The real-time monitoring of cerebral hemorrhage can reduce its disability and fatality rates greatly. On the basis of magnetic induction phase shift, we in this study used filter and amplifier hardware module, NI-PXI data-acquisition system and LabVIEW software to set up an experiment system. We used Band-pass sample method and correlation phase demodulation algorithm in the system. In order to test and evaluate the performance of the system, we carried out saline simulation experiments of brain hemorrhage. We also carried out rabbit cerebral hemorrhage experiments. The results of both saline simulation and animal experiments suggested that our monitoring system had a high phase detection precision, and it needed only about 0.030 4s to finish a single phase shift measurement, and the change of phase shift was directly proportional to the volume of saline or blood. The experimental results were consistent with theory. As a result, this system has the ability of real-time monitoring the progression of cerebral hemorrhage precisely, with many distinguished features, such as low cost, high phase detection precision, high sensitivity of response so that it has showed a good application prospect.
ObjectiveTo analyze the clinical characteristics of cerebral shock after intracerebral emorrhage (ICH) to enhance the understanding of cerebral shock after ICH. MethodsA total of 136 patients with ICH admitted to hospital from February 2010 to December 2011 were enrolled in this study.Barthel index (BI) and NIH Stroke Scale (NIHSS) were finished within 48 hours.All the patients were divided into cerebral shock group and no cerebral shock group.All of the 136 patients were matched to shock group (39 cases) and no shock group (39 cases) by the baseline NIHSS score.After 6 months,we judged the prognosis of stroke patient by mRS and compared the prognosis between the two groups. ResultsIn 136 patients,95 had cerebral shock (69.85%),and 41 didn't.The NIHSS score in the shock group was higher than that in the no shock group,but the BI score was lower in the shock group.Six months later,2 patients died in shock group,in which lost follow up was in 1,good prognosis in 11,and poor prognosis in 25.In no shock group,1 patient died,2 were lost of follow up,and the prognosis was good in 29 and poor in 7.The prognosis in the shock group was poorer than that in the no shock group. ConclusionThere are neurological deficit symptoms and poor self-care ability in ICH patients associated with brain shock.The period of brain shock impact the prognosis of the patients with cerebral hemorrhage;early functional rehabilitation for stroke patients with brain shock is expected to improve the prognosis of patients with cerebral stroke.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
Objective To investigate the clinical characteristics and risk factors of immature hematomas in patients with primary intracerebral hemorrhage. Methods Patients with primary intracerebral hemorrhage who admitted in West China Hospital of Sichuan University between March 2012 and January 2021 were retrospectively analyzed. Brain CT scan was used to evaluate the presence of immature hematomas, as well as hematoma volume and the morphological features such as the number of hematoma projections or satellite foci, and finger-like projections. Imaging markers of cerebral small vessel disease such as lacunes, microbleeds, white matter hyperintensities (WMH), and enlarged perivascular space were evaluated on MRI. Mature hematomas were defined when the hematomas were completely homogeneous, without any irregularity or hypodensity, otherwise the hematomas were regarded as immature. Patients were divided into two groups: mature hematomas and immature hematomas. Multivariate Logistic regression was used to analyze the risk factors of immature hematomas. Results A total of 170 patients were included. Among them, there were 121 males (71.2%). The average age was (60.9±13.3) years old, and 129 cases (75.9%) had immature hematomas. The comparison between the mature hematomas group and the immature hematomas group showed that higher admission National Institutes of Health Stroke Scale score, larger hematoma volume, hematoma volume >30 mL, more hematoma projections or satellite foci, lower incidence of round or oval hematomas, cerebral small vessel disease score, lower WMH burden, and lower burden of cerebral small vessel disease were associated with the occurrence of immature hematomas. The results of multiple logistic regression analysis showed that lower incidence of round or oval hematomas, lower incidence of WMH, and lower periventricular WMH scores were associated with the occurrence of immature hematomas after adjusting for age, gender, hypertension, diabetes, smoking, alcohol consumption, admission National Institutes of Health Stroke Scale score, and hematoma volume. Conclusion Lower incidence of round or oval hematomas and lower periventricular WMH burden are associated with immature hematomas.
Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.
