全身免疫炎症指数预测脑出血患者的预后

目的 评估全身免疫炎症指数(SII)对脑出血患者预后的预测价值。方法 采用回顾性研究方法,纳入脑病科急性脑出血患者,收集所有患者的基线资料及入院24 h内的SII指数,根据出院改良Rankin(mRS)评分,分为预后良好组(mRS≤2分)、预后不良组(mRS>2分),采用独立样本t检验、Mann-Whitney U检验、多因素logistic回归分析和ROC曲线分析。结果 共纳入320例脑出血患者,111例(34.7%)取得了良好预后,多因素logistic回归分析显示,入院出血量、NIHSS评分、SII是预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,SII指数预测预后的曲线下面积0.785,95.0%可信区间(0.705～0.812,P<0.05),最佳截断值1 383.94,特异度64.5%,敏感度79.2%。结论 早期SII指数升高与脑出血患者出院时的不良预后高度相关,可用于脑出血患者预后的预测。     

早期适量放血疗法治疗高血压中小量脑出血38例

目的：观察早期适量放血疗法治疗中小量高血压脑出血的临床疗效。方法：将68例急性高血压性脑出血患者随机分为2组。治疗组38例西医内科常规治疗,同时配合早期一次性适量放血治疗;对照组30例采用西医内科常规治疗。2组均以治疗28天为1个疗程。观察2组患者治疗前后神经功能缺损积分变化情况及血肿吸收情况。结果：基本治愈率治疗组为26.32%,对照组为16.67%,2组相比差异有统计学意义（P〈0.05）;总有效率治疗组为94.74%,对照组为86.67%,2组相比差异有统计学意义（P〈0.05）;治疗后2组神经功能缺损积分均降低（P〈0.05）,且治疗组降低较对照组明显（P〈0.05）;治疗组血肿吸收率较对照组明显,差异有统计学意义（P〈0.05）。结论：早期西医内科常规治疗同时配合一次性适量放血治疗中小量高血压性脑出血能降低神经功能缺损积分,促进颅内血肿吸收。     

早期针刺治疗对高血压脑出血微创术后患者意识状态影响临床观察

[目的]观察针刺治疗对高血压脑出血微创术后患者意识状态的影响。[方法]将研究对象随机分为微创术后常规治疗加针刺组(命名为治疗组,下同)患者20例、微创术后常规治疗组(命名为对照组,下同)患者20例。分别评定两组入院时、入院第4天、第10天、第20天、第30天的格拉斯哥昏迷量表(GCS)积分情况。[结果]治疗组与对照组GCS评分第30天时比较差异有统计学意义(P<0.01),两组间第30天时间相点与第4天时间相点GCS积分差值比较差异有统计学意义(P<0.01)。[结论]早期针刺治疗对高血压脑出血微创术后患者具有较好的促醒作用。     

基质金属蛋白酶-9和S100B蛋白与脑出血

基质金属蛋白酶(MMP)-9与脑出血后脑水肿、炎症反应、细胞凋亡等病理生理学过程密切相关.S100B作为特异性脑源性蛋白,不同的剂量水平可呈现不同的生理或病理学效应,其浓度能反映中枢神经系统损伤程度.文章对MMP-9和S100B在脑出血中的作用机制进行了综述.     

铁超载与脑出血后脑损伤

脑出血(intracerebral hemorrhage,ICH)是一种常见神经系统疾病,其死亡率和致残率均很高,但目前对ICH后脑损伤的机制尚未完全阐明.最新的研究表明,铁超载在ICH后脑损伤中起着重要作用.文章对脑铁分布和功能、ICH后铁超载引起脑损伤的机制以及铁螯合剂应用等方面的研究进展进行了综述.     

手术治疗高血压脑出血短期预后因素分析

【摘要】 目的 探讨影响手术治疗高血压脑出血患者短期预后的相关因素,为指导临床和预后评估提供依据。方法 回顾性分析我院神经外科自2000年1月至2009年12月间收治的76例经手术治疗的高血压脑出血病例。入院时年龄、体重指数、收缩压、血肿体积、入院GCS评分、脑室是否有积血、是否出现肺部感染等资料为自变量,发病后3个月功能性评定(FIM)评分为因变量;利用t检验、方差分析以及线性相关分析,建立多重线性回归模型,筛选有意义的影响因素并确定其影响力。结果 体重指数、血肿体积、入院GCS评分、入院时收缩压水平、是否肺部感染等因素均与手术治疗高血压脑出血的短期预后相关。结论 高血压脑出血与多种因素相关。体重指数、血肿体积、入院GCS评分、入院时收缩压水平、是否肺部感染5因素是高血压脑出血短期预后的关键性预测因素。临床中应加强对这些因素的治疗、控制和预防。     

Factors affecting outcome of intracerebral hemorrhage in patients undergoing chronic hemodialysis

To date, despite a markedly high incidence of intracerebral hemorrhage (ICH) in patients with end-stage renal disease, only few studies have focused on factors that affect patient's prognosis. To elucidate these factors, we retrospectively investigated 22 consecutive patients who had chronic renal failure, were maintained by hemodialysis (HD), had suffered from ICH, and were hospitalized and treated in our institute from 2006 to 2008. Hematoma volume, blood pressure on admission, blood pressure 3 days after ICH onset, and neurological deterioration significantly affected patient mortality. Progression of neurological symptoms during HD was observed often in patients with hematoma of more than 60 mL or in patients with pontine hemorrhages. Age, gender, duration of HD, anti-platelet or anticoagulant therapies, or maximal dose of nicardipine did not affect patient's prognosis. Based on this study we conclude that controlling blood pressure on admission and within 3 days after onset of ICH may be the most important factor that would improve patient's prognosis. Further, special care might be required for patients with large hematomas (more than 60 mL) or those with brainstem hemorrhages, because progression of neurological symptoms occurs often in such patients.     

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs

The aim of the study was to identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Patients admitted in our ICU from 2002 to 2010 for spontaneous ICH and placed under mechanical ventilation were retrospectively analyzed. Of the 72 patients, 49% evolved to BD, 39% died after withdrawal of life support, and 12% were discharged alive. The most discriminating characteristics to predict BD were included in two models; Model 1 contained ≥3 abolished brainstem responses [adjusted odds ratios (OR) = 8.4 (2.4, 29.1)] and the swirl sign on the baseline CT‐scan [adjusted OR = 5.0 (1.6, 15.9)] and Model 2 addressed the abolition of corneal reflexes [unilateral/bilateral: adjusted OR = 4.2 (0.9, 20.1)/8.8 (2.4, 32.3)] and the swirl sign on the baseline CT‐scan [adjusted OR = 6.2 (1.9, 20.0)]. Two scores predicting BD were created (sensitivity: 0.89 and 0.88, specificity: 0.68 and 0.65). Risk of evolution toward BD was classified as low (corneal reflexes present and no swirl sign), high (≥1 corneal reflexes abolished and swirl sign), and intermediate. Simple signs at ICU admission can predict BD in comatose patients with ICH and could increase the potential for organ donation.