氨甲环酸联合钻孔引流术治疗慢性硬膜下血肿

目的研究慢性硬膜下血肿钻孔引流术联合血肿腔内应用氨甲环酸对慢性硬膜下血肿(CSDH)术后复发率的影响。方法采用前瞻性随机对照研究,将本院近2年内慢性硬膜下血肿50例随机分为实验组和对照组,每组25例。实验组行钻孔引流术,同时血肿腔注入氨甲环酸治疗,对照组仅行钻孔引流术,其它常规治疗两组均相同。分别检测两组患者手术冲洗前后血肿液及手术后血肿腔引流液的D-二聚体,术后随访6个月,分析复发率。结果两组患者血肿液D-二聚体在术中冲洗前均高于正常,在术中冲洗后均降低,两组比较均无统计学差异(P>0.05)。术后2天,实验组血肿腔引流液D-二聚体显著低于对照组,统计有显著差异(P<0.05)。50例患者术后均全部治愈出院,实验组25例有2例复发,对照组有8例复发,实验组复发率显著低于对照组,统计有显著差异(P<0.05)。结论血肿腔局部纤溶功能亢进在慢性硬膜下血肿发病机制及复发中起重要作用,术中氨甲环酸在血肿腔内局部应用可抑制其纤溶功能亢进,显著降低术后血肿腔引流液D-二聚体浓度,从而显著降低慢性硬膜下血肿患者的术后复发率,值得临床推广应用。     

特殊止凝血指标检测在诊断产科早期DIC患者中的价值

目的:探讨血小板(PLT)、纤维蛋白原(FIB)、D-二聚体(D-dim er)、纤维蛋白单体(FM)在诊断产科早期弥漫性血管内凝血(DIC)患者中的价值。方法:分别检测42例正常孕龄≥29w的孕晚期妇女,38例产科早期DIC患者的PLT、FIB、D-dimer及FM的水平。结果:与正常孕晚期妇女相比,产科早期DIC患者中的PLT明显减少,差别具有统计学意义(P<0.05);FIB含量无明显变化(P>0.05),D-dimer及FM浓度显著升高,具有统计学差异(P<0.05)。结论:PLT、D-dimer及FM是诊断产科早期DIC患者的灵敏指标。     

颅脑损伤患者早期D-二聚体含量与伤情及预后的关系

目的探讨血浆D-二聚体(D-dimer,DD)含量作为早期观察因子在颅脑损伤患者伤情评估、预后预测中的作用。方法通过对刚入院63例单纯颅脑损伤患者血浆D-二聚体含量的测定,探讨D-二聚体含量与格拉斯哥昏迷分析(GCS)、脑CT扫描中线移位程度及格拉斯哥预后评分(GOS)的关系。结果颅脑损伤早期就出现D-二聚体含量增高;D-二聚体含量与GCS呈负相关,与中线移位程度呈正相关,D-二聚体含量越高伤情越重;D-二聚体含量与GOS呈负相关,D-二聚体含量越高预后越差。结论伤后早期D-二聚体含量测定有助于颅脑损伤患者伤情评估及预后预测。     

急性下肢深静脉血栓形成P-选择素与D-二聚体的变化及意义

目的 探讨下肢深静脉血栓形成(DVT)患者P-选择素与D-二聚体变化及其临床药物干预后的变化.方法 用流式细胞术(FCM),以单克隆抗体为探针测定40例下肢DVT患者及20例健康人P-选择素阳性表达率,应用免疫方法测定D-二聚体(D-dimer)含量.结果 DVT组在发病的早期P-选择素与D-二聚体阳性表达率均高于对照组(P均＜0.05),溶栓抗凝等治疗后不同时间P-选择素与D-二聚体阳性表达率呈降低趋势,其中应用奥扎格雷钠组与非奥扎格雷钠组比较P-选择素阳性表达率有显著差异.D-二聚体的变化无显著差异.出院1个月后P-选择素与D-二聚体含量明显降低,但P-选择素阳性表达率较正常人偏高.结论 急性DVT患者早期体内血小板活化,纤维蛋白溶解处于亢进状态;奥扎格雷钠能降低血小板活化;P-选择素,D-二聚体可做为DVT诊断的指标之一;出院后DVT患者仍是血栓形成的高危人群,需要定期随访.     

