目的 探讨自发性脑出血（SICH）患者静脉血栓栓塞症（VTE）的独立危险因素,并评估针对性分层预防措施的有效性及安全性, 为临床优化防治策略提供依据。方法 回顾性纳入2022年1月—2025年1月收治的86例SICH患者, 根据下肢深静脉超声结果分为深静脉血栓（DVT）组（n=16）与非DVT组（n=70）。采集患者基线资料、临床特征及实验室指标, 采用单因素及多因素Logistic回归分析VTE危险因素, 并基于独立危险因素制定分层预防方案。结果 多因素分析显示, 体质指数（BMI）升高（OR=1.22, 95%CI：1.06~1.41）、中心静脉置管（OR=5.23, 95%CI：1.37~19.95）、止血药物使用（OR=4.80, 95%CI：1.21~19.01）及NIHSS评分升高（OR=1.20, 95%CI：1.02~1.42）是VTE的独立危险因素（均P<0.05）。因此需针对SICH患者进行针对性干预, 包括基于BMI的个体化干预、中心静脉置管的精细化管控、止血药物的动态调控及神经功能保护与早期康复。结论 SICH患者VTE发生与代谢、医源性及神经功能损伤多因素交互作用密切相关, 应针对患者构建基于BMI、中心静脉管理及凝血监测的分层预防策略。
Objective To explore the independent risk factors for venous thromboembolism（VTE）in patients with spontaneous intracerebral hemorrhage（SICH）and to assess the effectiveness and safety of targeted stratified prophylaxis to provide a basis for optimizing prevention and treatment strategies in the clinic．Methods A retrospective analysis was conducted on 86 SICH patients admitted between January 2022 and January 2025．Based on lower-extremity venous ultrasound findings, patients were divided into a deep venous thrombosis（DVT）group（n=16）and a non-DVT group（n=70）．Baseline characteristics, clinical features, and laboratory indicators were collected．Univariate and multivariate Logistic regression analyses were performed to identify VTE risk factors, and a stratified prevention protocol was developed based on independent risk factors．Results Multivariate analysis revealed that elevated body mass index（BMI）（OR=1.22, 95%CI：1.06-1.41）, central venous catheterization（OR=5.23, 95%CI：1.37-19.95）, hemostatic drug use（OR=4.80, 95%CI：1.21-19.01）, and higher NIHSS scores（OR=1.20, 95%CI：1.02-1.42）were independent risk factors for VTE（all P<0.05）．Consequently, targeted nursing interventions should be implemented for SICH patients, including BMI-based personalized care, refined management of central venous catheters, dynamic regulation of hemostatic drugs, and neuroprotective early rehabilitation．Conclusions VTE in SICH patients is closely associated with the interplay of metabolic, iatrogenic,and neurological injury factors．A stratified prevention strategy incorporating BMI monitoring, central venous catheter management, and coagulation surveillance is critical for reducing thrombotic risk while ensuring safety．
自发性脑出血（SICH）是脑卒中的一种常见形式,其预后通常较差,因此早期评估和调节患者出血后的免疫状态至关重要。免疫检查点是评估T淋巴细胞活跃性和增殖状态的关键指标,监测这些检查点有助于预测脑出血患者的预后。程序性死亡蛋白1（PD-1）和细胞分化抗原28（CD28）作为两个典型的免疫检查点,它们在脑出血预后评估中的应用正逐渐成为研究的热点。该文综述了脑出血后机体免疫状态的变化,以及PD-1和CD28在脑出血后评估和治疗中的研究进展。
Spontaneous intracerebral hemorrhage（SICH）is a common cause of stroke,with specific outcomes often being poor．Therefore,early assessment and modulation of the immune status after hemorrhage are of critical importance．Immune checkpoints serve as key indicators for assessing the activation and proliferation of T cells,and monitoring these checkpoints can help to predict the outcomes of patients with intracerebral hemorrhage．PD-1（programmed death 1）and CD28（Cluster of Differentiation 28）are two representative immune checkpoints,and their use in prognostic assessment after intracerebral hemorrhage is becoming a focus of research．This article reviews the changes in the immune state of the body after intracerebral hemorrhage,as well as the research progress on the use of PD-1 and CD28 in the evaluation and treatment following intracerebral hemorrhage．
目的 分析基底节区脑出血患者接受神经内镜手术治疗的疗效。方法 将2019年6月—2020年8月接诊且行开颅血肿清除术的33例基底节区脑出血患者作为对照组,将同期接诊且行神经内镜手术的33例基底节区脑出血患者作为观察组,对组间美国国立卫生研究院卒中量表(NIHSS)、独立功能量表(FIM)、日常生活能力(ADL)评分、手术情况、血清水通道蛋白4(AQP4)水平、脑水肿体积、并发症情况展开分析。结果 (1)组间NIHSS、FIM、ADL评分在术前无明显差异,P>0.05;术后,观察组NIHSS评分更低,且FIM、ADL评分更高,P<0.05;(2)观察组骨窗大小(2.53±0.66)cm、切口长度(4.22±0.67)cm、术中失血量(47.58±11.25)mL、手术用时(1.58±0.42)h均少于对照组(10.88±1.13)cm、(11.84±2.31)cm、(149.83±33.76)mL、(2.99±0.63)h,且血肿清除率(88.84±9.62)%大于对照组(75.31±7.24)%,P<0.05;(3)观察组术后1周、术后2周、术后1个月时的AQP4水平、脑水肿体积均小于对照组,P<0.05;(4)观察组发生1例并发症(3.03%),对照组发生7例并发症(21.21%),P<0.05。结论 对基底节区脑出血患者进行神经内镜手术治疗,手术创伤小,可以降低AQP4水平,减少脑水肿体积及并发症,提高生活能力,值得推广。
