Hypertensive Intracerebral Hemorrhage Research Articles

Neuroendoscopic-assisted versus mini-open craniotomy for hypertensive intracerebral hemorrhage: a retrospective analysis

ObjectiveTo compare outcomes in neuroendoscopic-assisted vs mini-open craniotomy for hypertensive intracerebral hemorrhage (HICH), so as to provide reasonable surgical treatment.MethodsClinical data of 184 patients with HICH in the hospital from January 2019 to May 2021 were analyzed retrospectively. The patients were divided into mini-open craniotomy group and neuroendoscopic-assisted group. The operation time, hematoma clearance rate, intraoperative blood loss, neurological function recovery, and postoperative mortality of the two groups were compared by retrospective analysis.ResultsThe operation time and intraoperative blood loss in the mini-open craniotomy group were more than those in the neuroendoscopic-assisted group, but there was no significant difference between the two groups. There was no significant difference in hematoma clearance rate between the two groups, but for the rugby hematoma, the hematoma clearance rate in the neuroendoscopic-assisted group was higher than in the mini-open craniotomy group, the difference was statistically significant. Within 1 month after the operation, there was no significant difference in mortality between the two groups. 6 months after the operation, there was no significant difference in the recovery of neurological function between the two groups.ConclusionNeuroendoscopic-assisted and mini-open craniotomy for the treatment of HICH has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate. Although the two surgical methods can improve the survival rate of patients, they do not change the prognosis of patients. Therefore, the choice of surgical methods should be adopted based on the patient's clinical manifestations, hematoma volume, hematoma type, and the experience of the surgeon.

Automatic and Efficient Prediction of Hematoma Expansion in Patients with Hypertensive Intracerebral Hemorrhage Using Deep Learning Based on CT Images.

Patients with hypertensive intracerebral hemorrhage (ICH) have a high hematoma expansion (HE) incidence. Noninvasive prediction HE helps doctors take effective measures to prevent accidents. This study retrospectively analyzed 253 cases of hypertensive intraparenchymal hematoma. Baseline non-contrast-enhanced CT scans (NECTs) were collected at admission and compared with subsequent CTs to determine the presence of HE. An end-to-end deep learning method based on CT was proposed to automatically segment the hematoma region, region of interest (ROI) feature extraction, and HE prediction. A variety of algorithms were employed for comparison. U-Net with attention performs best in the task of segmenting hematomas, with the mean Intersection overUnion (mIoU) of 0.9025. ResNet-34 achieves the most robust generalization capability in HE prediction, with an area under the receiver operating characteristic curve (AUC) of 0.9267, an accuracy of 0.8827, and an F1 score of 0.8644. The proposed method is superior to other mainstream models, which will facilitate accurate, efficient, and automated HE prediction.

Risk Assessment of Cnm-Positive Streptococcus mutans in Stroke Survivors (RAMESSES): Protocol for a Multicenter Prospective Cohort Study.

IntroductionThe role of commensal microbiota in systemic diseases, including brain diseases, has attracted increasing attention. Oral infectious diseases, such as dental caries and periodontitis, are also involved in cerebrovascular diseases and cognitive impairment. Cerebral microbleeds (CMBs) and intracerebral hemorrhage due to small vessel disease (SVD), are presumably associated with a high risk of vascular cognitive impairment and stroke. We previously reported that Streptococcus mutans (S. mutans, the main pathogen of dental caries), harboring the cnm gene that encodes the collagen-binding protein Cnm, is associated with the development of hypertensive intracerebral hemorrhage and aggravation of CMBs. We also proposed a mechanism by which the circulating Cnm-expressing S. mutans causes intracerebral hemorrhage or CMBs; it binds to denuded basement membranes mainly composed of collagen IV through damaged tight junctions or it directly invades endothelial cells, resulting in blood-brain barrier injury. In November 2018, we initiated a multicenter, prospective cohort study (RAMESSES: Risk Assessment of Cnm-positive S. mutans in Stroke Survivors; UMIN Clinical Trials Registry: UMIN000045559) to explore the longitudinal association between Cnm-positive S. mutans and CMBs with comprehensive dental findings, which should determine the effect of Cnm-positive S. mutans in the oral cavity on the risk of CMB development and cognitive decline.MethodsFifteen domestic institutes will be enlisted to enroll 230 patients who have at least one CMB in the deep brain area and develop a stroke within the past year. The prevalence of Cnm-positive S. mutans based on oral specimens and dental hygiene will be examined. The primary outcome is the number of newly developed deep CMBs. The secondary outcomes include the new development of lobar, subtentorial, or any type of CMBs; symptomatic intracerebral hemorrhage or ischemic stroke; changes in cognitive function or frailty; major bleeding; all-cause mortality; and antibody titers against periodontal pathogens. The observation period will be 2 years.DiscussionThe 2-year longitudinal prospective cohort study is expected to establish the role of Cnm-positive S. mutans in SVD including CMBs and intracerebral hemorrhage from the perspective of the “brain-oral axis” and provide guidance for novel prophylactic strategies against Cnm-positive S. mutans-induced SVD.