膝关节镜手术患者血浆纤维蛋白原和D-二聚体检测结果分析

[目的]探讨血浆中纤维蛋白原及D-二聚体的检测对膝关节镜手术患者并发深静脉血栓(DVT)的早期诊断价值.[方法]对796例膝关节镜手术患者术前及术后第3～5 d进行血浆中纤维蛋白原、D-二聚体的水平检测,并与正常对照组(30例)比较.[结果]30例并发DVT组术后与术前及正常对照组血浆中纤维蛋白原、D-二聚体的检测结果差异有统计学意义(P＜0.05);未并发DVT组术前、术后与正常对照组血浆中纤维蛋白原、D-二聚体的检测结果均无统计学意义(P＞0.05).[结论]血浆中纤维蛋白原及D-二聚体的动态检测对膝关节镜手术患者并发深静脉血栓具有早期的诊断价值.     

髋关节置换后监测D-二聚体、纤维蛋白原及纤维蛋白降解产物对诊断预防下肢深静脉血栓的临床意义

目的检测人工全髋关节置换术前、术后血浆纤维蛋白原,纤维蛋白降解产物,D-二聚体含量变化,探讨其对诊断及预防下肢深静脉血栓形成的临床指导意义。方法选择人工全髋关节置换患者133例,根据术后有无DVT将其分为DVT组和Control组,分别于入院后1d、术后1d、7d、14d检测凝血功能纤维蛋白原（FIB）、纤维蛋白降解产物（FDB）、D-二聚体（D-dimer）,并进行分析比较。结果血浆FIB含量在手术前后Control组和DVT组差异无统计学意义,术后两组均有一过性升高趋势,但术后14d降至正常;FDB手术前后两组差异无统计学意义（P＞0.05）,Control组术前含量较低,术后同样有一过性升高趋势,术后14d逐渐降低,术后各个时间点同术前比较差异有统计学意义（P＜0.05）,DVT组术前FDP含量较高,术后1d达峰值,之后逐渐下降,各时间点差异无统计学意义（P＞0.05）;D-dimer术后两组含量逐渐增高,术后7d、14d同术前比较差异有统计学意义（P＜0.05）,术后7d、14d DVT组含量显著高于Control组,差异有统计学意义（P＜0.05）。结论纤维蛋白原、纤维蛋白降解产物和D-二聚体的检测在低分子肝素预处理后的人工全髋关节置换术后DVT的早期预防及治疗上具有临床应用价值,尤其是D-二聚体是诊断深静脉血栓的实验室无创伤检查的首选方法。     

大剂量乌司他丁对大面积烧伤患者凝血功能的影响及意义

目的：观察大剂量乌司他丁对大面积烧伤患者凝血功能的影响。方法：4例大面积烧伤患者入院后第3天起每天给予大剂量乌司他丁(60万U,4次/d),用药前及用药后1d、3d、7d、10d、14d,抽血观察血浆纤维蛋白原含量(Fib-c)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)及血浆D-二聚体含量的变化。结果：用药前血浆D-二聚体及纤维蛋白原含量明显升高,PT时间显著延长;给予大剂量乌司他丁1d后,血浆D-二聚体及纤维蛋白原含量明显减低,PT时间迅速恢复。结论：大面积烧伤患者早期应用大剂量乌司他丁可显著改善凝血功能,预防播散性血管内凝血的发生。     

创伤患者血浆D-二聚体、纤维蛋白原与骨折部位及创伤程度的相关性研究

目的通过分析骨折患者与正常体检者的血浆D-二聚体和纤维蛋白原水平,研究其与骨折部位及创伤程度的相关性。方法选取2014年7月至2015年7月因骨折至我院骨科入住的患者230例(创伤组)及同期正常体检者100例(对照组),将创伤组患者根据不同骨折部位分为7组:肱骨骨折(32例)、尺桡骨骨折(32例)、股骨骨折(35例)、胫腓骨骨折(33例)、足骨骨折(31例)、脊柱骨折(32例)、多发性骨折(35例),同时依据损伤严重程度(injury severity score,ISS)评分划分为轻度创伤组(113例),中度创伤组(47例)和重度创伤组(70例)。测定创伤组患者的血浆D-二聚体及纤维蛋白原浓度,与对照组进行比较,并就不同骨折部位及不同创伤程度的D-二聚体及纤维蛋白原浓度进行统计学分析。结果创伤组患者血浆D-二聚体及纤维蛋白原水平明显高于对照组,差异有统计学意义(P0.01)。不同骨折部位患者血浆D-二聚体水平有显著差异(H=104.27,P0.01),由高到低依次为多发伤、脊柱、股骨、胫腓骨、足骨、肱骨和尺桡骨;不同骨折部位患者血浆纤维蛋白原浓度差异有统计学意义(H=62.84,P0.01),由高到低依次为多发伤、脊柱、股骨、足骨、胫腓骨、肱骨和尺桡骨。创伤程度越重,患者的血浆D-二聚体及纤维蛋白原越高,各创伤程度组间差异均存在统计学意义(P0.01)。结论骨折患者的血浆D-二聚体和纤维蛋白原水平明显高于正常人,与骨折部位有密切相关性,且会随创伤程度的加重而逐渐升高,因此骨折患者的血浆D-二聚体及纤维蛋白原监测对其早期病情判断有重要价值。     