Objective To analyze the curative effect of neuroendoscopic surgery in patients with basal ganglia intracerebral hemorrhage. Methods From June 2019 to August 2020, 33 patients with basal ganglia intracerebral hemorrhage who received craniotomy and hematoma clearance were selected as the control group, and 33 patients with basal ganglia intracerebral hemorrhage who received neuroendoscopic surgery at the same period were selected as the observation group. NIHSS,FIM and ADL scores,details of the surgery, levels of AQP4, brain edema volume and complications were analyzed. Results (1) There were no significant differences in NIHSS, FIM and ADL scores between the two groups before operation, P＞0.05; after operation, NIHSS score of the observation group was lower, and FIM and ADL scores were higher, P＜0.05. (2) Bone window size of the observation group was (2.53±0.66) cm, incision length was (4.22±0.67) cm, intraoperative blood loss was (47.58±11.25) mL, and operation time was (1.58±0.42) h, which were less than those of the control group [(10.88±1.13) cm and (11.84±2.31) cm, (149.83±33.76) mL, (2.99±0.63) h], and the hematoma clearance rate (88.84±9.62)% was higher than that of the control group (75.31±7.24)%, P＜0.05. (3) The AQP4 level and brain edema volume of the observation group 1 week, 2 weeks and 1 month after operation were lower than those of the control group, P＜0.05. (4) There was one complication (3.03%) in the observation group and seven complications (21.21%) in the control group,P<0.05. Conclusion Neuroendoscopic surgery for patients with basal ganglia cerebral hemorrhage can reduce the level of AQP4, the volume of brain edema and complications, and improve the ability of life, which is worthy of promotion.
目的 探讨高血压性脑出血在不同时点给药丹参酮ⅡA磺酸钠的疗效分析及对神经保护作用。方法 选取我院2014年10月—2016年10月期间收治的66例高血压性脑出血患者作为研究对象,按照随机数字表的方法分为观察组(n=33)和对照组(n=33),对照组患者于入院后第10天采用丹参酮ⅡA磺酸钠进行治疗,观察组则于入院后第3天采用丹参酮ⅡA磺酸钠进行治疗,分别对2组患者的临床疗效、不良反应、治疗前后的神经功能以及随访一年的脑卒中影响量表(SIS)进行客观比较。结果 经比较,观察组患者的临床总有效率为90.90%,对照组的临床总有效率为69.70%,2组比较,差异有统计学意义(P<0.05);观察组患者的不良反应稍低于对照组,但2组比较差异无统计学意义(P>0.05);此外,观察组患者治疗后的神经功能评分优于对照组和治疗前,差异有统计学意义(P<0.05);在随访一年的时间里发现,观察组患者的SIS量表亦更优于对照组(P<0.05)。结论 早期采用药丹参酮ⅡA磺酸钠治疗高血压性脑出血的临床疗效显著,不良反应相对较小,且在一定程度上发挥了保护患者神经功能的作用,值得推广。
Objective: To investigate the effect of tanshinone II A sulfonate treatment on hypertensive cerebral hemorrhage at different time and the neuroprotective effect. Methods: In our hospital from October 2014 to October 2016 66 cases of hypertensive cerebral hemorrhage patients were enrolled as the research object, according to the random number table method divided into observation group (n=33) and control group (n=33), patients in the control group on the tenth day after admission of sodium tanshinone A sulfonate treatment, The observation group was treated with tanshinone A sodium sulfonate on the third day after admission. The clinical efficacy, adverse reactions, neurological function before and after treatment, and Stroke Scale (SIS) were compared between the two groups. Results: by comparison, the observation group of patients with clinical total efficiency 90.90%, clinical control group in the total efficiency 69.70%, compared with significant difference (P<0.05); to observe the adverse reaction of patients was slightly lower than that of control group, but the difference between the two groups was not statistically significant (P>0.05); in addition, the patients in the observation group the neurological score was significantly better than the control group and before treatment, the difference was significant (P<0.05); Conclusion: the early treatment of sodium tanshinone II A sulfonate in the treatment of hypertensive intracerebral hemorrhage has a significant clinical effect, a relatively small adverse reaction, and to a certain extent, it plays a protective role in patients with neurological function, and is worthy of promotion.