MiR-145-5p targets MMP2 to protect brain injury in hypertensive intracerebral hemorrhage via inactivation of the Wnt/β-catenin signaling pathway.

BackgroundDifferences in microRNA (miRNA) expression after hypertensive intracerebral hemorrhage (HICH) have been reported in human and animal models. miRNA-145 plays an important role in vascular endothelial cells. The purpose of this work was to determine the role of miR-145-5p in HICH and the molecular mechanisms by which it acts.MethodsIn this study, we constructed a model of hemoglobin-induced HICH in rats and used thrombin-treated human brain microvascular endothelial cells (hBMECs) to create a HICH cell model. To determine brain damage, we tested the rats’ neurological performance and measured the cerebral water level of their brain tissue. Cell counting kit 8 (CCK8) was used to determine the viability of cells. Apoptosis was detected using the terminal TdT-mediated dUTP nick end labeling (TUNEL) assay and flow cytometry (FCM). Starbase and TargetScan were used to predict and confirm target genes. Luciferase reporter gene experiments were used to confirm the predictions. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to identify the associated genes and proteins.ResultsWe observed a reduction in miRNA-145-5p expression in both the HICH cell model and the rat model. miRNA-145-5p overexpression increased cell survival and preserved newly created blood vessels and vascular permeability in hBMECs. MiRNA-145-5p has been predicted to target matrix metalloproteinase 2 (MMP2). Additionally, MMP2 was identified as a miR-145-5p target gene and shown to be substantially expressed in the thrombin-treated hBMECs. MMP2 overexpression suppressed miR-145-5p-mediated effects and increased hBMECs’ malfunction. In comparison with controls, the HICH + AAV-miR-145-5p group performed better on behavioral tests and had less brain water. Additionally, miR-145-5p injection increased ZO-1 and occludin expressions, as determined by immunohistochemical staining in the HICH rat model.ConclusionsmiRNA-145-5p protects against brain injury following HICH by targeting MMP2, suggesting a possible therapeutic mechanism for HICH.

Analysis of the Therapeutic Effect and Prognostic Factors of 126 Patients With Hypertensive Cerebral Hemorrhage Treated by Soft-Channel Minimally Invasive Puncture and Drainage.