血D-二聚体、FIB和CRP水平对评价肝癌TACE疗效和预后的临床价值

目的:探讨原发性肝细胞癌患者肝动脉化疗栓塞(TACE)前后血浆D-二聚体、纤维蛋白原(FIB)、C反应蛋白(CRP)动态变化对疗效和预后判定的价值。方法:2010年4月—2013年1月行TACE治疗128例原发性肝癌患者,根据实体瘤疗效评价方法(mRECIST)分为疾病进展组(47例)和有效组(81例)。检测治疗前后两组患者血浆D-二聚体、FIB和CRP含量,随访患者生存情况,多元Logistic回归分析D-二聚体、FIB和CRP是否为患者生存的独立预测因素。结果:全部患者TACE治疗后D-二聚体、FIB含量较治疗前均降低(P0.05),而CRP含量变化不显著(P0.05);有效组TACE前、后血浆D-二聚体、FIB、CRP含量的差异无统计学意义(P0.05),但疾病进展组TACE后较TACE前含量显著增高(P0.05)。多因素Logistic回归分析显示,D-二聚体和TNM分期和血管侵犯为影响患者生存的独立预测因素。结论:TACE治疗前后血浆D-二聚体、FIB和CRP动态水平变化是判断HCC患者疗效和预后的理想指标,D-二聚体可作为影响患者生存的独立预测因素。     

不同类型冠心病患者凝血纤溶指标的对比分析

目的 探讨不同类型冠心病患者血浆纤溶指标的变化及其临床意义。方法 测定80例不同类型冠心病患者和30例正常对照者血浆中的D-二聚体、纤维蛋白原、凝血酶原时间和部分凝血酶原时间。结果 急性心肌梗死组(27例)和不稳定性心绞痛组(20例)的D-二聚体、纤维蛋白原含量明显高于对照组(30例)、稳定性心绞痛组(16例)和陈旧性心肌梗死组(17例)，P＜0．0l；急性心肌梗死组的D-二聚体、纤维蛋白原含量高于不稳定性心绞痛组(P＜0．05)；稳定性心绞痛组和不稳定性心绞痛组凝血酶原时间、部分凝血酶原时间比其他各组明显缩短(P＜0．01)。对照组、稳定性心绞痛组和陈旧性心肌梗死组各组间4个指标无明显差异(P＞0．05)。结论 冠心病患者体内存在着高凝状态和继发性纤溶活性增强。血小板活化、凝血激活系统及内皮细胞损伤在急性心肌梗死和不稳定性心绞痛的发生发展中起重要作用。     

基于CT纹理特征及临床-影像学特征构建模型预测慢性硬膜下血肿钻孔引流术后复发

目的观察基于CT纹理特征及临床-影像学特征建立的支持向量机(SVM)模型对于预测慢性硬膜下血肿(CSDH)钻孔引流术后复发的价值。方法回顾性分析146例经颅钻孔引流术后CSDH患者,术后随访3个月,统计复发例数。对比复发与未复发患者的一般资料及病灶CT特征,以Mazda软件在术前CT所示血肿最大层面勾画ROI,提取纹理参数。采用主成分分析法提取特征参数,建立SVM模型;以受试者工作特征(ROC)曲线分析模型对复发的预测效能。结果经颅钻孔引流术后3个月内32例(32/146,21.92%)CSDH复发,114例(114/146,78.08%)未复发;复发与未复发患者间术前血肿体积及血肿亚型差异均有统计学意义(P均0.05)。对每例患者提取304个术前CT纹理特征,最终筛选出30个特征,复发与未复发者间仅S(5,0)SumAverg差异有统计学意义(P=0.03)。经主成分分析,最终提取S(5,0)Contrast、S(5,0)SumAverg、Teta2、S(3,-3)Entropy 4个纹理特征及糖尿病、血肿体积及亚型3个临床-影像学特征。分别基于4个纹理特征及4个纹理特征+3个临床-影像学特征建立SVM模型,ROC曲线结果显示,前者预测CSDH术后复发的AUC为0.85,后者为0.92(P=0.075)。结论基于CT纹理特征及临床-影像学特征构建的SVM模型有助于预测CSDH经钻孔引流术治疗后复发。     

Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study

OBJECT: To evaluate the role of local inflammation in the pathogenesis and postoperative recurrence of chronic subdural hematoma (CSDH), the authors conducted an investigation in a selected group of patients who could clearly recall a traumatic event and who did not have other risk factors for CSDH. Inflammation was analyzed by measuring the concentration of the proinflammatory and inflammatory cytokines interleukin (IL)-6 and IL-8. The authors also investigated the possible relationship between high levels of local inflammation that were measured and recurrence of the CSDH. METHODS: A prospective study was performed between 1999 and 2001. Thirty-five patients who could clearly recall a traumatic event that had occurred at least 3 weeks previously and who did not have risk factors for CSDH were enrolled. All patients were surgically treated by burr hole irrigation plus external drainage. The concentration of inflammatory cytokines was very high in the lesion, whereas it was normal in serum. In five cases in which recurrence occurred, concentrations of both IL-6 and IL-8 were significantly increased (p < 0.01) in comparison with cases without a recurrence. In a layering hematoma, the IL-6 and IL-8 concentrations were significantly higher (p < 0.05). Layering CSDHs were also significantly correlated with recurrence. Trabecular hematoma had the lowest cytokine levels and the longest median interval between trauma and clinical onset. The interval from trauma did not significantly influence recurrence, although it did differ significantly between the trabecular and layering CSDH groups. Concentrations of IL-6 and IL-8 in the CSDHs did not differ significantly in relation to either the age of the hematoma (measured as the interval from trauma) or the age of the patient. CONCLUSIONS: Brain trauma causes the onset of an inflammatory process within the dural border cell layer; high levels of inflammatory cytokines were significantly correlated with recurrence and layering CSDH. A prolonged postoperative antiinflammatory medicine given as prophylaxis may help prevent the recurrence of a CSDH.     

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

OBJECT: The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. METHODS: In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of beta -trace protein (beta TP) in the subdural fluid (betaTPSF) and serum (betaTPSER), and the CSDH/SH recurrence rate. The betaTPSF was considered to indicate an admixture of CSF to the subdural fluid if betaTPSF/betaTPSER>2. RESULTS: The median beta TPSF level for the whole patient group was 4.29 mg/L (range 0.33-51 mg/L). Cerebrospinal fluid leakage, as indicated by betaTPSF/betaTPSER>2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p=0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the betaTPSF concentrations (median 6.69 mg/L, range 0.59-51 mg/L) were significantly higher (p=0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33-26.8 mg/L). CONCLUSIONS: As indicated by the presence of betaTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of betaTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.     

Clinical factors of recurrent chronic subdural hematoma

The clinical, radiological, and operative factors of recurrent chronic subdural hematoma (CSDH) were retrospectively analyzed in 116 patients with CSDH in 134 hemispheres, treated by one burr hole surgery. The correlation of recurrence was evaluated with personal and clinical factors such as age, sex, history of head injury, and interval from onset of initial symptoms to hospitalization; laboratory findings such as bleeding tendency and liver function; computed tomography (CT) findings such as hematoma density and brain atrophy; and operative findings such as additional procedures and postoperative residual air. The recurrence group (RG) included 10 hemispheres (7.5%) in 10 patients (8.6%). The interval from onset of symptoms to hospitalization was significantly shorter in the RG than in the nonrecurrence group (NRG). Headache was more frequently seen in the RG than in the NRG. Density of hematoma on CT was classified into five types: Low, iso, and high density, niveau, and mixed, and the incidence of recurrence was 0%, 2.3%, 17.2%, 12.5%, and 6.5%, respectively. Larger amounts of residual air in the postoperative hematoma cavity were associated with recurrence of CSDH. CSDH that progresses rapidly in the acute stage and appears as high density on preoperative CT is associated with a high incidence of recurrence. Intraoperative air invasion to the hematoma cavity should be avoided to prevent recurrence.     

A case of complete clearance of chronic subdural hematoma accompanied by recurrent glioblastoma multiforme after administration of bevacizumab

The efficacy of bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), as an adjuvant therapy against various malignant tumors was recently established. Its pharmacological effects in malignant tumors, including gliomas, were speculated to involve neovascularization inhibition and vascular permeability. Recently, it has been reported that the outer membrane of chronic subdural hematoma (CSDH) contains high levels of VEGF, which were implicated in neovascularization of the outer membrane. Furthermore, studies suggested that VEGF has the etiology in CSDH development, although its involvement is not fully understood. Here, we report the first case of chronic subdural hematoma that was improved by bevacizumab administration for recurrent glioblastoma. The present case could contribute to the hypothesis that VEGF may be associated with CSDH. We also discuss the pathogenesis and mechanism of CSDH recurrence from the viewpoint of VEGF function.     

Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study

BackgroundChronic subdural hematoma (CSDH) is commonly encountered in the elderly patients and the recurrence rate is still high, therefore, identifying risk factors for CSDH recurrence is essential. The present study aimed to identify clinical and radiological factors predicting the recurrence of CSDH.MethodsWe retrospectively identified 461 patients with CSDH who underwent surgical evacuation in our department. Univariable analyses were performed at first, variables with a P-value of <0.05 were entered into multivariable logistic regression model. Kendall's tau-b test was used to evaluate the relationship between brain atrophy and postoperative pneumocephalus.ResultsUnivariable analyses revealed that patients with the following characteristics have a higher recurrence rate, including age ≥80 years, antiplatelet and/or anticoagulant use, GOS = 3, the volume of drainage ≥100 ml, midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus. Multivariable logistic regression demonstrated that midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence. Kendall's tau-b test revealed that there was no correlation between brain atrophy and postoperative pneumocephalus.ConclusionsMidline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence, CSDH patients with these characteristics should be taken precautions of recurrence and a closely follow-up should be carried out.     

Local elevation of the anti-inflammatory interleukin-10 in the pathogenesis of chronic subdural hematoma

We investigated the relationship between inflammatory and anti-inflammatory cytokines in the pathogenesis of chronic subdural hematoma (CSDH) by measuring the plasma and subdural fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10). The levels of IL-6, IL-8 and IL-10 were measured in the subdural fluid obtained from 34 patients with CSDH, using the enzyme-linked immunosorbent assay. The patients were classified into a high IL-10 group and a low IL-10 group according to the level of IL-10 in their subdural fluid samples. The subdural fluid levels of IL-6 and IL-8 were significantly higher in the high IL-10 group than in the low IL-10 group (P<0.05). A tendency for the patients in the low IL-10 group to show the separated or layer type of pattern on the CT scans was noted.     

Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate

Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. The diagnosis and treatment are well established, but recurrence, complications, and factors related to these problems, especially in the elderly, are not completely understood. This study evaluated the clinical features, radiological findings, and surgical results in a large series of the patients treated at the same institution. 500 consecutive patients (359 men and 141 women) with CSDH were treated by burr hole craniostomy with closed system drainage from January 1987 through February 1999. Causes, clinical and computed tomographic findings, surgical results, re-expansion of brain after surgery, and hematoma recurrence were statistically analyzed to elucidate the potential risks of CSDH. Most patients (89.4%) had good recovery, 8.4% showed no change, and 2.2% worsened. Six patients (1.2%) died, three due to disseminated intravascular coagulation. Recurrence of hematoma was recognized in 49 patients (9.8%), at 1 to 8 weeks (3.5 +/- 1.9 weeks) after the first operation. The brain re-expansion rate at one week after operation was 45.0 +/- 21.4% in patients with hematoma recurrence and significantly lower than 55.3 +/- 19.1% in patients without recurrence (p < 0.001). Old age, pre-existing cerebral infarction, and persistence of subdural air after surgery were significantly correlated with poor brain re-expansion (p < 0.001). Twenty-seven patients (5.4%) suffered postoperative complications, of which 13 cases were acute subdural hematoma caused by incomplete hemostasis of the scalp wound and four cases were tension pneumocephalus. Careful hemostasis and complete replacement of subdural hematoma by normal saline to prevent influx of air into the subdural space will further improve the surgical outcome for patients with CSDH.     

The risk factors for recurrence of chronic subdural hematoma

Chronic subdural hematoma (CSDH) is a common disease in the elderly, and the recurrence rate of CSDH is reported to range from 2.3 to 33 %. We performed a retrospective review of a number of CSDH cases and the potential factors associated with CSDH recurrence. The patient population comprised 112 men and 65 women with a mean age of 74.7 years. We analyzed the following factors: age, sex, antiplatelet and anticoagulant use, hematoma laterality, hematoma thickness, degree of midline shift and internal architecture of the hematoma in the preoperative CT films, use of irrigation, direction of the drainage tube, width of the subdural space, and degree of midline shift and the presence of a massive subdural air collection in the postoperative CT films. Univariate analysis revealed that there was a trend for different rates of recurrence among the different types of hematomas. The presence of a postoperative massive subdural air collection tended to be associated with the recurrence of hematoma. Multivariate analysis revealed that separated hematomas were significantly associated with CSDH recurrence, whereas the presence of postoperative massive subdural air collection tended to be associated with hematoma recurrence. Neither univariate nor multivariate analysis could demonstrate an association between the direction of the drainage tube and the recurrence of CSDH.