| Background:Stroke is the second highest cause of death in the world after ischemic heart disease,and hemorrhagic stroke bears the highest rate of disability,accounting for 10-15% of all stroke types,according to the 2019 Global burden of Disease study reported by Lancet.Cerebral hemorrhage(also named Intracerebral Hemorrhage,ICH)is the main type of hemorrhagic stroke.In China,the incidence of ICH is as high as 17-51%.In recent years,the incidence of ICH has significantly increased with the rapid development of Chinese society and economy,the change of national diet structure and the sharp increase in the pressure of work and life,which has brought serious economic and mental burden to our society and families.Emerging studies have been performed in the treatment of ICH,but the current methods can not effectively improve the prognosis of neurological function in patients with ICH.Therefore,exploring key factors that determine the prognosis and take targeted measures is a hope to improve the therapeutic efficacy of ICH.First,a retrospective analysis of the clinical data was performed related to 1598 patients with ICH treated in our hospital.The data indicated that the mortality rate from 2010 to 2014 was lower than that from 2000 to 2004,but there was no change in neurological function.The severity of the patient`s condition on admission wasa key factor to determine the prognosis.Hence,objective and real-time evaluation of the condition for ICH patients on admission is the first link to determine the follow-up treatments and their prognosis.At present,the condition of ICH patients is mainly assessed through the observation of medical staff using the existing rating scale for evaluation,which holds varying degrees of subjectivity.Furthermore,the majority of ICH patients are often transported form grass-roots hospitals,where are short of objective examingequipment such as CT and MRI,and even the medical staff might not tell the accurate diagnosis of ICH.These factors seriously affect timely diagnosis of ICH and effective treatment of ICH patients.Herein,exploring appropriate and easy-to-do methods must increase the accurate diagnosis for grass-roots hospitals and might improve the therapeutic efficacy of ICH.Therefore,the bioelectrical impedance technologyis firstly employed to evaluate the effectiveness and accuracyas a supplementarytool in monitoring and diagnosis of ICH in rhesus monkey.Furthermore,the bioelectrical impedance technologyis applied to monitor the edema in ICH patients,who have been diagnosed by CT or MRI,in order to validate the effectiveness and accuracy in differential diagnosis,and severity of ICH,as well as predicting prognosis of ICH.Meanwhile,the aim of the present study is to provide real,objective and effective clinical data for further improving measuring methods and clinical application of this technologyin the future.The detailed contents are as follows:Part ?.Prognostic risk factors in a single center large sample of ICH patients: a retrospective analysisObjectives:The retrospective study analyzed the data of ICH patients admitted in our hospital,and compared them from the aspects of epidemiology and clinical characteristics to find the factors that affect the prognosis of ICH patients in our hospital,and provide the basis and ideas for subsequent clinical research.Methods:Patients with ICH admitted to our hospital from 2000 to 2014 were retrospectively collected.Patients were enrolled according to the inclusion and exclusion criteria.Comprehensive demographic data,disease incidence,previous medical history,personal history,vital signs at admission,imaging data,hospitalization and condition assessment,complications,and follow-up datawere collected.The patients were divided into two groups A and B for epidemiological research according to time period,and divided into good prognosis group(m RS<3)and poor prognosis group(m RS?3).Results:1.There were significant differences in hypertension,smoking history,and drinking history between the two time periods,P <0.05.2.Hypertension,smoking and alcohol consumption were still the main risk factors for ICH.3.The mortality rate of patients treated in our hospital had been significantly changed from 26.9% in 2000-2004 to 18.9% in 2010-2014,P<0.05.4.GCS score,NIHSS score,intracerebral hematoma volume,age,rebleeding,cerebral hernia,upper gastrointestinal bleeding and pneumonia were all risk factors for poor prognosis in patients with ICH.Conclusion:The severity(GCS score,NIHSS score,intracerebral hematoma volume)and complications(rebleeding,cerebral hernia,upper gastrointestinal bleeding and pneumonia)after ICH were all risk factors for poor prognosis in patients with ICH.Hence,exploring the techniques and methods for assessing the severity of ICH patients is an important direction for future ICH research.Part ? .Experimental study of bioelectrical impedance technique in the model of intracerebral hemorrhage in rhesus monkeysObjectives:Our previous study found that the severity of the disease was important risk factor affecting the prognosis of patients with ICH.Therefore,we intend to establish a rhesus monkey intracerebral hemorrhage model to simulate the whole pathophysiological process of clinical intracerebral hemorrhage and hematoma enlargement,and to observe the parameter changes of bioelectrical impedance technique in the process of intracerebral hemorrhage.In order to clarify the application value and significance of this equipment in judging and monitoring the severity of intracerebral hemorrhage.Methods:The rhesus monkey intracerebral hemorrhage model was made by autologous blood injection.Simultaneously,invasive intracranial pressure and bioelectrical impedance were monitored in the model animals,and the changes of the two monitoring values during the ICH modeling were observed.The success of the model was confirmed by MRI.Results:1.A stable rhesus