BackgroundSurgery is the main method for the clinical treatment of hypertensive cerebral hemorrhage. Traditional craniotomy faces the disadvantages of the long operation time, easy to cause secondary injury to patients during the operation, and prone to infection after the operation, which is not conducive to the rehabilitation of patients. At present, it is urgent to find a surgical scheme, which can clear hematoma in time, protect brain tissue, and effectively reduce surgical trauma in the clinic.Materials and MethodsThe case database of our hospital was consulted, and the clinical data of patients with hypertensive intracerebral hemorrhage (HICH) treated with soft channel minimally invasive puncture and drainage from February 2018 to October 2021 were retrospectively analyzed. Patients were evaluated for efficacy, and the changes in serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), homocysteine (Hcy), endothelin (ET), and vasopressin (AVP) levels before surgery, 3 days after surgery, and 7 days after surgery were analyzed. Clinical data were collected and Logistic regression was used to analyze the prognostic factors.ResultsFinally, according to the inclusion and exclusion criteria, 126 patients were selected as the research object. Among them, there were 24 cases (19.05%) of recovery, 47 cases (37.30%) of markedly effective, 34 cases (26.98%) of effective, 11 cases (8.73%) of ineffective, and 10 cases (7.94%) of death. The total effective rate was 83.33%. The hematoma was basically removed in 116 cases (92.06%). The average evacuation time of hematoma was (7.82 ± 1.63) days. Post-operative intracranial infection occurred in 2 cases (1.59%) and post-operative rebleeding occurred in 5 cases (3.97%). The average hospital stay was (34.16 ± 16.59) days. Serum CRP, TNF-α, IL-6, Hcy, ET, and AVP levels of all patients on the third and seventh days after surgery were lower than those before surgery, and those on the seventh day after surgery were lower than those on the third day after surgery (p < 0.05). The differences in pre-operative Glasgow Coma Scale (GCS) score, bleeding volume, ventricular rupture, complicated cerebral hernia, and attack time to surgery between the good prognosis group and the bad prognosis group were statistically significant (p < 0.05). Pre-operative GCS score, bleeding volume, ventricular rupture, complicated cerebral hernia, and onset time to surgery were all independent factors that affect the prognosis of patients (p < 0.05).ConclusionSoft-channel minimally invasive puncture and drainage treatment of HICH has a significant effect, which is conducive to the complete removal of hematoma, reducing hospitalization time, while adjusting the balance and stability of various cytokines, and improving patient prognosis. Pre-operative GCS score, bleeding volume, rupture into the ventricle, complicated cerebral hernia, and time from onset to operation are all independent factors that affect the prognosis of patients.

When less is more: Non-contrast head CT alone to work-up hypertensive intracerebral hemorrhage

Hypertension is a common cause of intracerebral hemorrhage (ICH). The work up typically involves neuroimaging of the brain and blood vessels to determine etiology. However, extensive testing may be unnecessary for presumed hypertensive hemorrhages, and instead prolong hospital stay and increase costs. This study evaluates the predictive utility of hemorrhage location on the non-contrast head CT in determining hypertensive ICH. Patients presenting with non-traumatic ICH between March 2014 and June 2019 were prospectively enrolled. Hemorrhage etiology was determined based on previously defined criteria. Chi square and Student’s t tests were used to determine the association between patient demographics, ICH severity, neuroimaging characteristics, and medical variables, with hypertensive etiology. Multivariable regression models and an ROC analysis determined utility of CT to accurately diagnose hypertensive ICH. Data on 380 patients with ICH were collected; 42% were determined to be hypertensive. Along with deep location on CT, black race, history of hypertension, renal disease, left ventricular hypertrophy, and higher admission blood pressure were significantly associated with hypertensive etiology, while atrial fibrillation and anticoagulation were associated with non-hypertensive etiologies. Deep location alone resulted in an area under the curve of 0.726. When history of hypertension was added, this improved to 0.771. Additional variables did not further improve the model’s predictability. Hypertensive ICH is associated with several predictive factors. Using deep location and history of hypertension alone correctly identifies the majority of hypertensive ICH without additional work-up. This model may result in more efficient diagnostic testing without sacrificing patient care.

Comparison of Clinical Efficacy of Sodium Nitroprusside and Urapidil in the Treatment of Acute Hypertensive Cerebral Hemorrhage.

This paper mainly studies the clinical efficacy of sodium nitroprusside and urapidil in the treatment of acute hypertensive intracerebral hemorrhage and analyzes the brain CT image detection based on a deep learning algorithm. A total of 132 cases of acute hypertension admitted to XXX hospital from XX 2019 to XX 2020 were retrospectively analyzed. The diseases of all patients were clinically confirmed, and patients were divided into groups according to the differences in treatment methods. Urapidil was used for group 1; sodium nitroprusside was used for group 2; and urapidil combined with sodium nitroprusside was used for group 3. A convolutional neural network in deep learning is used to construct intelligent processing to classify brain CT images of patients. The network performance of AlexNet, GoogLeNet, and CNN3 is predicted. The results show that GoogLeNet has the highest prediction accuracy of 0.83, followed by AlexNet with 0.80 and CNN3 with 0.74. The results of the performance parameter curve show that the GoogLeNet has the highest performance parameter of 0.89, followed by AlexNet and CNN3 network. The performance parameter curve of machine learning is above 0.80. After five weeks of drug treatment, the hematoma volume was (3.8 ± 2.6) mL in group1, (7.6 ± 2.8) mL in group 2, and (2.8 ± 1.5) mL in group 3. After 5 days of treatment, the patients' heart rate changed compared with before treatment. Compared with group 2, there were significant differences between groups 1 and 3 (P < 0.01), indicating that the therapeutic effect of the combination group was significantly better than that of the other groups alone. In summary, the combination of sodium nitroprusside and urapidil has a significantly better effect than that of urapidil alone. A convolutional neural network based on deep learning improves the recognition accuracy of medical images.

