自发性脑出血的血肿周围低密度区CT动态观察

对９６例自发性脑出血病人ＣＴ扫描３１３次，动态观察不同大小、部位的血肿周围低密度区变化过程，发现其严重程序、分布特点和持续时间与血肿大小、部位密切相关，并将发展过程分为超早期、进展期、高峰期和消退期四期，以指导脱水剂的使用。作者还根据ＣＴ影像变化的特点，结合血肿周围脑组织的病理生理变化，提出血肿周围低密度区既反映脑水肿，又反映周围组织的缺血灶。     

脑出血后继续出血21例临床分析

目的 证实脑出血后有继续出血现象并对产生继续出血的可能因素进行探讨。方法 对21例脑出血病情加重后重复CT检查，采用多田氏公式计算血肿大小，并进行临床分析。结果 21例脑出血患者病情加重后重复CT检查均发现血肿增大，发生率为6．8％。血肿形态不规则、长期饮酒、肝肾功能异常者继续出血可能性大。结论 脑出血后继续出血是病情加重的重要因素。     

凝血因子在脑出血继续出血治疗方面的研究进展

脑出血(intracerebral hemorrhage,ICH)是指原发性非外伤性脑实质内出血。传统观念认为脑出血的发生在数分钟内即可结束,发病当天的神经功能缺失是由于脑水肿以及脑出血的占位效应引起的。但近年来,随着CT等影像技术的普及,越来越多的研究显示脑出血继续出血引起的血肿增大是导致病情加重的重要因素。国外的研究显示:18%~38%的脑出血患者在发病3h内出现血肿增大,并与神经功能缺失高度相关。国内褚晓凡教授(1998)在对50例ICH死亡患者进行尸解时发现有26例血肿增大,继续出血发生率为死亡患者的52%[1],并认为长期饮酒、血肿不规则、不恰当…     

脑出血后继续出血56例临床观察

目的探讨脑出血后继续出血的发生时间、发生率、相关因素、防治和预后.方法对306例住院确诊的脑出血患者于入院6h、24h、1周内作CT动态观察,并结合临床进行分析.结果 306例脑出血患者中继续出血56例(18.3%),6h内发生45例(80.4%),6～24h内发生9例(16.1%),1周内2例(3.6%).继续出血与卒中史、长期饮酒史、服用阿司匹林、血肿形态有关,与血压、年龄无关.结论继续出血是导致病情加重和死亡的重要因素.     

脑出血后继续出血的临床研究

目的 搪塞脑出血后继续出血的发生率、发生时间、相关因素、防治和预后。方法 对２０６例脑出血患者于入院后２４小时内、１周内、２周内作ＣＴ动态观察,并结合临床资料进行分析。结果 继续出血的发生率为１６％,继续出血发生在２４小时内占６０．６％。继续出血与慢性肝病、卒中史、长期饮和服用阿司匹林有关,而与血压及发病年龄无关。继续出血部位以丘脑最多因肿形态不规则者易发生继续出血。继续出血患者死亡率高。结论 继     

脑出血继续出血38例临床分析

目的探讨脑出血后继续出血的发生率、发生时间、影响因素、防治和预后。方法回顾性分析213例脑出血患者的动态头颅CT检查结果，结合临床资料进行分析，结果继续出血发生率17．84％。发生在24h内60．52％，发生原因与基础疾病、出血部位、血肿形态等有关，继续出血患者死亡率高，结论继续出血是导致病情加重和死亡的重要原因。     

CT定位血肿穿刺治疗脑出血

自1999年10月至今，我科共收治脑出血患124例，其中82例在CT定位下实施脑内血肿穿刺置管后应用尿激酶冲洗引流，取得良好的治疗效果。现总结如下。     

脑出血后继续出血的临床分析

目的 :探讨脑出血后继续出血的概念、诊断、相关因素和治疗。方法 :对 2 76例脑出血患者病情恶化后行头颅CT扫描 ,并结合临床资料进行分析。结果 :脑出血继续出血的发生率为 18 97%。继续出血部位以丘脑最多见。血肿形态不规则者易发生继续出血。继续出血患者预后较差。结论 :继续出血是导致病情加重和预后不良的重要因素     

脑出血后继续出血的临床分析

目的：探讨脑出血后继续出血的概念、诊断相关因素和治疗。方法：对276例脑出血患者病情恶化后行头颅CT扫描,并结合临床资料进行分析。结果：脑出血继续出血的发生率为18．97％。继续出血部位以丘脑最多见。血肿形态不规则者易发生继续出血。继续出血患者预后较差。结论：继续出血是导致病情加重和预后不良的重要因素。     

