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1.
Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0years vs 66.5 years, P＜0.05). There was a significantly higher number ofhematomas≥30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH.Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH. 相似文献
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Yun-zhen Hu Jian-wen Wang Ben-yan Luo 《Journal of Zhejiang University. Science. B》2013,14(6):496-504
Ethnicity and socioeconomic factors can influence disease susceptibility, clinical presentation, and outcome. We investigated the clinical characteristics (age, sex, seasonal variation, lesion site, symptoms, complications, prognosis, and sequelae) and risk factors for intracerebral hemorrhage (ICH) in 266 cases treated at our hospital in Hangzhou City, China, from January 2011 to December 2011. Risk of ICH increased dramatically with age; only 4.3% of cases were <30 years old, while 44.4% were >60 years of age. Men outnumbered women by 2:1 (67.3% vs. 32.7%). Single hemorrhage was most often located in the cerebral lobes (37.2% of cases), basal ganglia (34.2%), thalamus (8.3%), cerebellum (6.8%), ventricle (1.5%), and brainstem (1.1%), while 10.9% of cases exhibited hemorrhages at multiple sites. Hypertension was also a major risk factor for ICH, as 47% of all patients were hypertensive and the percentage increased with age. In hypertensive patients, the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia. In patients with leukemia (all forms), most hemorrhages were lobar. Warfarin- and encephalic operation-associated ICHs were all lobar. Headache was the major symptom of occipital, temporal, and frontal lobe hemorrhage. Dizziness, nausea, and vomiting were the major symptoms of cerebellum hemorrhage. Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage. Disturbed level of consciousness was the major symptom in multisite, ventricular, parietal lobe, and brainstem hemorrhage. Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage. Hospital mortality was 24.4% (n=65) with a mean delay from presentation to death of (10.5±18.5) d. The majority of fatalities were cerebral hernia cases (58.5%) and these patients also had the shortest time to death [(2.9±3.5) d]. Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct. Thrombopenia-associated ICH also had a high mortality rate (81.0%), while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis (46.2% recovery). 相似文献
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[目的]探讨大鼠脑出血双侧纹状体区细胞凋亡的时程变化规律和早期立体定向血肿抽吸术干预治疗对细胞凋亡的影响.[方法]雄性Sprague-Dawley(SD)大鼠80只,随机分成正常对照组,假手术组,脑出血自然恢复组,6 h血肿抽吸组,12 h血肿抽吸组以及24 h血肿抽吸组.采用立体定向注入Ⅶ型胶原酶建立脑出血模型.采用原位末端标记法检测出血周边组织细胞的凋亡.[结果]①大鼠脑出血周边组织12 h出现凋亡细胞,3d凋亡细胞达峰值,11 d仍有凋亡细胞表达.②血肿抽吸术干预后出血周边组织凋亡细胞数与脑出血组对应时间点比较显著下降(P<0.05).③6 h血肿抽吸组与24 h血肿抽吸组比较细胞凋亡数明显低于24 h血肿抽吸组,差异有显著性(P<0.05).[结论]立体定向血肿抽吸术干预治疗大鼠脑出血可明显影响细胞凋亡的表达,脑出血各种临床治疗的“时间窗”应为出血后12 h之内.早期(6 h)立体定向血肿抽吸术治疗可以显著减少脑出血后细胞凋亡. 相似文献
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Background
Antithrombotic therapy using new oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH), we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs.Methods
We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents (and doses) were treated as separate nodes. Odds ratios (ORs) and 95% confidence intervals (CIs) were modeled using Markov chain Monte Carlo methods.Results
Indirect comparisons with the Bayesian model confirmed that aspirin+clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo (OR 0.33, 95% CI 0.01–0.92). Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg (OR 3.42, 95% CI 1.22–7.24) and dabigatran 110 mg (OR 3.56, 95% CI 1.10–8.45). We further ranked the NOACs for the lowest risk of GIB (apixaban 5 mg) and ICH (apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg).Conclusion
Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.5.
