Intracranial hematoma removal ICD coding and DRG group analysis / 现代医院

In the case of intracranial hemorrhage,coders tend to ignore the cause of intracranial hemorrhage in the cod-ing,whether it is spontaneous intracranial hemorrhage or intracranial hemorrhage caused by trauma,and the coding of the two is completely different in ICD-10.The former is classified as I60-I62 while the latter is classified as S06.Different etiology will also enter different DRG groups when DRG is included.When determining the cause,the site of intracranial hemorrhage should be determined whether it is subarachnoid hemorrhage,or epidural/subdural hemorrhage or cerebral parenchymal hemorrhage,be-cause different bleeding sites have different codes in ICD-9-CM-3 when performing blood removal in cranial swelling.The classifi-cation of epidural hematoma removal was on 01.24,subdural or subarachnoid hematoma removal was on 01.31,and intracerebral parenchymal hematoma removal was on 01.39.The removal of intracranial hematoma is usually divided into cone craniotomy,skull trepanation and drainage and traditional craniotomy according to different operation methods.The operation process of these three operations is obviously different,and coders need to understand the characteristics of the three operations to achieve accurate classification.In the DRG grouping,the disease code is different from the surgical code and the DRG group will be different.Through understanding the definition and etiology of intracranial hematoma removal,the coding ideas of intracranial hematoma re-moval were analyzed,so as to improve the professional ability of coders and ensure the accuracy of DRG data.

External Validation of a Clinical Nomogram for Predicting Intracranial Hematoma Following Head Computed Tomography in Pediatric Traumatic Brain Injury / Validação externa de um nomograma clínico para previsão de hematoma intracraniano após tomografia computadorizada de cabeça em lesão cerebral traumática pediátrica

Introduction Over-investigation of head computed tomography (CT) has been observed in children with TBI. Long-term effects from a head CT brain scan have been addressed and those should be balanced. A nomogram is a simple prediction tool that has been reported for predicting intracranial injuries following a head CT of the brain in TBI children in literature. This study aims to validate the performance of the nomogram using unseen data. Additionally, the secondary objective aims to estimate the net benefit of the nomogram by decision curve analysis (DCA). Methods We conducted a retrospective cohort study with 64 children who suffered from traumatic brain injury (TBI) and underwent a CT of the brain. Nomogram's scores were assigned according to various variables in each patient; therefore sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and F1 score were estimated by the cross-tabulation of the actual results and the predicted results. Additionally, the benefits of a nomogram were compared with "None" and "All" protocols using DCA. Results There were 64 children with TBI who underwent a head CT in the present study. From the cross-tabulation, the nomogram had a sensitivity of 0.60 (95%CI 0.29­ 0.90), specificity of 0.96 (0.91­1.0), PPV of 0.75 (0.44­1.0), NPV of 0.92 (0.86­0.99), accuracy of 0.90 (0.83­0.97), and an F1 score of 0.66 (0.59­0.73). Also, the area under the curve was 0.78 which was defined as acceptable performance. For the DCA at 0.1 high-risk threshold, the net benefit of the nomogram was 0.75, whereas the "All" protocol had the net benefit of 0.40 which was obviously different. Conclusion A nomogram is a suitable method as an alternative prediction tool in general practice that has advantages over other protocols.

