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L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage

Neural Regeneration Research 2022年第6期17卷 1278-1285页

作者： Teng-Da Qian Xi-Feng Zheng Jing Shi Tao Ma Wei-Yan You Jia-Huan Wu Bao-Sheng Huang Yi Tao Xi Wang Ze-Wu Song Li-Xin Li Department of Neurosurgery Jintan HospitalAffiliated Hospital of Jiangsu Vocational College of MedicineJintanJiangsu ProvinceChina Department of Gastroenterology Jintan HospitalAffiliated Hospital of Jiangsu Vocational College of MedicineJintanJiangsu ProvinceChina Department of Neurosurgery Changzhou First People’s HospitalSuzhou UniversityChangzhouJiangsu ProvinceChina Deparment of Neurobiology Basic Medical CollegeNanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurosurgery Sir Run Run Hospital Affiliated to Nanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurosurgery Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurosurgery First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceChina

There is no effective treatment for hemiplegia after hypertensive intracerebral *** that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve *** models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal *** L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the *** investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral *** a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over *** 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic *** 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve *** addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal *** and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination *** findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal *** from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrh

关键词： central hemiplegia end-to-end anastomosis functional regeneration hypertensive intracerebral hemorrhage L4 nerve root neural regeneration neurotization rat model reinnervation skilled restoration

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Activating Blood Circulation to Remove Stasis Treatment of hypertensive intracerebral hemorrhage:A Multi-Center Prospective Randomized Open-Label Blinded-Endpoint Trial

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Chinese Journal of Integrative Medicine 2016年第5期22卷 328-334页

作者：李净娅院立新张根明周莉高颖李庆彬陈澈 Dongzhimen Hospital Affiliated to Beijing University ofChinese Medicine Beijing 100700China Tongzhou Traditional Chinese Medicine Hospital of Beijing Beijing 101100China

Objective： To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation （TRABC） in treatment of hypertensive intracerebral hemorrhage （HICH）. Methods： This was a multi-center prospective randomized open-label blinded-endpoint （PROBE） trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale （mRS）. Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale （NIHSS） scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. Results： After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups （P〈0.01）. Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group （P=0.038）. Average Barthel scores in the treatment group after treatment was 89.11 ＋ 19.93, and in the control group 82.18 ＋ 24.02 （P=0.003）. NIHSS scores of the two groups after treatment decreased significantly compared with before treatment （P=0.001）. Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment （P〈0.05）. There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. Conclusion： The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

关键词： hypertensive intracerebral hemorrhage activating blood circulation to remove stasis Chinese herbs prospective randomized open-label blinded-endpoint trial

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Changes of vasoactive polypeptides during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage

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Chinese Medical Journal 2007年第23期120卷 2129-2131页

作者： WANG Zhi WANG Xue-feng WANG Chao LUAN Wen-zhong Department of Neurosurgery Fourth Affiliated Hospital of Harbin Medical University Harbin 150001 China Department of Neurosurgery People＇s Hospital Peking University Beiiing 100044 China

Background hypertensive crisis could be found after operation in patients with hypertensive intracerebral hemorrhage （HICH）. The aim of this study was to explore the changes and th; roles of some vasoactive polypeptides during postoperative hypertensive crisis in patients with HICH. Methods A total of 31 patients, who were admitted for craniotomy, were enrolled into this study. After the operation, the patients were divided into three groups. Group I consisted of 9 patients with postoperative hypertensive crisis, and group Ⅱ was composed of 13 patients without postoperative hypertensive crisis. Nine patients, who denied history of hypertension or HICH, were set as group Ⅲ. The levels of some vasoactivators in the three groups were measured before and after the operation. The differences in the results among the groups were analyzed using the ANOVA. The data collected before and after the operation in the group Ⅰ was compared by Wilcoxon test. Results The concentration of endothelin in group Ⅰ was significantly higher than that in group Ⅲ （P〈0.05）. The level of thromboxane A2 and the ratio of thromboxane B2 to 6-keto-PGF1α in group Ⅰ were significantly higher than those in the other two groups （P〈0.05）. In group Ⅰ, the levels of plasma renin activity, angiotensin Ⅱ, aldosterone, catecholamine, and endothelin before the operation were significantly higher than those determined after the operation （P〉0.05）. Conclusions Postoperative hypertensive crisis may be due to the increased thromboxane A2 and relatively inadequate prostacyclin, especially 6-keto-PGF1α. The increased level of endothelin and intraoperative stimulation also play a certain role in the development of postoperative hypertensive crisis.

关键词： hypertensive intracerebral hemorrhage " hypertensive crisis " vasoactive polypeptide

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Progress in Analgesic-Sedative Treatment in Perioperative Period of hypertensive intracerebral hemorrhage

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Surgical Science 2022年第7期13卷 327-334页

作者： Gang Yang Department of Neurosurgery Zhuji Affiliated Hospital of Wenzhou Medical University Shaoxing China

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.

关键词： hypertensive intracerebral hemorrhage Postoperative Period Analgesic-Sedative Treatment

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Changes of TXA_2 and PGI_2 during Postoperative hypertensive Crisis in Patients with hypertensive intracerebral hemorrhage

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2008年第1期28卷 87-89页

作者：王智王超张伟光王来藏雷霆 Department of Neurosurgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Department of Neurosurgery The Fourth Affiliated Hospital of Harbin Medical University

In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups： group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups （P〈0.01）. Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups （P〈0.05）. The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.

关键词： hypertensive intracerebral hemorrhage hypertensive crisis TXA2 PGI2

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Blood Pressure and hypertensive intracerebral hemorrhage A Prospective Clinical Study

Blood Pressure and Hypertensive Intracerebral Hemorrhage A P...