高血压脑出血血肿扩大相关因素分析

目的通过对比分析明确幕上高血压脑出血血肿扩大的危险因素。方法将幕上高血压脑出血患者313例,根据是否存在血肿扩大,分为血肿扩大组和非血肿扩大组,明确血压、早期使用甘露醇、血肿特点、发病时搬动与血肿扩大的关系。结果 (1)血肿扩大组入院时收缩压200mmHg者占40.34%,非血肿扩大组占12.37%;血肿扩大组入院时舒张压110mmHg者占57.14%,非血肿扩大组占26.80%,两组比较,血肿扩大组血压明显高于非血肿扩大组,差异显著(P0.01)。(2)血肿扩大组早期(发病6h内)使用甘露醇者占85.71%,非血肿扩大组占54.12%,差异显著(P0.01)。(3)血肿扩大组丘脑出血占38.66%,显著多于非血肿扩大组的26.28%(P0.05);血肿扩大组出血量20ml者58.82%,显著高于非血肿扩大组的16.50%(P0.01);血肿扩大组血肿形态不规则者93.28%,显著高于非血肿扩大组的61.34%(P0.01)。(4)血肿扩大组存在搬动史者57.98%,非血肿扩大组41.75%,差异显著(P0.01)。结论血压升高(收缩压200mmHg和/或舒张压110mmHg)、发病早期(6h内)使用甘露醇、丘脑出血、出血量大于20ml、血肿形态不规则、发病早期存在搬动是脑出血血肿扩大的危险因素。     

血肿密度与脑出血早期血肿扩大的相关性

目的分析脑出血早期血肿不均匀密度与血肿扩大的关系。方法收集深圳市数家医院发病6h内行第1次头部CT检查,48h内复查头部CT的非手术脑出血病例资料,共120例。将入院后首次头部CT所示血肿按不同的密度分级标准评级,分为血肿密度均匀组和血肿密度不均匀组,统计学分析对比两组年龄、性别、入院时收缩压、舒张压、出血量、纤维蛋白原浓度及血肿扩大发生率的差异。结果密度均匀组和密度不均匀组的年龄、性别、入院时收缩压、舒张压、纤维蛋白原浓度无显著性差异。密度不均匀组血肿比密度均匀组血肿明显大(t=-3.660,P=0.000);血肿扩大发生率显著增高(χ2=5.40,P=0.026),但两组首次头部CT出血量无显著差异t=-1.005,P=0.317)。血肿密度不均匀组发生血肿扩大和不发生血肿扩大的出血量无显著差异(t=0.843,P=0.405)。结论较大血肿的密度更不均匀,密度不均匀血肿比密度均匀血肿更易出现血肿扩大。出血量不是血肿扩大的危险因素。密度不均匀血肿可能是血肿扩大的重要危险因素之一。     

脑出血早期血肿扩大的临床特点及相关因素分析

目的分析脑出血后早期血肿增大的临床特点,探讨其相关危险因素及防治策略。方法 492例脑出血患者,根据病情演变及脑CT变化,分为血肿增大组和血肿稳定组,对两组患者病史、临床特点、生化指标及头颅CT特征进行对比分析。结果 492例患者中,114例出现血肿增大,发生率为23.17%;不规则血肿、肝功能异常、肾功能异常、凝血功能异常、长期饮酒者的患者易发生血肿扩大,两组比较有差异有统计学意义(P<0.05)。结论脑出血后血肿增大多发生在24h内,肝、肾功能受损、凝血功能异常、长期饮酒者可能为血肿增大的主要危险因素。     

脑出血后血肿状态对神经功能损伤的动物实验性研究

目的探讨大鼠脑出血后早期血肿状态对神经功能损伤的影响。方法采用预置管二次注射法,分别用加入促凝剂(6-氨基己酸)、抗凝剂(低分子肝素钠)以及无促凝剂和抗凝剂的大鼠自体动脉血建立尾状核脑出血模型,不同时间点(1h、6h、12h、24h、3d)对比实验组大鼠血肿容积、脑组织水肿病理变化与神经功能损伤的关系。结果血肿容积比较:1h时间点(P0.05);6h、12h、24h时间点,抗凝组血肿容积大于其他2组,差异有统计学意义(P0.01);神经功能损伤比较:6h、12h、24h时间点,促凝组神经损伤评分大于其他2组(P0.01),1h、3d时间点差异均无统计学意义(P0.05);脑组织水肿比较:6h、12h、24h时间点,促凝组大鼠脑组织水肿程度重于其他2组(P0.01)。结论大鼠脑出血后急性期血肿不同状态对神经功能损伤有影响,液化血肿易于血液扩散,益于减轻神经功能损伤。     

自发性脑出血患者早期血肿增大的危险因素分析

目的探讨自发性脑出血（SICH）患者早期血肿增大的危险因素。方法对105例SICH患者发病后48h进行动态CT检查,观察血肿的体积变化,血肿量平均增大33％或者6ml以上定为血肿增大。结果本组16例患者血肿增大,89例患者血肿未增大。单因素分析发现,患者年龄、入院时国际标准化比率较高、平均动脉压较高、既往有高血压病史、影像学检查示白质疏松及初始血肿体积较大的SICH患者易发生早期血肿增大。多因素Logistic回归分析发现,高血压病史（优势比为3．683,95％可信区间为1．057～12．837,P〈0．05）、头部CT示白质疏松（优势比为4．665,95％可信区间为1．437～15．129,P〈0．05）是SICH患早期血肿增大的独立危险因素。结论SICH患者早期血肿增大与诸多因素相关,人院后动态头部CT检查有助于早期发现。     

A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage

Background and Purpose

The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study.