脑血管痉挛（cerebral vasospasm,CVS）是指颅内动脉的一支或多支发生部分或完全性的狭窄,是蛛网膜下腔出血（subarachnoid hemorrhage,SAH）最常见的并发症。在SAH病人中30％-70％可出现脑血管痉挛,严重的脑血管痉挛可造成脑缺血和脑损害,是增加病人死亡和致残最重要的原因。近年来随着分子生物学技术的发展,国内外对SAH导致CVS的机制研究有了一些较新的认识,治疗方法也有了新的进展。 相似文献
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目的:探讨慢性肺心病继发消化道出血防治。方法:回顾分析24例慢性肺心病继发消化道出血的表现。结果:慢性肺心病继发消化道出血死亡率很高,本文通过对24例患者的观察,死亡率为72.5％,其中因窒息死亡率为53.33％。结论:慢性肺心病继发消化道出血患者早期预防和治疗是减少死亡率的关键。 相似文献
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目的:探索新生儿惊厥的病因,临床特点和治疗方法.方法:对我院最近6年96例住院新生儿惊厥患者的临床资料,治疗措施的有效性进行分析总结.结果:新生儿惊厥病因最多见的是新生儿缺氧缺血性脑病45例(46.87%),其次是颅内出血18例(18.75%),低钙惊厥12例(12.5%),此三种病因占全部病例的78%以上.结论:减少新生儿惊厥发生的关键是做好围产期保健,提高治愈率的方法是快速止惊,纠正缺氧,尽早病因治疗. 相似文献
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目的:探讨腰池放液治疗蛛网膜下腔出血的疗效。方法:将蛛网膜下腔出血患者随机分为两组,分别采用腰大池穿刺放液配合小剂量甘露醇降颅压方法(简称腰穿组)和大剂量甘露醇降颅压方法(简称对照组)治疗,观察颅内压变化及病程。结果:腰穿组降颅压效果显著优于对照组;病程也较对照组明显缩短。结论:腰池穿刺放液配合小剂量甘露醇降颅压方法治疗蛛网膜下腔出血疗效显著,值得临床推广。 相似文献
10.
目的:探讨零缺陷护理模式对脑出血患者术后神经康复效果与生活质量的影响。方法:纳入赣州市人民医院2016年3月至2018年1月收治的、行手术治疗的100例脑出血患者作为研究对象,随机分为观察组(n=50)和对照组(n=50)。对照组采用心理疏导、健康宣教、切口护理、饮食指导等常规护理,观察组在对照组的基础上采用零缺陷护理模式。两组均干预1个月,收集并分析两组患者神经功能评分(NIHSS)、生活自理能力评分(FIM)及生活质量变化情况。结果:观察组干预后NIHSS评分低于对照组,差异具有统计学意义(P<0.05);观察组干预后FIM评分高于对照组,差异具有统计学意义(P<0.05);观察组一般健康状况、生活能力、生理职能、情感职能、躯体疼痛、生理机能、精神健康、社会功能评分均高于对照组,差异具有统计学意义(P<0.05)。结论:零缺陷护理模式能提高脑出血患者患者神经功能修复,提高患者日常生活活动能力,提高患者临床预后效果。 相似文献
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研究大鼠脑出血给予三七总皂甙治疗后,神经元Bcl-2和Bax的表达有无变化,并观察脑出血大鼠在不同时间点相干/湿重法测定脑含水量的变化.神经行为学检测结果表明,脑出血组大鼠的神经功能评分分值升高;2d后治疗组大鼠与脑出血组相比分值下降（P＜0.01）.免疫组织化学结果显示,治疗组Bcl-2的阳性表达较脑出血组高（P＜0.01）、Bax的阳性表达较脑出血组低（P＜0.01）,Bcl-2/Bax蛋白比值增高;脑含水量即12 h开始增加,24 h后比较明显,48 h达高峰,7d之后与正常组无明显差异.三七总皂甙治疗组48 h ～72h干预后,脑含水量明显低于其脑出血组（P＜0.05）. 相似文献
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目的:探讨造成剖宫产术后晚期产后出血原因及预防方法.方法:通过收集近5年来在我院产科发生及由下级医院转来的剖宫产术后晚期产后出血22例临床病历进行回顾性综合分析.结果:因剖宫产术后子宫切口坏死、感染、部分裂开20例,合并胎盘胎膜残留1例,合并产后子宫收缩乏力1例,其中15例切口裂开位于子宫切口角部,5例位于子宫切口中央,13例行全子宫切除术,4例行子宫次全切除术,保守治疗5例.22例患者均治愈.结论:对于剖宫产术后晚期出血,重在预防,应防治结合. 相似文献
13.
本文回顾性研究和分析1991年1月至1997年5月经CT平扫证实的42例无偏瘫型脑出血患者．其结果表示：在42例病例中,对例（78.6％）大于60岁活动中起病35例（83.3％）．临床表现多种多样．38例入院时神志清醒,入院前与入院后CT平扫发现出血位于脑的不同部位,且量较少,约0．5～60ml（平均79±11.5ml,出血破入脑室10例（23.8％）本文显示：无偏瘫型脑出血临床症状多种多样,典型的症状不是很明显,所以给诊断带来困难．放对此类病人应尽早行头CT平扫,同时应详细采集病史和进行神经系统查体,以助确诊和避免误诊． 相似文献
14.