Introdução A investigação excessiva da tomografia computadorizada (TC) de crânio tem sido observada em crianças com TCE. Os efeitos a longo prazo de uma tomografia computadorizada de crânio foram abordados e devem ser equilibrados. Um nomograma é uma ferramenta de predição simples que foi relatada na literatura para prever lesões intracranianas após uma tomografia computadorizada de crânio em crianças com TCE. Este estudo tem como objetivo validar o desempenho do nomograma usando dados não vistos. Adicionalmente, o objetivo secundário visa estimar o benefício líquido do nomograma por meio da análise da curva de decisão (DCA). Métodos Realizamos um estudo de coorte retrospectivo com 64 crianças que sofreram traumatismo cranioencefálico (TCE) e foram submetidas a tomografia computadorizada de crânio. As pontuações do Nomograma foram atribuídas de acordo com diversas variáveis em cada paciente; portanto, sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN), acurácia e escore F1 foram estimados pela tabulação cruzada dos resultados reais e dos resultados previstos. Além disso, os benefícios de um nomograma foram comparados com os protocolos "Nenhum" e "Todos" usando DCA. Resultados Houve 64 crianças com TCE que foram submetidas a tomografia computadorizada de crânio no presente estudo. A partir da tabulação cruzada, o nomograma apresentou sensibilidade de 0,60 (IC95% 0,29­0,90), especificidade de 0,96 (0,91­ 1,0), VPP de 0,75 (0,44­1,0), VPN de 0,92 (0,86­0,99), acurácia de 0,90 (0,83­0,97) e uma pontuação F1 de 0,66 (0,59­0,73). Além disso, a área sob a curva foi de 0,78, definida como desempenho aceitável. Para o DCA no limiar de alto risco de 0,1, o benefício líquido do nomograma foi de 0,75, enquanto o protocolo "Todos" teve o benefício líquido de 0,40, o que foi obviamente diferente. Conclusão Um nomograma é um método adequado como ferramenta alternativa de predição na prática geral que apresenta vantagens sobre outros protocolos.

Risk factors for intracranial hematoma progression in patients with traumatic brain injury at early stage / 中华神经医学杂志

Objective:To investigate the risk factors for intracranial hematoma progression in patients within 24 h of traumatic brain injury.Methods:A prospective study was performed; 184 patients with traumatic brain injury admitted to our hospital from January 2018 to June 2021 were enrolled. According to the states of intracranial hematoma indicated by head CT within 24 h of injury, these patients were divided into intracranial hematoma progression group ( n=52) and intracranial hematoma stable group ( n=132). The clinical data of patients in the two groups were compared and the independent risk factors for intracranial hematoma progression were screened by multivariate Logistic regression analysis. Results:As compared with intracranial hematoma stable group, patients in the intracranial hematoma progression group had significantly advanced age, significantly higher systolic blood pressure and blood glucose levels, statistically higher proportions of patients with parenchymal hemorrhage, subarachnoid hemorrhage, and multiple hematomas, significantly longer prothrombin time, significantly higher international standardization index and D-dimer level, significantly higher proportion with patients with fibrinogen<2.0 g/L, statistically increased K value (blood coagulation time) of thromboelastic map, proportion of patients with α Angle (blood coagulation angle)<64°, level of vascular endothelial biomarker syndecan-1 (Syn-1), and von willebrand factor (vWF) activity, and significantly decreased Glasgow Coma Scale (GCS) scores at admission and platelet count ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.066, 95%CI: 1.018-1.117, P=0.007), systolic blood pressure ( OR=1.076, 95%CI: 1.041-1.111, P<0.001), multiple hematoma ( OR=6.559, 95%CI: 2.025-21.245, P=0.002), fibrinogen<2.0 g/L ( OR=6.164, 95%CI: 1.586-23.954, P=0.009), K value ( OR=6.500, 95%CI: 1.755-24.082, P=0.005) and Syn-1 level ( OR=1.111, 95%CI: 1.015-1.215, P=0.022) were independent risk factors for intracranial hematoma progression in patients with traumatic brain injury at early stage. Conclusion:Traumatic brain injury patients, at early stage, with advanced age, multiple intracranial hematoma, high systolic blood pressure, low fibrinogen, prolonged K value and high Syn-1 level are trend to have intracranial hematoma progression.

