surgical procedure : hematoma removal with temporal lobectomy(Group I) and hematoma removal only(Group II). GCS score at discharge, GOS score, Barthel index and mortality were compared between the two groups. In overall comparison of GCS score at discharge, GOS score, rate of persistent vegetative state, and death rate between the two groups, there was no significant difference, but among patients with a GCS score 6 and below, this score was higher and the rate of persistent vegetative state and death were lower in Group I than in Group II(p<0.05). Among those with a GCS score of above 6, there was no difference between the two groups. We conclude that for patients whose neurological status is poor(GCS score 6 and below), the benefit of temporal lobectomy in addition to hematoma removal is greater than that of hematoma removal alone.

Clinical Analysis and Operative Management of Spontaneous Brain Stem Hemorrhage

Spontaneous brain stem hemorrhage usually results in higher mortality and morbidity with poorer prognosis than any other intracranial vascular lesions in spite of meticulous medical or surgical treatment. We have experienced 86 cases of spontaneous brain stem hemorrhage who were admitted to Wonju college of medicine from January 1983 to Octobr 1995. 33 cases were treated with operation and 53 cases with non-operative treatment. The results were as follows: 1) Clinical parameters in both operative and non-operative groups showed no significant differences. 2) Treatment results were better in the operative group. Operative treatment is recommended in cases of GCS score below 7, hematoma size larger than 10ml, young age, and normotensive patients. 3) Appropriate operative approaches should be considered according to the patient's status. Recently, we most frequently performed a stereotactic approach. 4) Better outcome was obtained when the patients were operated from 72 hours to one or two weeks following the h emorrhage. 5) Hypertension, old age, and GCS score above 7 showed no statistical differences in terms of outcome between the operative and non-operative groups.

The Influence of Computed Tomographic Findings on initial Mental Status and Prognosis in Spontaneous Cerebellar Hemorrhages

The authors analyzed 53 cases with spontaneous intracerebellar hemorrhage diagnosed by brain CT scan and assessed the correlation between the mental status at admission, the outcome and the CT findings. The location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the mental status assessed by GCS at admission. The GCS score at admission, location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the outcome. We conclude that decreased GCS score at admission, large volume of hematoma, quadrigeminal cistern obliteration, presence of intraventricular hemorrhage and hydrocephalus could be considered as surgical indications and contributing factors for poor prognosis in the patients with spontaneous intracerebellar hemorrhage.

A Clinical Study of Traumatic Intracerebral Hemorrhage

125 cases of traumatic intracerebral hematoma among 935 head injury in-patients were diagnosed with brain computed tomography in the department of neurosurgery, Chungnam National University hospital from Feb. 1986 to Feb. 1990. The authors attempted to analyse these cases clinically by reviews them with pertinent literature. The results were summarized as follows ; 1) The common age incidence was between fifth and sixth decade and almost all patients were male. 2) The most common cause of trauma was traffic accident. 3) The most common site of hematoma was the frontal lobe followed by temporal lobe. 4) There were 39 cases(31.2%) that had hematoma with contralateral skull fracture. 5) Subdural hematoma was the most common combined single lesion. 6) Almost all of the medically treated patients had a hematoma amount below 20cc. 7) The total mortality rate of the patients was 27.2%. 8) High GCS score at admission was good prognostic factor. However, pupil abnormality and rigidity at admission were poor prognostic factors.