Study On The Selection Of Operation Time Window For Minimally Invasive Surgery For Intracerebral Hemorrhage

BackgroudIntracerebral hemorrhage(ICH)is one of the most common cause of stroke with high rates of mortality and morbidity.After ICH,hematoma will compress brain tissue and lead to mechanical damage and secondary damage,including damage of nerve function,damage of blood-brain barrier and apoptosis of nerve cells.Minimally invasive treatment of cerebral hemorrhage is safe and effective.It can quickly relieve the nerve function damage caused by hematoma,with the advantages of low mortality,low disability rate,low infection rate,low risk of anesthesia,low incidence of re-bleeding,fast recovery time,etc.Meanwhile,the long-term prognosis and improvement of quality of life are better than conservative treatment and craniotomy hematoma removal.However,there are some problems,such as the difficulty in hemostasis compared with the removal of craniotomy hematoma,the early or late surgical time selection has no guidelines for reference,and clinical practice is more based on personal experience.Therefore,this experiment is designed to explore the selection of the time window for minimally invasive surgery from the tissue and molecular levels.ObjectiveAutologous femoral venous blood is injected into caudate nucleus of SD rats by using stereotactic brain localizer to establish experimental cerebral hemorrhage model in rats.Minimally invasive removal of hematoma combined with urokinase dissolution of hematoma is given at three different time periods to observe the changes of nerve function injury,BBB permeability and apoptosis after treatment in different time periods.The purpose of this study is to explore the time window and surgical options for minimally invasive hematoma clearance.Method1.Experimental group:36 male SD rats(200g-300g)are randomly divided into sham operation group(6 groups)and minimally invasive treatment group(6 groups),and there are three rats in each group.Three groups are selected from the sham operation group and the minimally invasive treatment group respectively to determine the changes of apoptosis,and the remaining six groups of rats are used to measure the changes of blood-brain barrier.2.Model establishment:Autologous femoral venous blood is injected into the right basal ganglia of rats;3.The hematoma is removed by minimally invasive surgery:appropriate amount of urokinase is injected into the hematoma cavity,and after the hematoma is dissolved,the hematoma is drained;4.Neurological function score:Neurologic function of rats is evaluated by modified mNSS and preconditioning experiments.The higher the mNSS score is,the more serious the neurological function damage is;otherwise,the less the damage is.The higher the Tentacle test positive,the better the nerve function.5.Determination of blood brain barrier:After successful modeling,Evans blue method is used to determine the changes in blood-brain barrier permeability at three different time periods;6.Cell apoptosis determination:after intracerebral hemorrhage,cell apoptosis is determined by TUNEL assay in three different time periods,and apoptosis cell count is conducted;7.Statistical analysis:SSPS22.0 software is used,and the results are all expressed as mean± standard deviation.T test is used to compare the sham operation group and minimally invasive treatment group,and P<0.05 is considered statistically significant.Analysis of variance is used to compare the three minimally invasive treatment groups in different time periods,and P<0.05 is considered statistically significant.Result1.Neurological function score:In the minimally invasive treatment group,there is no significant difference in neurological function score between the three subgroups.(P>0.05)2.1n the minimally invasive treatment group,the amount of Evans blue leakage in the 12-16h subgroup is less than that in the 6-10h subgroup,the Evans blue leakage in the 6-10h subgroup is higher than that in the 22-26h subgroup and there is no significant difference in Evans blue leakage between the 12-16h subgroup and the 22-26h subgroup(P>0.05).3.In the minimally invasive treatment group,the number of apoptotic cells in the 12-16h subgroup is less than that in the 6-10h subgroup,the number of apoptotic cells in the 6-10h subgroup is higher than that in the 22-26h subgroup and there is no significant difference in the number of apoptotic cells between the 12-16h subgroup and the 22-26h subgroup(P>0.05).Conclusion1.By comparing the effect of minimally invasive aspiration combined with urokinase hematomolysis in the treatment of cerebral hemorrhage in different time periods,rats in the 12-16h subgroup show the most significant improvement in the BBB than the other two subgroups.2.By comparing the effect of minimally invasive aspiration combined with urokinase hematomolysis in the treatment of cerebral hemorrhage in different time periods,the improvement of peripheral nerve cell apoptosis is most obvious in the 12-16h subgroup.3.Minimally invasive aspiration combined with urokinase hematomolysis is selected to treat cerebral hemorrhage at 12-16h can obviously improve the microenvironment of brain tissue around hematoma and reduce brain injury.The 12-16h period is the time window for the treatment plan.