The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage

PurposeThe triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy.Materials and methodsAn audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation.ResultsUnderestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24 h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8 l/24 h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation.ConclusionsThis study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.     

天麻钩藤饮加减对妊娠期高血压疾病患者RSS系统的影响

目的观察天麻钩藤饮加减对妊娠期高血压疾病(HDCP)患者RSS系统的影响。方法将160例HDCP患者随机分为治疗组和对照组各80例。对照组给予硫酸镁注射液静脉滴注;治疗组在硫酸镁注射液治疗基础上加用天麻钩藤饮加减治疗。于两组治疗前和治疗72 h后比较血压、24 h尿蛋白定量及血清肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)水平变化。结果两组治疗后收缩压和舒张压与治疗前比较均明显下降,差异均有统计学意义(P0.01)。治疗后,治疗组收缩压和舒张压显著优于对照组,与对照组比较差异具有统计学意义(P0.01)。两组治疗后24 h尿蛋白定量与治疗前比较均明显下降,差异均有统计学意义(P0.01)。治疗后,治疗组24 h尿蛋白定量显著优于对照组(P0.01)。治疗后,治疗组血清肾素活性(PRA)和血管紧张素Ⅱ(AngⅡ)下降明显(P0.01)。结论在硫酸镁解痉药物治疗基础上应用天麻钩藤饮加减治疗HDCP能够显著改善患者血压和24 h尿蛋白定量,其作用可能与降低血清PRA和AngⅡ水平有关。     

心电图与心脏超声诊断高血压性心脏病的效果比较

目的:分析心电图与心脏超声在诊断高血压性心脏病方面的效果差异。方法:选择2018年1月至2018年12月期间我院所收治的70例高血压性心脏病患者,对其心电图和心脏彩超的临床资料进行回顾性分析。分别使用心电图和心脏超声进行诊断,总结分析两者在诊断方面的作用。结果:本次研究结果显示,患者通过心脏彩超进行检查后,其阳性率远远高于用心电图进行检查,同时能够明确高血压性心脏病患者的早期心脏表现与变化情况。结论:心脏彩超在高血压性心脏病的诊断方面更加具备敏感性与特异性,与心电图进行结合使用可以更加直观、稳定地对疾病特征进行明确,为临床工作提供参考。     

Identification of intracerebral hemorrhage in the early-phase of MM1+2C-type sporadic Creutzfeldt–Jakob disease: A case report

We report a case of early-phase sporadic Creutzfeldt–Jakob disease (sCJD) complicated by intracerebral hemorrhage (ICH), classified as MM1 + 2C-type based on autopsy. A 61-year-old Japanese man presented to our hospital with speaking difficulties including repeated usage of the same words. He was hospitalized on the seventh day after symptom onset, and diffusion-weighted images on magnetic resonance imaging showed hyperintense regions in the frontal cortex and caudate nucleus. On the 11th day after symptom onset, head computed tomography revealed ICH in the right occipital and parietal lobes. Routine laboratory evaluations and angiography revealed no cause of ICH. Myoclonus of the extremities and drowsiness were observed on the 15th day after symptom onset. He reached the state of akinetic mutism approximately two months after symptom onset. The cerebrospinal fluid test revealed positive real-time quaking-induced conversion and 14-3-3 protein. Electroencephalography revealed periodic sharp wave complexes. A clinical diagnosis of probable Creutzfeldt–Jakob disease was made according to the diagnostic criteria. After a relapse of pneumonia, he passed away on the 103rd day after symptom onset. Postmortem examination revealed ICH in the right posterior cingulate gyrus. No pathological change that might have caused ICH was obtained. Although the effect of sCJD on the onset of ICH is undeniable, the cause of ICH was unknown. Prion protein immunohistochemistry revealed the following results: (1) weak synaptic-type deposits in the tissue rarefacted by ICH; (2) synaptic-type deposits in the cerebral cortex, which showed fine vacuoles; and (3) perivacuolar-type deposits in the inferior temporal gyrus and lingual gyrus, which showed frequent large confluent vacuoles. Although it could be considered MM1-type sCJD clinically, this case was neuropathologically diagnosed as having MM1 + 2C-type sCJD. It was shown that ICH may occur in early-phase sCJD. To improve sCJD prognosis, treatment of complications and careful follow up are important. Furthermore, pathological diagnosis is indispensable for sCJD type diagnosis.     

血脑屏障通透性与接受溶栓的急性脑梗死患者预后的相关性

目的 探讨血脑屏障通透性与接受溶栓治疗的急性脑梗死患者预后的相关性。方法 纳入绵阳市盐亭县人民医院在2018年5月-2019年5月收治的急性脑梗死且接受溶栓治疗的患者共76例,随访3个月,根据预后情况分为预后良好组和预后不佳组,比较2组患者临床资料、实验室检查指标水平、血脑屏障通透性等。结果 所有研究对象随访3个月后共有8例患者失访,其中mRs评分为良好(0～1分)共32例,为预后良好组,余为预后不佳组(2～6分)共36例; 2组患者性别、BMI、梗死部位、冠心病史、高血压病史、糖尿病史、高脂血症史、脑卒中史、发病时间、吸烟史、饮酒史、家族史、应用药物、基线NIHSS评分、Cr,BUN,HDLc,LDLc,PLT,HGB,APTT,DD、空腹血糖、糖化血红蛋白水平均无明显差异(P>0.05); 预后良好组患者年龄、房颤史的比例、UA水平与预后不佳组比较均有明显差异(P<0.05); 2组患者AUC无明显差异(P>0.05); 预后良好组患者K_trans及V_P与预后不佳组比较均有明显差异(P<0.05); 进行logistics回归分析显示年龄(OR=1.190,P=0.026)、K_trans(OR=1.104,P=0.005)为预后不佳的危险因素,V_P(OR=0.556,P=0.022)为保护因素。结论 血脑屏障通透性为影响接受溶栓治疗的急性脑梗死患者预后的相关因素。     

Robot-assisted neurosurgery versus conventional treatment for intracerebral hemorrhage: A systematic review and meta-analysis

The aim of this review is to determine the efficacy and safety of robotic surgery for intracranial hemorrhage (ICH). PICO question was formulated as: whether robot-assisted neurosurgery is more effective and safer than conventional treatment for ICH with respect to drainage time, complications, operation time, extent of evacuation and neurological function improvement. We searched PubMed, Web of Science, Wiley Online, OVID, Embase, Cochrane Library, Clinical Trails, Current Controlled Trials, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), OpenGrey and references of related papers. Key words included robot, robotic, hematoma, hemorrhage and neurosurgery. Then we used Microsoft Excel to collect data. Except from qualitative analysis, we did meta-analysis using Review Manager 5.3. 9 papers were included in qualitative synthesis, 6 in meta-analysis for rebleeding rate and 4 in analysis for operative and drainage time. Qualitative synthesis showed shorter operative time and drainage time, a larger extent of evacuation, better neurological function improvement and less complications in robotic group, while meta-analysis suggested that robot-assisted surgery reduced rebleeding rate compared to other surgical procedures, but whether it is superior to conservative treatment in preventing rebleeding still needs more proof. Meta-analysis for operative and drainage time should be explained cautiously because a significant heterogeneity existed and we supposed that differences in baseline characteristics might influence the results. Finally, we drew a conclusion that robotic neurosurgery is a safe and effective approach which is better than conventional surgery or conservative treatment with respect to rebleeding rate, intracranial infection rate and neurological function improvement.