Clinical analysis of remote intracranial hematoma after interventional embolization of intracranial aneurysm / 中华神经医学杂志

Objective:To investigate the clinical characteristics and possible mechanisms of remote intracranial hematoma (RIH) in patients with intracranial aneurysm after interventional embolization.Methods:Six patients with RIH from a series of 58 consecutive patients with intracranial aneurysm, admitted to and performed interventional embolization in our hospital from January 2016 and December 2018, were chosen in our study. Their clinical data were analyzed retrospectively and compared with those without RIH at the same period.Results:In these 6 patients, 4 had history of hypertension, 5 had aneurysm located in the internal carotid artery, 5 were treated with stents combined with postoperative routine anticoagulation treatment. The remote intracranial hematoma occurred within 7 d of interventional embolization, and the hematoma was located in the cerebral hemisphere on the same side of the aneurysm; 4 patients underwent intracranial hematoma puncture catheter drainage; 1 patient was treated conservatively, and one was treated by craniotomy. After treatment, 1 patient recovered (modified Rankin scale [mRS] score of 1), 1 patient had poor prognosis (mRS scores of 5) and discharged automatically, and the rest 4 patients (mRS scores of 3-5) left some degrees of neurological dysfunction. As compared with 52 patients without RIH, 6 patients with RIH had significantly higher percentages of patients used stents and postoperatively used anticoagulation, and higher percentages of patients with poor clinical outcomes at discharge ( P<0.05). Conclusion:Stent-assisted coil embolization in patients with internal carotid artery aneurysm combined with hypertension should be highly vigilant about the possibility of RIH.

Neuroendoscopic treatment for non-acute traumatic intracranial hematoma: an efficacy and safety analysis / 中华神经医学杂志

Objective:To investigate the efficacy and safety of neuroendoscopy in the treatment of non-acute traumatic intracranial hematoma.Methods:Thirty-six patients with non-acute traumatic intracranial hematoma, admitted to our hospital from June 2018 to December 2019, were chosen in our study. These patients accepted small-bone window craniotomy and straight incision, or removal of intracranial hematoma by neuroendoscopy. The clinical data of these patients were retrospectively analyzed. Pain numerical rating scale (NRS) was used to assess degrees of pain in 22 patients with headache one d before surgery and three d after surgery. The neurological functions after treatment were evaluated by activity of daily living (ADL) evaluation criteria one d before surgery and 7 d after surgery.Results:All 36 patients were cured and discharged from hospital, and no death was noted; length of hospital stays was (6.7±1.1) d. No secondary hemorrhage re-craniotomy was needed, no postoperative complications such as cerebrospinal fluid leakage were noted, and no re-injection of urokinase was needed to melt the hematoma. As compared with the preoperative NSR scores (7.82±1.097), the postoperative NSR scores of 22 headache patients were significantly decreased (1.05±0.653, P<0.05). In these 36 patients, preoperative ADL level I was noted in 8 patients, level II in 14 patients, level III in 12 patients, and level IV in 2 patients. Postoperative nerve function in 30 patients were fully recovered, with ADL level I; and 6 patients had mild symptom of dizziness, with ADL level II. Conclusion:Non-acute traumatic intracranial hematoma treated by neuroendoscopy enjoys good curative effect, less surgical trauma, short hospital stays and high safety.

Curative effect of minimally invasive removal of intracranial hematoma in the treatment of cerebral hemorrhage and its influence on neurological functional recovery, serum inflammatory factor levels / 中国基层医药

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.

Effect of Directional targeted soft channel intracranial hematoma drainage combined with autologous serum or urokinase in the treatment of hypertensive cerebral hemorrhage / 中国综合临床

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.

Ultra-early microsurgical treatment of ruptured anterior communicating artery aneurysms with intracranial hematoma / 中国脑血管病杂志

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.

Curative effect of minimally invasive removal of intracranial hematoma in the treatment of cerebral hemorrhage and its influence on neurological functional recovery, serum inflammatory factor levels / 中国基层医药

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.

Endoscopic hematoma evacuation and soft channel drainage for hypertensive intracerebral hemorrhage / 中国内镜杂志

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.

Comparison of effectiveness between two different modes of surgical intervention for the treatment of intracerebral hemorrhage in hypertensive patients / 中华急诊医学杂志

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.