目的 探讨内科治疗的高血压基底节区出血的疗效及预后相关的因素。方法 回顾性分析2005年4月—2014年12月贵阳市第二人民医院神经外科收治的174例高血压脑出血患者的临床资料,所有患者均采用内科保守治疗,对疗效及影响患者预后的因素进行分析。结果 174例患者中,死亡50例,持续植物生存状态4例,对124例存活患者进行随访,随访时间2~117个月,随访ADL分级Ⅰ级43例,Ⅱ级53例,Ⅲ级21例,Ⅳ级3例,Ⅴ级4例,预后较好者(ADL分级Ⅰ~Ⅱ级)96例,预后不良者(ADL分级Ⅲ~Ⅴ级)28例。χ2检验显示入院 GCS评分和出血量是影响患者预后的因素。结论 影响高血压基底节区脑出血患者的预后因素较多,GCS评分较高、出血量少的患者可采用内科治疗,多数患者预后较好。
Objective To investigate treatment efficacy and the factors influencing prognosis of conservative treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was conducted on the clinical data of 174 patients with hypertensive intracerebral hemorrhage in basal ganglia who were admitted to our hospital during the period from April 2005 to December 2014. All the patients were given internal medicine conservative treatment and followed up to observe the clinical curative effect to analyze the prognosis. Results Of the 174 patients, 50 patients died and 4 patients were persistent vegetative state. 124 patients were followed up for 2-117 months and they were classified according to ability of daily life(ADL) prognosis scale: 43 cases were in I grade, 53 cases in II grade, 21 cases in III grade, 3 cases in IV grade, 4 cases in V grade. 96 cases achieved favourable outcomes and 28 cases got poor outcomes.The results of Chi square test revealed that GCS scale and intracerebral hemorrhage volume were the factors influencing prognostic of hypertensive intracerebral hemorrhage in basal ganglia. Conclusion There were many prognosis factors related with hypertensive intracerebral hemorrhage. The curative effect and prognosis in patients with conservative treatment is obvious in these patients with high GCS scale and less intracerebral hemorrhage volume.
自发性脑出血（SICH）是脑卒中的一种常见形式，其预后通常较差，因此早期评估和调节患者出血后的免疫状态至关重要。免疫检查点是评估T淋巴细胞活跃性和增殖状态的关键指标，监测这些检查点有助于预测脑出血患者的预后。程序性死亡蛋白1（PD-1）和细胞分化抗原28（CD28）作为两个典型的免疫检查点，它们在脑出血预后评估中的应用正逐渐成为研究的热点。该文综述了脑出血后机体免疫状态的变化，以及PD-1和CD28在脑出血后评估和治疗中的研究进展。
Spontaneous intracerebral hemorrhage（SICH）is a common cause of stroke，with specific outcomes often being poor．Therefore，early assessment and modulation of the immune status after hemorrhage are of critical importance．Immune checkpoints serve as key indicators for assessing the activation and proliferation of T cells，and monitoring these checkpoints can help to predict the outcomes of patients with intracerebral hemorrhage．PD-1（programmed death 1）and CD28（Cluster of Differentiation 28）are two representative immune checkpoints，and their use in prognostic assessment after intracerebral hemorrhage is becoming a focus of research．This article reviews the changes in the immune state of the body after intracerebral hemorrhage，as well as the research progress on the use of PD-1 and CD28 in the evaluation and treatment following intracerebral hemorrhage．