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2011中华医学会神经外科学学术会议

作者： Bal Krishna Shrestha 四川大学华西医院

Objective To identify all the patients with hypertensive intracerebral hemorrhage and study the blood pressure variation after the hemorrhage. Furthermore, study the relationship of blood pressure with outcome, its ma... 详细信息

关键词： Blood pressure Hypertension hypertensive intracerebral hemorrhage

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Computed Tomography Imaging of intracerebral Hematoma Anatomy in hypertensive intracerebral hemorrhage

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Journal of Cerebrovascular Disease 2022年第4期5卷 20-24页

作者： Tian-Xiang Zhan Yu-Xiang Weng Yue-Hui Ma Department of Neurosurgery The First Affiliated HospitalZhejiang UniversitySchool of MedicineHangzhou 310003China

Objective:The image data of intracerebral hematoma in hypertensive intracerebral hemorrhage(HICH)patients were obtained by three-dimensional(3D)spiral computed tomography(CT)scan in this study to provide a basis for clinical minimally invasive surgery and the development and research of related surgical ***:From June 2020 to March 2022,33 patients with supratentorial HICH admitted to the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University,School of Medicine were *** patients underwent 3D spiral CT *** reconstruction(MPR)was used to reconstruct along any plane to obtain coronal,sagittal,cross-sectional,or arbitrary angle reconstructed ***,we observed and measured relevant data indicators on these three planes by measuring ***:All hemorrhage sites of these 33 HICH patients were basal ganglia hemorrhage,including left basal ganglia hemorrhage in 13 cases and right basal ganglia hemorrhage in 20 *** was also found that basal ganglia hematomas were usually elliptical,and the anteroposterior diameter was significantly larger than the transverse diameter,almost twice the size of the transverse diameter[(62±10)mm vs.(35±9)mm,P<0.05].Although the depth of the hematoma on the transfrontal(sagittal)approach was significantly greater than that on the transtemporal(transverse)approach[(100±15)mm vs.(59±14)mm,P<0.05],the angle of the hematoma on the transfrontal approach was significantly smaller than that on the transtemporal approach[(37±11)°vs.(70±17)°,P<0.05],which was conducive to improving the clearance rate of the ***:During neuroendoscopic surgery for HICH patients,different lengths of the tubular port should be selected according to the transfrontal or transtemporal surgical approach to meet the needs of hematoma removal.

关键词： hypertensive intracerebral hemorrhage Basal ganglia hemorrhage intracerebral hematoma Computed tomography Multiplanar reconstruction

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Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage

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World Journal of Emergency Medicine 2014年第3期5卷 203-208页

作者： Feng-ling Chi Tie-cheng Lang Shu-jie Sun Xue-jie Tang Shu-yuan Xu Hong-bo Zheng Hui-song Zhao Department of Neurosurgery Shanghai 7th Hospital Yueyang Hospital Aff iliated to Shanghai University of Traditional Chinese Medicine Emergency Medicine Department Dongfang Hospital of Shanghai Second Hospltal of Dalian Medical University Shanghai Pudong New Area Gongli Hospital First People's Hospital of Qiqihaer City Third Aff iliated Hospital Qiqihar Medical College

BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical ***:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(Phemorrhage.

关键词： hypertensive intracerebral hemorrhage hemorrhage position hemorrhage volume Surgical timing Stereotactic drilling drainage Treatment effect Individualized Polycentric

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Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

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World Journal of Clinical Cases 2021年第28期9卷 8358-8365页

作者： Jian-Hui Wei Ya-Nan Tian Ya-Zhao Zhang Xue-Jing Wang Hong Guo Jian-Hui Mao Department of Neurosurgery Harrison International Peace HospitalHengshui 053000Hebei ProvinceChina Department of Neurology Harrison International Peace HospitalHengshui 053000Hebei ProvinceChina

BACKGROUND hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality *** severely affects the patients’quality of *** To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral *** From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical *** control group used a hard-channel minimally invasive puncture and drainage *** observation group underwent minimally invasive neuroendoscopic *** changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were *** related indicators and prognosis were compared between the two *** The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control *** hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,*** prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hype

关键词： Neuroendoscopic minimally invasive surgery Hard-channel minimally invasive puncture drainage hypertensive intracerebral hemorrhage Prognosis Hematoma clearance

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Tripartite intensive intervention for prevention of rebleeding in elderly patients with hypertensive cerebral hemorrhage

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World Journal of Clinical Cases 2021年第33期9卷 10106-10115页

作者： Cai-Xia Li Li Li Jin-Feng Zhang Qi-Hong Zhang Xiao-Hong Jin Guo-Juan Cai Department of Critical Care Affiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina Department of Emergency Zhuji People’s Hospital of Zhejiang ProvinceZhuji 311800Zhejiang ProvinceChina

BACKGROUND hypertensive cerebral hemorrhage(HICH)is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood *** condition is characterized by high disability and high *** formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and ***,minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial ***,special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma *** The study aim was to determine the value of intensive intervention,including doctors,nurses,and patient families,for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal event METHODS A total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned *** control group was given conventional nursing intervention and the observation group was given tripartite intensive *** length of hospital stay,cost,complication rate,satisfaction rate,and rebleeding rate during hospitalization were *** in cerebral blood flow indicators were recorded in both *** in the National Institutes of Health Stroke Scale(NIHSS)score,quality of life index(QLI)score,and health behavior score were evaluated at the National Institutes of *** Duration of hospitalization was shorter in the in the observation group than in the control group,the hospitalization cost was less than in the control group,and the rate of rebleeding during hospitalization was lower than in the control group(all P<0.05)

关键词： Tripartite intensive intervention by doctors Nurses and patient families hypertensive intracerebral hemorrhage Rebleeding Rehabilitation Nerve function

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