Intracranial hematoma micro-invasive craniopuncture scavenging technique in patients with hypertensive cerebral hemorrhage: a Meta-analysis / 中国中西医结合急救杂志

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.

S100β level and prognosis influence of mild hypothermia therapy assisted intracranial hematoma evacuation in treatment of patients with cerebral hemorrhage / 中国综合临床

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.

Clinical effect of minimally invasive operation that alteplase assisted for the patients with moderate amount of cerebral basilar hemorrhage / 临床神经病学杂志

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.

Influence of delayed traumatic intracranial hemorrhage followed by large decompressive craniectomy in prognosis of patients with severe traumatic brain inj ury / 吉林大学学报(医学版)

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.

Application of Bedside Cranial Soft Channel Drainage in Intracranial Hematoma / 现代医院

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 .

Analysis of risk factors of progressive hemorrhagic injury in patients with craniocerebral injury / 中国基层医药

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.

Treatment of cerebral venous sinus thrombosis associated with intracranial hematoma: a systematic review / 中华神经医学杂志

Objective To systemically evaluate the efficacy of all kinds of therapies of cerebral venous sinus thrombosis (CVST) associated with intracranial hematoma (ICH) and provide reference for making treatment scheme.Methods We searched English databases (Pubmed,ISI Web of science and Cochrane library databases) for publications on CVST associated with ICH and the relevant references of those articles.Retrieval time deadline was up to January 2015,and the language was set to English.All publications were searched without restrictions of publication type or published fields.Documents were screened to extract data and to analyze systemically.Results In total,17 articles fulfilled the inclusion criteria and included 31 patients.Because of the severities of reported cases were greatly different and treatments were varied,these patients were divided into 3 levels to get a better understanding of the efficacy.In 6 patients of stage Ⅰ,3 accepted anticoagulation,1 operative treatment,1 endovascular intervention and the left one used more than one methods;the prognosis was good and modified Rankin scale (mRS) score was 0 no matter which kind of therapy was performed.In 11 patients of stage Ⅱ,2 accepted anticoagulation enjoyed mRS scores of 0 and 6,3 operative treatment enjoyed mRS scores of 0,1 and 6,1 endovascular intervention enjoyed mRS scores of 0,and the left 5 used more than one method enjoyed mRS scores of 0,1,1,2 and 2.In 8 patients of stage Ⅲ,1 accepted anticoagulation enjoyed mRS scores of 2,3 operative treatment enjoyed mRS scores of 1,2 and 4,and 4 endovascular intervention enjoyed mRS scores of 0,1,1 and 1.Conclusion It seems that anticoagulation therapy alone may not be effectively enough for those patients that with severe clinical or imaging features;individualized therapy strategies with different types would be more effective.

Research on the clinical efficacy of standard large trauma craniotomy for intracranial hematoma ;caused by severe traumatic brain injury / 临床外科杂志

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.

The high risk factors and emergency treatments to the patients with in-traoperative acute encephalocele caused by delayed intracranial hematomas at non operating region:An investigate of 40 cases / 中国现代医生

Objective To investigate the high risk factors and emergency treatments to the patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region. Methods The clinical data of 40 patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region from January 2000 to December 2013 were analyzed retrospectively. Summarized the high risk factors and emergency treatments in this case. Results The 22 cases with contrecoup injury. 14 cases with extensive contusion of brain,16 cases with skull fracture and 10 cases with small intracranial hematoma (Volume <15mL).The delayed intracranial hematomas to the acute encephalocele include,32 cases at the offside. And 24 cases with epidural hematoma. 32 cases had to undergo reoperation, survived 16 cases. The total death rate was 60%. Conclusion The high risk factors are ex-tensive contusion of brain, offside skull fracture and the delayed intracranial hematomas at non operating region. Under-standing Its high risk factors in clinical, with much more foreseeability, and sufficient preoperative preparation, right in-traoperative treatment, a scientific system comprehensive treatment postoperation can save the patients' life in maximum.