Document Type : Research articles

Authors

1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China

2 Department of Obstetrics, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an, Shaanxi710054

Abstract

Background: Cerebral hemorrhage refers to a hemorrhagic disease caused by primary non-traumatic rupture of blood vessels in the brain parenchyma. It is a common acute cerebrovascular disease in the elderly.Objectives: To observe the effect of perioperative nursing on minimally invasive intracranial hematoma removal surgery in patients with cerebral hemorrhage.Methods: This randomized controlled trial study was conducted on 106 patients undergoing treatment for minimally invasive internal hematoma (MIRIH) at the First Hospital of Jilin University, Jilin, China, between January and December 2022. These patients were randomly divided into two groups, namely the control and observation groups (n=53 each). The observation group received perioperative care in addition to routine care. Differences between groups were compared using t-tests and Chi-square tests.Results: On the first day, there were no significant differences in the baseline characteristics between the groups. However, on the 7th and 14th days of admission, the observation group showed an increase in potassium ions and a decrease in chloride ions, lactate dehydrogenase, trace microalbumin, and the National Institutes of Health Stroke Scale (NIHSS) scores, compared to the control group (P<0.05). The observation group also had a lower incidence of postoperative complications, including pneumonia, lower limb vein thrombosis, and cerebral hernia, compared to the control group (P<0.05). NIHSS scores on days 7 and 14 were significantly lower in the observation group than in the control group (day 7: 9.60±4.11 vs 12.02±2.83, P<0.05; day 14: 6.77±3.47 vs 9.19±2.86, P<0.05).Conclusion: Perioperative nursing leads to improvement in electrolyte/metabolic levels, neurological recovery, and reduction in post-MIRIH surgical complications.