Effect Analysis of Continuous Nursing on Complications of Patients with Hypertensive Intracerebral Hemorrhage

Effect Analysis of Continuous Nursing on Complications of Patients with Hypertensive Intracerebral Hemorrhage

Evaluation of Intracranial Hypertension in Patients With Hypertensive Intracerebral Hemorrhage Using Texture Analysis.

PurposeTexture analysis based on clinical images had been widely used in neurological diseases. This study aimed to achieve depth information of computed tomography (CT) images by texture analysis and to establish a model for noninvasive evaluation of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH).MethodsForty-seven patients with HICH were selected. Related CT images and ICP value were collected. The morphological features of hematoma volume, midline shift, and ventriculocranial ratio were measured. Forty textural features were extracted from regions of interest. Four models were established to predict intracranial hypertension with morphological features, textural features of anterior horn, textural features of temporal lobe, and textural features of posterior horn.ResultsModel of posterior horn had the highest ability to predict intracranial hypertension (AUC = 0.90, F1 score = 0.72), followed by model of anterior horn (AUC = 0.70, F1 score = 0.53) and model of temporal lobe (AUC = 0.70, F1 score = 0.58), and model of morphological features displayed the worst performance (AUC = 0.42, F1 score = 0.38).ConclusionTexture analysis can realize interpretation of CT images in depth, which has great potential in noninvasive evaluation of intracranial hypertension.

External validation study on the value of deep learning algorithm for the prediction of hematoma expansion from noncontrast CT scans

BackgroundHematoma expansion is an independent predictor of patient outcome and mortality. The early diagnosis of hematoma expansion is crucial for selecting clinical treatment options. This study aims to explore the value of a deep learning algorithm for the prediction of hematoma expansion from non-contrast computed tomography (NCCT) scan through external validation.Methods102 NCCT images of hypertensive intracerebral hemorrhage (HICH) patients diagnosed in our hospital were retrospectively reviewed. The initial computed tomography (CT) scan images were evaluated by a commercial Artificial Intelligence (AI) software using deep learning algorithm and radiologists respectively to predict hematoma expansion and the corresponding sensitivity, specificity and accuracy of the two groups were calculated and compared. Comparisons were also conducted among gold standard hematoma expansion diagnosis time, AI software diagnosis time and doctors’ reading time.ResultsAmong 102 HICH patients, the sensitivity, specificity, and accuracy of hematoma expansion prediction in the AI group were higher than those in the doctor group(80.0% vs 66.7%, 73.6% vs 58.3%, 75.5% vs 60.8%), with statistically significant difference (p < 0.05). The AI diagnosis time (2.8 ± 0.3 s) and the doctors’ diagnosis time (11.7 ± 0.3 s) were both significantly shorter than the gold standard diagnosis time (14.5 ± 8.8 h) (p < 0.05), AI diagnosis time was significantly shorter than that of doctors (p < 0.05).ConclusionsDeep learning algorithm could effectively predict hematoma expansion at an early stage from the initial CT scan images of HICH patients after onset with high sensitivity and specificity and greatly shortened diagnosis time, which provides a new, accurate, easy-to-use and fast method for the early prediction of hematoma expansion.