monkey ICH model was established.On the 1st,2nd,3rd and 7th day after operation,the neurological function scores of the animals were 28.67±0.89,27.33 ±1.11,25.33±1.11,23.67±0.89.2.MRI scans showed that slight low signal on T1 and high signal on T2 in the left basal ganglia,the midline shifted slightly to the right,and the left ventricle was obviously compressed,which verified the stability of the model.3.After ICH,the monitoring value of invasive intracranial pressure increased from 9.2±0.5mm Hg to 27.2±1.3mm Hg;disturbance coefficient increased from 102.5±6.0 to 146.5±5.3,and the full-frequency phase slope increased from-0.9558±0.0038 to-0.9445±0.0043.Conclusions:In the model of intracerebral hemorrhage in rhesus monkeys,the change trend of the monitoring index of bioelectrical impedance techniquewas consistent with that of invasive intracranial pressure monitoring index,it indicated that this techniquecan reflect the amount of cerebral hemorrhage and the process of increasing intracerebral hematoma,which has a certain application value in the auxiliary diagnosis of ICH and the judgment of the severity of the disease.Part ? .Application of Bioelectrical impedance technique in differential diagnosis of patients with ICHObjectives:The purpose of this study is to apply the bioelectrical impedance technique to early monitor the condition of patients with cerebral hemorrhage,and to explore the effectiveness and accuracy of this technique in differential diagnosis of patients with cerebral hemorrhage.Methods:Using prospective clinical research design method,162 patients with acute cerebral stroke were enrolled.All patients were monitored by bioelectrical impedance technique and the perturbative index wasmeasured.The gender,age,GCS score,NIHSS score,brain lesion location and other indicators were counted.Finally,the diagnosis was confirmed by CT or MRI.Results:1.The perturbative index of intracerebral hemorrhage group and cerebral infarction group was 80.29±7.80 and 71.64±7.81,respectively(P<0.01).2.The working characteristic curve of subjects indicated that if the perturbative index was more than 78.5,the possibility of intracerebral hemorrhage was higher(sensitivity 52.4%,specificity 88.9%),and the area under the curve was 0.778.The perturbative index measured between 4.5-24 hours was preferred to tell stroke type.Conclusions:The bioelectrical impedance technique is helpful in early differential diagnosis of cerebral hemorrhage.Part ?.The application of bioelectrical Impedance technique in evaluating the condition and predicting the prognosis of ICH patientsObjetives:To explore the value of bioelectrical impedance techniquein evaluating the condition and predicting the prognosis of ICH patients.Methods:Non-invasive monitoring of cerebral edema was prospectively carried out in ICH patients admitted to our hospital from October 2017 to October 2020.The demographic data,medical history and personal history,the vital signs,imaging data,diagnosis and treatment of admission and follow-up data were collected to evaluate the patients.According to the patient's age,sex,hematoma volume and hematoma site,the monitoring group were matched with the control group.And each group was divided into surgical treatment group and conservative treatment group.According to the results of 30-day m RS scores,the patients were divided into two groups: good prognosis group(m RS< 3)and poor prognosis group(m RS?3).The prognostic factors were analyzed.Results:1.In the monitoring group,the postoperative disturbance coefficient of the patients with intracerebral hemorrhage after operation was significantly lower than that of before operation,and the difference was statistically significant.While the disturbance coefficient tended to decrease with the increase of edema area in the acute stage in the patients with conservative treatment.2.The non-invasive intracranial pressure index was positively correlated with the hematoma volume and absolute edema volume of the patients;the non-invasive intracranial pressure index of the dead patients was higher than that of the survival patients;the non-invasive intracranial pressure index of the surgical patients was higher than that of the conservative treatment patients.3.On ROC analysis,the AUC for prediction of surgery by non-invasive intracranial pressure index was 0.78,corresponding to a maximum specificity of 0.70 and sensitivity of0.73 for surgery at a cut-off of 11.55.the AUC for prediction of dead by non-invasive intracranial pressure index was 0.70,corresponding to a maximum specificity of 0.60 and sensitivity of 0.74 for surgery at a cut-off of 13.65.4.The patients in monitoring group had significantly lower mortality rate than that in the control group.The time of discovery of pupil changes in the monitoring group was 2 hours earlier than that in the control group;the time of discovery of hematoma enlargement in the monitoring group was 2 hours earlier than that in the control group;the time of discovery of hydrocephalus discovery was 23 hours earlier than that of the control group;and that of epilepsy was 6 hours earlier than the control group.The detection time of postoperative brain edema in the monitoring group was 2 hours earlier than that in the control group;and the time of postoperative cerebral infarction in the monitoring group was earlier than that in the control group;the detection time of intracranial infection in the monitoring group was 12 hours earlier than that in the control group.But the difference was not statistically significant.Conclusions:For patients with hemorrhagic stroke,bioelectrical impedance technique can be used to evaluate the severity of patients with intracerebral hemorrhage,which help to find the changes of patients' condition in time,judge the timing of operation,predict the prognosis of patients,and it can be used as a new monitoring method. |
PDF Full Text Request