Keywords

  1. Gross BA, Jankowitz BT, Friedlander RM. Cerebral Intraparenchymal Hemorrhage: A Review. JAMA. 2019;321(13):1295-303. doi: 10.1001/jama.2019.2413. [PubMed: 30938800].
  2. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018;392(10154):1257-68. doi: 10.1016/S0140-6736(18)31878-6. [PubMed: 30319113].
  3. Dang L, Dong X, Yang J. Influence of Nanoparticle-Loaded Edaravone on Postoperative Effects in Patients with Cerebral Hemorrhage. J Nanosci Nanotechnol. 2021;21(2):1202-1211. doi: 10.1166/jnn.2021.18668. [PubMed: 33183463].
  4. Lee SH. Symptoms and Signs of Hemorrhagic Stroke. In: Lee S-H, editor. Stroke Revisited: Hemorrhagic Stroke. Springer Singapore. 2018:103-8. doi: 10.1007/978-981-10-1427-7_8.
  5. Chowdhury SS, See AP, Eriksson LP, Boulouis G, Lehman LL, Hararr DB, et al. Closing the Gap in Pediatric Hemorrhagic Stroke: A Systematic Review. Semin Pediatr Neurol. 2022;43:101001. doi: 10.1016/j.spen.2022.101001. [PubMed: 36344021].
  6. Etminan N, Macdonald RL. Chapter 9 - Neurovascular disease, diagnosis, and therapy: Subarachnoid hemorrhage and cerebral vasospasm. In: Hetts SW, Cooke DL, editors. Handb Clin Neurol. 2021;176:135-169. doi: 10.1016/B978-0-444-64034-5.00009-2. [PubMed: 33272393].
  7. Tao J, Qi S, Wang Z, Dong S. Mitochondrial Omi/HtrA2 signaling pathway is involved in neuronal apoptosis in patients with cerebral hemorrhage. Am J Transl Res. 2023;15(6):4033-4044. [PubMed: 37434840].
  8. Wang CJ, Gu HQ, Zhang XM, Jiang Y, Li H, Bettger JP, et al. Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke Vasc Neurol. 2023;8(1):34-50. doi:
  9. 1136/svn-2022-001552. [PubMed: 35985768].
  10. Unnithan AKA, J MD, Mehta P. Hemorrhagic Stroke. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK559173.
  11. Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, et al. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circ Res. 2022;130(8):1204-1229. doi: 10.1161/CIRCRESAHA.121.319949. [PubMed: 35420918].
  12. Castello JP, Pasi M, Abramson JR, Rodriguez-Torres A, Marini S, Demel S, et al. Contribution of Racial and Ethnic Differences in Cerebral Small Vessel Disease Subtype and Burden to Risk of Cerebral Hemorrhage Recurrence. Neurology. 2021;96(20):e2469-e80. doi: 10.1212/WNL.0000000000011932. [PubMed: 33883240].
  13. Al Fauzi A, Sensusiati AD. Epidemiology of Intra-Cerebral Hemorrhage in Young Adult Patients. Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga. 2020;11(2):65-8. doi: 10.20473/juxta.V11I22020.65-68.
  14. Yang YC, Liu SH, Hsu YH, Wu YL, Chu PT, Lin PC. Cerebrospinal fluid predictors of shunt-dependent hydrocephalus after hemorrhagic stroke: a systematic review and meta-analysis. Neurosurg Rev. 2022;45(3):1847-1859. doi: 10.1007/s10143-022-01731-5. [PubMed: 35015193].
  15. Zeiler FA, Thelin EP, Czosnyka M, Hutchinson PJ, Menon DK, Helmy A. Cerebrospinal Fluid and Microdialysis Cytokines in Aneurysmal Subarachnoid Hemorrhage: A Scoping Systematic Review. Front Neurol. 2017;8:379. doi: 10.3389/fneur.2017.00379. [PubMed: 28848487].
  16. Schwarz G, Banerjee G, Hostettler IC, Ambler G, Seiffge DJ, Ozkan H, et al. MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage. Int J Stroke. 2023;18(1):85-94. doi: 10.1177/17474930211062478. [PubMed: 34994246].
  17. Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician. 2015;91(8):528-36. [PubMed: 25884860].
  18. Zheng Z, Wang Q, Sun S, Luo J. Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage. Front Neurol. 2022;13:755501. doi: 10.3389/fneur.2022.755501. [PubMed: 35273553].
  19. Steiger HJ, Beez T, Beseoglu K, Hänggi D, Kamp MA. Perioperative Measures to Improve Outcome After Subarachnoid Hemorrhage-Revisiting the Concept of Secondary Brain Injury. In: Fandino J, Marbacher S, Fathi A-R, Muroi C, Keller E, editors. Neurovascular Events After Subarachnoid Hemorrhage: Towards Experimental and Clinical Standardisation. Springer International Publishing. 2015:211-6. doi:10.1007/978-3-319-04981-6_36.
  20. Hsieh PC, Awad IA, Getch CC, Bendok BR, Rosenblatt SS, Batjer HH. Current Updates in Perioperative Management of Intracerebral Hemorrhage. Neurol Clin. 2006;24(4):745-64. doi: 10.1016/j.ncl.2006.05.005. [PubMed: 16935200].
  21. Sondag L, Schreuder FHBM, Pegge SAH, Coutinho JM, Dippel DWJ, Janssen PM, et al. Safety and technical efficacy of early minimally invasive endoscopy-guided surgery for intracerebral haemorrhage: the Dutch Intracerebral haemorrhage Surgery Trial pilot study. Acta Neurochir. 2023;165(6):1585-1596. doi: 10.1007/s00701-023-05599-2. [PubMed: 37103585].