Results of using the neuroprotective drug Cellex in non-traumatic intracranial hemorrhage

Introduction.In the Russian Federation, neuroprotective agents are widely used in the treatment of patients with ischemic stroke. There are accumulated data on the efficacy and safety of the neuroprotective agent Cellex® in ischemic stroke. The use of this drug in hemorrhagic stroke has been studied to a lesser extent.Aim. To study the efficacy and safety of Cellex® in non-traumatic intracerebral hemorrhage.Materials and methods. The study included 60 patients with hypertensive intracerebral hemorrhage aged 30 to 80 years. Thirty patients (the main group) received Cellex 0.1 mg (1 ml) once a day for 10 days in addition to basic therapy; the remaining 30 patients (control group) received only basic therapy. Over the course of 30 days, the patients were evaluated for various parameters on the Glasgow Coma Scale, stroke severity on the NIHSS scale, patient disability on the Modified Rankin Scale, Barthel Index and Rivermead Mobility Index, speech disorders on the Speech Questionnaire, cognitive function on the Montreal Cognitive Scale (MoCA), and other parameters.Results and discussion. The survival rate was higher in the treatment group than in the control group (p = 0.0237). Speech function improved from 17.0 (14.0–22.0) to 25.0 (21.0–27.0) scores (p = 0.0073) in the Cellex group, no significant improvement in speech function was noted in the control group. There was a trend toward a more significant reduction in stroke severity according to the NIHSS scale and inpatient disability according to the Rankin, Barthel, and Rivermead scales in the Cellex group compared with the control group. Cognitive function on MoCA score improved in Cellex® group from 14.0 (12.0; 22.5) to 20.0 (14.5; 25.0). No adverse events were observed in the group of patients taking Cellex.Conclusion. The efficacy and safety of Cellex® in patients with hypertensive intracerebral hemorrhage has been proven.

Application of Fused Reality Holographic Image and Navigation Technology in the Puncture Treatment of Hypertensive Intracerebral Hemorrhage.

ObjectiveMinimally invasive puncture and drainage (MIPD) of hematomas was the preferred option for appropriate patients with hypertensive intracerebral hemorrhage (HICH). The goal of our research was to introduce the MIPD surgery using mixed reality holographic navigation technology (MRHNT).MethodWe provided the complete workflow for hematoma puncture using MRHNT included three-dimensional model reconstruction by preoperative CT examination, puncture trajectory design, immersive presentation of model, and real environment and hematoma puncture using dual-plane navigation by wearing special equipment. We collected clinical data on eight patients with HICH who underwent MIPD using MRHNT from March 2021 to August 2021, including the hematoma evacuation rate, operation time, deviation in drainage tube target, postoperative complications, and 2-week postoperative GCS.ResultThe workflow for hematoma puncture using MRHNT were performed in all eight cases, in which the average hematoma evacuation rate was 47.36±9.16%, the average operation time was 82.14±15.74 min, and the average deviation of the drainage tube target was 5.76±0.80 mm. There was no delayed bleeding, acute ischemic stroke, intracranial infection, or epilepsy 2 weeks after surgery. The 2-week postoperative GCS was improved compared with the preoperative GCS.ConclusionThe research concluded it was feasible to perform the MIPD by MRHNT on patients with HICH. The risk of general anesthesia and highly professional holographic information processing restricted the promotion of the technology, it was necessary for technical innovation and the accumulation of more case experience and verification of its superiority.

Application and Satisfaction Analysis of High Quality Nursing in Patients with Hypertensive Intracerebral Hemorrhage

Application and Satisfaction Analysis of High Quality Nursing in Patients with Hypertensive Intracerebral Hemorrhage

3D-Slicer Software-Assisted Neuroendoscopic Surgery in the Treatment of Hypertensive Cerebral Hemorrhage.

Objective To explore the 3D-slicer software-assisted endoscopic treatment for patients with hypertensive cerebral hemorrhage. Methods A total of 120 patients with hypertensive cerebral hemorrhage were selected and randomly divided into control group and 3D-slicer group with 60 cases each. Patients in the control group underwent traditional imaging positioning craniotomy, and patients in the 3D-slicer group underwent 3D-slicer followed by precision puncture treatment. In this paper, we evaluate the hematoma clearance rate, nerve function, ability of daily living, complication rate, and prognosis. Results The 3D-slicer group is better than the control group in various indicators. Compared with the control group, the 3D-slicer group has lower complications, slightly higher hematoma clearance rate, and better recovery of nerve function and daily living ability before and after surgery. The incidence of poor prognosis is low. Conclusion The 3D-slicer software-assisted endoscopic treatment for patients with hypertensive intracerebral hemorrhage has a better hematoma clearance effect, which is beneficial to the patient's early recovery and reduces the damage to the brain nerve of the patient.