观察血清基质金属蛋白酶-9（MMP-9）及血管内皮生长因子（VEGF）在实验性新西兰白兔蛛网膜下腔出血后的浓度变化,探讨它们与脑血管痉挛发生、发展及转归过程的关系,为临床诊断及治疗提供理论依据。实验结果表明血清MMP-9及VEGF的浓度变化可以作为预测蛛网膜下腔出血后脑血管痉挛的发作、判断其发展及预后的参考指标之一,为临床诊断与治疗提供依据。MMP-9及VEGF参与了蛛网膜下腔出血后的病理生理过程,与迟发性脑血管痉挛的发病机制有密切关系。 相似文献
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采用人工智能领域的层次任务网络(HTN)规划方法及相关的简单层次序列规划器2(SHOP2)构建一个动态教学规划系统(DTPS)。介绍了动态教学规划系统所必须要实现的功能,HTN规划及SHOP2的相关知识,及DTPS的系统特点。并介绍了如何设计一个用于描述教学活动的HTN规划的领域表示,以及DTPS系统的整体架构。最后用DTPS实现的规划实例,进一步阐述该技术在教学规划领域内的应用前景。 相似文献
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探讨传统中药蜕皮甾酮对大鼠实验性蛛网膜下腔出血后早期脑血管痉挛的干预效应。90只SD大鼠随机分为假手术组、SAH组、EDS干预组,观察各实验组大鼠24h死亡率和神经功能缺损、局部脑血流量及形态学变化。结果表明,与假手术组比较,SAH组大鼠有明显的神经功能缺损,局部脑血流量下降,基底动脉管腔缩小,内膜皱缩呈波纹状等形态学异常、EDS干预后神经功能缺损好转,局部脑血流量在EDS干预后12h增加,形态学也有不同程度改善。蜕皮甾酮能改善大鼠实验性蛛网膜下腔出血后早期脑血管痉挛。 相似文献
17.
Geng QIAN Hong-bin LIU Jin-wen WANG Chen WU Yun-dai CHEN 《Journal of Zhejiang University. Science. B》2013,14(8):736-742
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage. 相似文献
18.
目的：探讨护理措施及康复指导对高血压性脑出血患者治疗效果的作用。方法：随机抽取我院自2011年1月至2013年12月62例住院治疗的高血压性脑出血患者,作回顾性分析,总结护理经验及康复指导措施,为救治今后接诊的高血压性脑出血患者提供参考依据。结果：通过采取常规的护理措施及预防并发症的护理措施后,62例高血压性脑出血患者中基本痊愈36例、部分恢复22例、死亡4例。结论：对高血压性脑出血患者在临床治疗期间进行有效的护理措施及康复指导,可提高治愈率,有效降低死亡率及致残率,提高患者的生活质量。 相似文献
19.
Li Shen Liu-guang Song Hong Ma Chun-na Jin Jian-an Wang Mei-xiang Xiang 《Journal of Zhejiang University. Science. B》2012,13(8):652-662
Objective: To determine the association between tea consumption and the risk of stroke. Methods: We searched the PubMed database from January 1966 to March 2012 and reviewed reference lists of retrieved articles to identify relevant studies. Studies were included if they reported relative risks (RRs) and corresponding 95% confidence intervals (CIs) of stroke with respect to three or more categories of tea consumption. A random-effects model was used to combine the study-specific risk estimates. Results: Fourteen studies, consisting of 513 804 participants with a median follow-up of 11.5 years, were included in this meta-analysis. We observed a modest but statistically significant inverse association between tea consumption and risk of stroke. An increase of three cups/d in tea consumption was associated with a 13% decreased risk of stroke (RR 0.87; 95% CI, 0.81–0.94). The decreased risk of stroke with tea consumption was consistent among most subgroups. Based on the three studies that provided results for stroke subtypes, tea consumption was also inversely associated with the risk of ischemic stroke (RR 0.76; 95% CI, 0.69–0.84), but not cerebral hemorrhage (RR 0.96; 95% CI, 0.82–1.11) or subarachnoid hemorrhage (RR 0.81; 95% CI, 0.57–1.16). Conclusions: Tea consumption is associated with a decreased risk of stroke, particularly ischemic stroke. More well-designed, rigorously conducted studies are needed in order to make confident conclusions about the association between tea consumption and stroke subtypes. 相似文献
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目的:分析新生儿缺氧缺血性脑病(HIE)的CT表现.方法:162例HIE患儿均作头颅CT扫描,并在病灶部位测量CT值.结果:162例HIE患儿CT改变主要为脑白质低密度,可合并颅内出血.结论:据新生儿宫内窒息缺氧病史及临床表现,结合头颅CT表现,对本病可做出诊断. 相似文献