  22. Song A, Yang H, Wu G, Ren S, Wang L, Qin G, et al. Study of Intracranial Hematoma Removal and High Intracranial Pressure Reduction Using a Novel Three-Needle Brain Puncture Technique. Int J Gen Med. 2022;15:8797-8805. doi: 10.2147/IJGM.S392149. [PubMed: 36605333].
  23. Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, et al. Cerebral hemorrhage: pathophysiology, treatment, and future directions. Circ Res. 2022;130(8):1204-1229. doi: 10.1161/CIRCRESAHA.121.319949. [PubMed: 35420918].
  24. Rajashekar D, Liang JW. Intracerebral Hemorrhage. StatPearls.
  25. https://www.ncbi.nlm.nih.gov/books/NBK553103.
  26. Tenny S, Thorell W. Intracranial Hemorrhage. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK470242/.
  27. Runde D. Calculated decisions: NIH Stroke Scale/Score (NIHSS). Emergency medicine practice. 2021;23(7):Cd6-7. [PubMed: 33112580].
  28. Duan T, Li L, Yu Y, Li T, Han R, Sun X, et al. Traditional Chinese medicine use in the pathophysiological processes of intracerebral hemorrhage and comparison with conventional therapy. Pharmacol Res. 2022;179:106200. doi: 10.1016/j.phrs.2022.106200. [PubMed: 35367344].
  29. Wu J, Zhang S. Analysis of the Therapeutic Effect and Prognostic Factors of 126 Patients With Hypertensive Cerebral Hemorrhage Treated by Soft-Channel Minimally Invasive Puncture and Drainage. Front Surg. 2022;9:885580. doi: 10.3389/fsurg.2022.885580. [PubMed: 35574537].
  30. Xu X, Zheng Y, Chen X, Li F, Zhang H, Ge X. Comparison of endoscopic evacuation, stereotactic aspiration and craniotomy for the treatment of supratentorial hypertensive intracerebral haemorrhage: study protocol for a randomised controlled trial. Trials. 2017;18(1):296. doi: 10.1186/s13063-017-2041-1. [PubMed: 28659171].
  31. Song D, Ji Y-B, Huang X-W, Ma Y-Z, Fang C, Qiu L-H, et al. Lithium attenuates blood–brain barrier damage and brain edema following intracerebral hemorrhage via an endothelial Wnt/β-catenin signaling-dependent mechanism in mice. CNS Neurosci Ther. 2022;28(6):862-872. doi: 10.1111/cns.13832. [PubMed: 35343071].
  32. Gao X, Zhang H, Peng Z, Zhuang Z, Li W. Elevated Level of Cerebrospinal Fluid Pyruvate Dehydrogenase Kinase 4 Is a Predictive Biomarker of Clinical Outcome after Subarachnoid Hemorrhage. Brain Sci. 2022;12(11):1507. doi: 10.3390/brainsci12111507. [PubMed: 36358433].
  33. Jin XX, Fang MD, Hu LL, Yuan Y, Xu JF, Lu GG, et al. Elevated lactate dehydrogenase predicts poor prognosis of acute ischemic stroke. PLoS One. 2022;17(10):e0275651. doi: 10.1371/journal.pone.0275651. [PubMed: 36206280].
  34. Gwak DS, Chung I, Kim BK, Lee S, Jeong HG, Kim YS, et al. High Chloride Burden and Clinical Outcomes in Critically Ill Patients With Large Hemispheric Infarction. Front Neurol. 2021;12:604686. doi: 10.3389/fneur.2021.604686. [PubMed: 34093385].
  35. Udensi UK, Tchounwou PB. Potassium Homeostasis, Oxidative Stress, and Human Disease. Int J Clin Exp Physiol. 2017;4(3):111-122. doi: 10.4103/ijcep.ijcep_43_17. [PubMed: 29218312].
  36. Pohl HR, Wheeler JS, Murray HE. Sodium and Potassium in Health and Disease. In: Sigel A, Sigel H, Sigel RKO, editors. Interrelations between Essential Metal Ions and Human Diseases. Met Ions Life Sci. 2013;13:29-47. doi: 10.1007/978-94-007-7500-8_2. [PubMed: 24470088].
  37. Kasar KA, Al-Bahrani MH, Mohsin AA. Interpreting Myocardial Enzymatic Biomarkers in the Setting of Acute Myocardial Infraction AMI. Journal of Techniques. 2022;4(4):105-10. doi:10.51173/jt.v4i4.782.
  38. Shin JH, Lee J, Jung YK, Kim KS, Jeong J, Choi D. Therapeutic applications of gene editing in chronic liver diseases: an update. BMB Rep. 2022;55(6):251-258. doi: 10.5483/BMBRep.2022.55.6.033. [PubMed: 35651324].
  39. Zheng G, Cai X, Zhu R, Yang L, Liu T. Effect of holistic rehabilitation nursing on postoperative neurological function recovery and limb function improvement in patients with intraintracerebral hemorrhage. Am J Transl Res. 2021;13(6):7256-7262. [PubMed: 34306490].
  40. Musa MJ, Carpenter AB, Kellner C, Sigounas D, Godage I, Sengupta S, et al. Minimally Invasive Intracerebral Hemorrhage Evacuation: A review. Ann Biomed Eng. 2022;50(4):365-386. doi: 10.1007/s10439-022-02934-z. [PubMed: 35226279].
  41. Wei L, Hong Q, Lin X, Chen Y, Yang F, Li F, et al. Effect of comprehensive high-quality nursing care on postoperative complications, degree of pain, and nursing satisfaction in gallstone patients during perioperative period. Am J Transl Res. 2021;13(4):2678-2685. [PubMed: 34017428].