Abstract 118: Cerebral Venous Reflux And Dilated Basal Ganglia Perivascular Space In Hypertensive Small Vessel Disease

Background: Cerebral venous flow alterations have been considered as a contributor in white matter ischemia and cognitive impairment, but their role in small vessel disease has never been investigated. Method: 297 patients with spontaneous hypertensive intracerebral hemorrhage who underwent brain MRI were included. Presence of cerebral venous reflux (CVR) was defined as abnormal signal intensity in the dural venous sinus (cavernous, inferior petrosal, sigmoid or transverse sinus) or internal jugular vein using MR angiography (Figure). Dilated basal ganglia (BG) perivascular spaces (PVS) was defined as the number of PVS &gt;20 or any PVS with size &gt; 3mm in short axis (L-PVS). The association between CVR and dilated BG-PVS were evaluated in univariate and multivariable models. Stroke recurrence was also analyzed in cox regression model. Results: Compared to patients without CVR, patients with CVR (n=37, 12,5%) had similar demographics, but showed a trend toward more severe SVD markers including microbleeds, white matter hyperintensities and lacunes. In addition, presence of CVR is significantly associated with dilated BG-PVS (BG-PVS &gt; 20, 62.2% vs. 34.6%, P = 0.002; L-PVS, 48.6% vs. 18.8%, P &lt; 0.001). In multivariable model, the presence of CVR remained independently associated with dilated BG-PVS (odds ratio 4.03 [1.68-9.68], p=0.002) after adjustment for age and other SVD markers. In cox model, CVR predicts higher risk of stroke recurrence independent of conventional SVD markers (odds ratio 2.32 [1.00-5.34], P = 0.049). Conclusion: We demonstrated a close relationship between CVR and dilated BG PVS, suggesting the potential role of venous drainage dysfunction in the formation of enlargement of PVS in hypertensive SVD.

Clinical Significance of Multiparameter Intracranial Pressure Monitoring in the Prognosis Prediction of Hypertensive Intracerebral Hemorrhage.

Objective: The present study aimed to investigate the clinical significance of multiparameter intracranial pressure (ICP) monitoring in the prediction of the prognosis of hypertensive intracerebral hemorrhage (HICH). Methods: A retrospective analysis was performed on the clinical data of 53 HICH patients. The patients underwent removal of intracranial hemorrhage and decompressive craniectomy after admission. A ventricular ICP monitoring probe was used to continuously and invasively monitor mean arterial pressure (MAP) and ICP after surgery. The NEUMATIC system was used to collect ICP data, including pressure reactivity index (PRx), ICP dose (DICP), amplitude and pressure regression (RAP), and cerebral perfusion pressure (CPP). The mean PRx, CPP, RAP, ICP, and DICP20 mmHg × h were calculated with 1 h as the time segment. According to the Glasgow outcome scale (GOS) scores after discharge, the patients were grouped into the poor prognosis group (GOS I–III) and the good prognosis group (GOS IV and V). The two groups were compared in terms of GOS scores in the treatment and prediction of prognosis of patients. Results: The good prognosis group showed significantly lower values of mean ICP, DICP20 mmHg × h, RAP, and PRx than the poor prognosis group, while CPP was significantly higher (p < 0.001). Conclusions: PRx, DICP, RAP, and CPP could reflect intracranial changes in patients and were significantly correlated with the prognosis of the patients. Mean ICP, PRx, DICP20 mmHg × h, and RAP were negatively correlated with prognosis, while CPP was positively correlated with prognosis.