Methods

We identified all subjects with primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland. Hematoma evacuation was carried out by using standard craniotomy or through a burr hole. We compared mortality rates and functional outcomes of patients with hematoma evacuation with those treated conservatively.

Results

Of 982 patients with verified ICH during the study period, 127 (13%) underwent hematoma evacuation. Surgically treated patients were significantly younger (mean ± SD, 63 ± 11 vs. 70 ± 12 years; p < 0.001), had larger hematomas (66 ± 36 vs. 28 ± 40 ml; p < 0.001), lower Glasgow Coma Scale scores (median, 11 vs. 14; p < 0.001) and more frequently subcortical hematomas (68% vs. 24%; p < 0.001) than those treated conservatively. In multivariable analysis, hematoma evacuation independently lowered 3-month mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43–0.88; p < 0.03), particularly among patients aged ≤70 years with ≥30 ml supratentorial hematomas (adjusted HR, 0.26; 95% CI, 0.14–0.49; p < 0.001). However, poor outcome was not improved by surgery (adjusted odds ratio 0.71; 95% CI 0.29–1.70).

Conclusions

Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged ≤70 years with ≥30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.     

A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage

Objective

Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage.

Materials and methods

We studied 201 patients with acute (<6 h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5 ml increase) was determined on the second scan performed within 24 h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5 h after admission (1.5 h-SBP). The discriminant value of the hematoma volume and 1.5 h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression.

Results

Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5 h-SBP were determined to be 16 ml and 160 mmHg, respectively. Hematoma volume above 16 ml (HV > 16) ([OR] = 5.05, 95% CI 1.32–21.36, p = 0.018), hematoma heterogeneity (HH) ([OR] = 7.81, 95% CI 1.91–40.23, p = 0.004) and 1.5 h-SBP above 160 mmHg (1.5 h-SBP > 160) ([OR] = 8.77, 95% CI 2.33–44.56, p = 0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%.

Conclusions

The presented model (HV > 16, HH, 1.5 h-SBP > 160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome.     

Effect of desmopressin on hematoma expansion in antiplatelet-associated intracerebral hemorrhage: A systematic review and meta-analysis

The purpose of this study was to perform a systematic review and meta-analysis on the effect of desmopressin on hematoma expansion (HE) in antiplatelet-associated intracerebral hemorrhage (AA-ICH). Secondary outcomes examined were the rate of thrombotic complications and neurologic outcome.Three databases were searched (Pubmed, Scopus, and Cochrane) for randomized clinical trials and controlled studies comparing desmopressin versus controls in adult patients with AA-ICH. The Mantel-Haenszel method was applied to calculate an overall effect estimate for each outcome by combining stratum-specific risk ratio (RR). Risk of bias was computed using the Newcastle-Ottawa Scale. The protocol was registered in PROSPERO (42020190234).Three retrospective controlled studies involving 263 patients were included in the meta-analysis. Compared to controls, desmopressin was associated with a non-significant reduction in HE (19.1% vs. 30%; RR:0.61; 95%CI, 0.27–1.39; P = 0.24), a similar rate of thrombotic events (5.5% vs. 9.9%; RR:0.47; 95%CI, 0.17–1.31; P = 0.15), and significantly worse neurologic outcome (mRS ≥ 4) (66.3% vs. 50%; RR:1.36; 95%CI, 1.08–1.7; P = 0.008). Qualitative analysis of included studies for each outcome revealed low to moderate risk of bias.The available literature does not support the routine use of desmopressin in the setting of AA-ICH. Until larger prospective trials are performed, the administration of desmopressin should be judiciously considered on a case-by-case basis.     

神经内镜高血压脑出血微创手术的三维重建手术定位

目的 探索神经内镜高血压脑出血(HICH)微创手术术前精确可靠的手术定位方法.方法南方医科大学珠江医院神经外科自2008年6月至2010年8月通过CT扫描及图像三维重建的方法定位脑内血肿、选择最佳内镜微创手术入路行神经内镜微创术治疗HICH患者18例,分析患者的临床资料和疗效.结果 根据CT三维重建结果,术者可以准确设计最佳内镜微创手术入路并实现颅骨钻孔部位的精确定位,减少手术前准备、麻醉及操作时间.本组患者平均手术时间仅1.5 h左右,手术失血量仅30～40mL,血肿清除率约为89.2%,且血肿清除后脑组织松弛,无需行去骨瓣减压.结论 HICH患者采用CT扫描、三维重建进行术前手术定位是一种快速、简便、可靠的神经内镜微创脑出血手术定位方法.

Abstract：

Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.