目的 研究高血压脑出血患者开始建立肠内营养的时间，以揭示其建立肠内营养的最佳时机。 方法 选取2010年7月－2011年9月收治的高血压脑出血患者69例，随机将其分为A、B、C组，A组23例在血流动力学稳定后24 h内采取鼻胃管方式开始建立肠内营养；B组23例在24～48 h内开始肠内营养支持；C组23例在48～72 h开始肠内营养支持，并分别于营养支持前1 d及营养支持后的14 d检测三组患者三头肌皮皱厚度、上臂肌围、血清白蛋白、血红蛋白水平等相关营养指标的波动情况；监测第3、14天各组患者腹泻、便秘、应激性溃疡、肺部感染等临床并发症的发生情况。 结果 相关营养指标监测结果研究发现：建立肠内营养支持14 d后，三组患者其三头肌皮皱厚度及上臂肌围在营养支持前后差异无统计学意义（P＞0.05）；A、B组患者其血清白蛋白及血红蛋白水平在营养支持后较前有增高表现，差异有统计学意义（P＜0.05），且B组患者其血清白蛋白及血红蛋白水平增高程度较A组更为显著；C组患者其血清白蛋白水平在营养支持后有增高表现，且差异有统计学意义（P＜0.05），但血红蛋白水平较前比较差异无统计学意义（P＞0.05）。相关临床并发症发生率的研究结果如下：给予肠内营养支持3 d后，A、C组患者分别与其余两组比较发现，其腹泻、胃潴留、应激性溃疡、肺部感染发生率较其余两组比较差异无统计学意义（P＞0.05）；B组患者与其余两组比较，其应激性溃疡发生率较其余两组减低，且差异有统计学意义（P＜0.05）；腹泻、胃潴留、肺部感染较其余两组比较无显著差异；但随着观察时间的不断延长，在肠内营养支持后的14 d，A组患者较其余两组比较，其腹泻、胃潴留、应激性溃疡发生率仍无显著差异，但其肺部感染的发生率较B组增高，而较C组减低，且差异有统计学意义（P＜0.05）；B组患者较其余两组比较，其腹泻、应激性溃疡、肺部感染的发生率较其余两组均减低，且差异有统计学意义（P＜0.05），并且其肺部感染发生率减低程度较A组明显，其胃潴留发生率与其余两组比较时差异无统计学意义（P＞0.05）；C组患者与其余两组比较，其应激性溃疡、肺部感染个例发生率较其余两组增高，但差异无统计学意义（P＞0.05）。 结论 高血压脑出血患者于血流动力学稳定后的24～48 h内给予建立肠内营养支持，可利于患者相关营养指标的恢复，减少相关临床并发症的发生，可能会在一定程度益于患者的预后。
目的 探讨脑出血患者病死率与发病早期不同血压水平的关系。 方法 选择2006年2月－2012年6月在我院住院、符合入选标准及排除标准的患者120例, 经头颅CT证实为基底节区脑出血，血肿体积20～40 mL，收缩压＜200 mm Hg（1 mm Hg=0.133 kPa），舒张压＜110 mm Hg。 按照中国高血压分级标准（1级高血压：收缩压140～159 mm Hg或舒张压90～99 mm Hg；2级高血压：收缩压160～179 mm Hg或舒张压100～109 mm Hg；3级高血压：收缩压≥180 mm Hg或舒张压≥110 mm Hg）将患者分组，各组采用降颅内压、营养神经、维持水电解质平衡、对症治疗及康复治疗和康复护理等常规治疗，观察2周内各组病死率。 结果 1级高血压组与2级高血压组2周内病死率比较，差异无统计学意义（χ2=0.075，P=0.785）；1级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=5.698，P=0.017）；2级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=4.528，P=0.033）。 结论 对于早期血压较高的脑出血患者，进行积极的降压治疗，将血压控制在2级高血压水平，可以明显降低病死率。
Objective To evaluate the efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage within 72 hours from the onset. Methods A randomized , double -blind, double-dummy, active control clinical study was performed. Patients who met the inclusion criteria were randomized into two groups. The treatment group （18 cases） received sodium citicoline tablets （0.2 g tid） and placebo capsule （0. 2 g tid）, while the control group （18 cases） received sodium citicoline capsule （0.2 g tid） and placebo tablets （0. 2 g tid）. The duration of treatment was 21 days for the two groups. National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI） were used to evaluate the recovery of neurological functions. Results NIHSS and BI scores increased significantly in both groups after treatment （P 〈0. 01 ）. There was no statistical difference of the improvement between the two groups （P 〉0. 05）. No adverse drug reaction or significant change in laboratory norms was found in either group. Conclusions Sodium citicoline tablets is effective and relatively safe in the treatment of acute cerebral hemorrhage. The efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage is similar to that of sodium citicoline capsule.
Cerebral hemorrhage is a serious cerebrovascular disease with high morbidity and high mortality, for which timely diagnosis and treatment are crucial. Electrical impedance tomography (EIT) is a functional imaging technique which is able to detect abnormal changes of electrical property of the brain tissue at the early stage of the disease. However, irregular multi-layer structure and different conductivity properties of each layer affect image reconstruction of the brain EIT, resulting in low reconstruction quality. To solve this problem, an image reconstruction method based on an improved densely-connected fully convolutional neural network is proposed in this paper. On the basis of constructing a three-layer cerebral model that approximates the real structure of the human head, the nonlinear mapping between the boundary voltage and the conductivity change is determined by network training, which avoids the error caused by the traditional sensitivity matrix method used for solving inverse problem. The proposed method is also evaluated under the conditions with or without noise, as well as with brain model change. The numerical simulation and phantom experimental results show that conductivity distribution of cerebral hemorrhage can be accurately reconstructed with the proposed method, providing a reliable basis for the diagnosis and treatment of cerebral hemorrhage. Also, it promotes the application of EIT in the diagnosis of brain diseases.