Perioperative Nursing of Minimally Invasive Intracranial Hematoma Removal for Hypertensive Intracerebral Hemorrhage

Perioperative Nursing of Minimally Invasive Intracranial Hematoma Removal for Hypertensive Intracerebral Hemorrhage

Progress in Analgesic-Sedative Treatment in Perioperative Period of Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage (HICH) refers to intra cerebral hemorrhage at basal ganglia, thalamus, ventricle, cerebellum and brainstem in patients with history of explicit hypertension disease, excluding secondary cerebral hemorrhage caused by trauma, vascular structural disorders, coagulation disorders, hematologic diseases, systematic diseases and neoplastic diseases. HICH is characteristic of high morbidity, fatality rate, disability rate and recurrence rate. HICH is the most common type of spontaneous cerebral hemorrhage and various surgical interventions are one of the major treatments for HICH. Surgical treatment is to eliminate hematoma, relieve oppression of hematoma on surrounding brain tissues, lower intracranial pressure and alleviate secondary brain tissue damages, thus enabling to decrease fatality rate of patients and improve the long-term quality of life. Patients with HICH often may have different degrees of coma, pains, dysphoria, anxiety and delirium in the postoperative period. After central pivot was damaged, the sympathetic central excitability spreading is strengthened in the state of cortical inhibition, which also might be accompanied by paroxysmal sympathetic hyperexcitation syndrome to strengthen disease conditions of patients and thereby influence subsequent treatment. Several professional guidelines all recommend analgesic-sedative treatment as an important component of ICU therapy. However, it lacks support by large sample sized clinical research results of analgesic-sedative treatment of HICH in the postoperative period. This study analyzed literature concerning analgesic-sedative treatment of HICH in the postoperative period in recent years, aiming to guide specific clinical implementation.

A comparative study on the efficacy of robot of stereotactic assistant and frame-assisted stereotactic drilling, drainage for intracerebral hematoma in patients with hypertensive intracerebral hemorrhage.

Objectives:To compare the clinical efficacy of robot of stereotactic assistant (ROSA) and frame-assisted stereotactic drilling and drainage for intracerebral hematoma in hypertensive intracerebral hemorrhage (HICH).Methods:A total of 142 patients with HICH treated in Baoding First Central Hospital from January 2018 to January 2020 were selected and divided into two groups using a random number table. The ROSA group was treated with a robot of stereotactic assistant, while the frame group underwent frame-assisted stereotactic drilling and drainage for intracerebral hematoma. Surgical duration, postoperative extubation time and complications were compared between the two groups. Venous blood (5 mL) was collected before and three days after surgery. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6)], as well as neurological function indexes [neuron-specific enolase (NSE), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)] were detected by enzyme-linked immunosorbent assay.Results:The surgical duration, postoperative extubation time, and incidences of infection and postoperative rehemorrhage in the ROSA group were lower than those in the frame group (P < 0.05). In the ROSA group, postoperative TNF-α, hs-CRP, IL-6 and NSE levels were significantly lower while NGF and BDNF levels were higher than those in the frame group (all P < 0.05).Conclusion:Compared with frame-assisted stereotactic drilling and drainage for intracerebral hematoma, ROSA in HICH treatment shortens the surgical duration and postoperative extubation time, reduces the risks of infection and rehemorrhage and decreases inflammatory level, which is helpful for the recovery of neurological function.

Comparison of the Effects of Sufentanil/Fentanyl Combined with Propofol on Stress Responses and Hemodynamics in Patients with Hypertensive Intracerebral Hemorrhage

To observe the effects of sufentanil/fentanyl combined with propofol on the stress response and hemodynamics in patients with hypertensive intracerebral hemorrhage. The control group received anesthesia with fentanyl plus propofol, while the observational group received sufentanil plus propofol. The hemodynamic measures, including diastolic blood pressure, systolic blood pressure, heart rate and stress response measures, including plasma angiotensin II, aldosterone and serum norepinephrine, in the two groups 5 min before induction of anesthesia (T0), at endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and at postoperative extubation (T3) were compared, and the anesthesia recovery and adverse reactions in the two groups after surgery were also compared. At T0~T3, the DBP, SBP and HR in the observational group fluctuated less than the control group (p<0.05). At T1, T2 and T3, the plasma angiotensin II, aldosterone and serum norepinephrine in the observational group were lower than those in the control group (p<0.05). There were no significant differences between the groups in the extubation time, awakening time and spontaneous breathing recovery time after surgery (p>0.05). The incidence of adverse reactions in the observational group was 12.24 % (6/49), lower than that in the control group 29.17 % (14/48) (p<0.05). Sufentanil-propofol anesthesia for patients with hypertensive intracerebral hemorrhage can steady intraoperative hemodynamic status, relieve stress responses of the body, reduce the incidence of adverse reactions and does not affect postoperative anesthesia recovery.