| Objective:To explore the correlation between blend sign of intracerebral hemorrhage and routine venous blood indexes.To analyze the anatomic characteristics and cell morphological changes of hematoma in hypo-attenuation area in patients with blend sign.To observe the changes of brain CT in hyperacute period after intracerebral hemorrhage in rabbits and the changes of CT in blend sign of different concentrations of blood components.o further explore the possible mechanism of blend sign.To provide a new idea for the prevention and follow-up treatment of patients with blend sign of intracerebral hemorrhage.Method:1.Clinical experiment(1)Correlation analysis between blend signs of intracerebral hemorrhage and venous blood indexes: Patients with intracerebral hemorrhage from January 2019 to June2020 in the emergency department of Neurology,Affiliated Hospital of Guizhou Medical University were continuously included.According to whether there were blend signs on CT,they were divided into blend sign group and control group.Baseline data and laboratory examination results of two groups were collected.After T-test or U-test were used to evaluate the laboratory examination related factors of blend sign.After adjusting the baseline data,binary logistic regression analysis was used to identify the predictive factors of blend sign laboratory examination,and ROC curve was drawn.(2)Anatomic characteristics of the hypo-attenuation area in patients with blend sign:From January 2017 to February 2021,167 patients with blend sign of intracerebral hemorrhage were enrolled in the Department of emergency neurology,Affiliated Hospital of Guizhou Medical University.The baseline data of patients with intracerebral hemorrhage,CT hematoma location of blend sign patients,anatomical location of hypo-attenuation area of blend sign,corresponding relationship between hypo-attenuation area and hyper-attenuation area(medial,lateral,upper and lower side)were analyzed retrospectively.Three dimensional CT reconstruction was performed in patients with blend sign to observe the anatomical position of the hypo-attenuation area in sagittal,coronal and horizontal planes.(3)The morphological changes of blood cells in the hypo-attenuation area of blend sign patients were compared with those of rabbits with different blood concentrations:the blood in the hypo-attenuation area of blend sign was accurately aspirated by stereotactic minimally invasive surgery for smear,and the cell morphology was observed under light microscope.The rabbit middle ear artery blood was extracted and blend with different proportions of normal saline,and the morphological changes of blood cells in rabbits with different blood concentrations were compared.2.Animal experiment(1)CT changes of rabbit cerebral hemorrhage in hyperacute stage: the rabbit cerebral hemorrhage model was established by injecting autologous arterial blood,and CT scanning was performed after the model was successfully constructed.According to the scanning time and blood injection,rabbits were divided into three groups: routine hemorrhage group,active hemorrhage group and non-coagulation group.In routine hemorrhage group,CT scanning was performed immediately after whole blood injection,while in active hemorrhage group,CT scanning was performed at the same time.In non-coagulation group,CT scanning was performed immediately after non coagulation injection.After completing the first CT scan,all rabbits were scanned again every 5 minutes.When the CT value of intracranial hematoma no longer increased continuously,they were scanned every 1 hour until 5 hours.The contents of hemoglobin,fibrin,platelet and D-dimer were detected before the experiment.(2)The change of CT value of rabbit intracerebral hemorrhage model constructed by different blood components: the imaging characteristics of blend sign were analyzed through clinical data,and the blend sign model was established according to the inferred possible causes.The model of cerebral hemorrhage was built by the method of auto arterial blood injection.All rabbits were injected with whole blood for the first time,and 1/2,1/3,1/4 of the whole blood,serum and plasma were injected into the first hematoma for the second time.The CT changes of different blood mixtures after cerebral hemorrhage were clarified.The contents of hemoglobin,fibrin,platelet and D-dimer were detected before the experiment.Results1.Clinical experiment(1)Correlation analysis between blend sign of cerebral hemorrhage and venous blood indexes: there was no significant difference in baseline data between blend sign group and control group.The results of laboratory examination showed that there were differences in absolute value of lymphocyte,distribution width of red blood cell volume,hematocrit,sodium,Cystatin C,thrombin time TT(SEC)and thrombin time TT(ratio)between the two groups.Binary logistic regression analysis was used to analyze the related factors of blend sign.The results showed that red blood cell volume distribution width,lymphocyte absolute value and thrombin time were predictive factors of blend sign,and red blood cell integral distribution width and lymphocyte absolute value were protective factors,Thrombin time TT(sec)was a destructive factor.ROC curve showed that the sensitivity and specificity of TT in predicting blend sign were 64.0% and 58.2%,respectively.AUC of area under the curve was 0.621.The AUC of red blood cell volume distribution width was 0.594,and the AUC of lymphocyte absolute value was 0.592.(2)Anatomic characteristics of hypodense areas in blend sign patients: blend sign of intracerebral hemorrhage often occurs in basal ganglia and cerebral lobes,and hypodense areas of blend sign mostly occur near lateral fissure,posterior horn of lateral ventricle and near cortex.There were 167 cases of cerebral hemorrhage,including 1 case of massive cerebral hemorrhage(0.6%),10 cases of parietal lobe hemorrhage(5.9%),4 cases of frontal lobe hemorrhage(2.4%),30 cases of temporal lobe hemorrhage(17.9%),116 cases of basal ganglia hemorrhage(69.5%),2 cases of thalamic hemorrhage(1.2%),1 case of intraventricular hemorrhage(0.6%)and 2cases of cerebellar hemorrhage(1.2%).According to the statistics of the anatomical position of the blend sign hypo-attenuation area,52 cases of patients with hematoma adjacent to the ventricle,mostly occurred in the basal ganglia and thalamus hemorrhage.There were 82 cases of hematoma adjacent to the lateral fissure,most of which occurred in the external capsule area.55 cases adjacent to the cortex,mostly occurred in lobar hemorrhage.Among all the hematomas,9 cases were adjacent to lateral fissure and cortex,6 cases were adjacent to ventricle and cortex,11 cases were adjacent to ventricle and lateral fissure,and 3 cases were adjacent to lateral fissure,ventricle and cortex.(3)The changes of blood cells in hypo-attenuation area and rabbits with different blood concentrations after intracerebral hemorrhage: the hematoma was removed by stereotactic minimally invasive surgery in patients with blend sign.The blood in hypodense area of blend sign was liquid,mostly non-coagulated,and the morphology of red blood cells was normal,The results showed that the main cells in the hypoattenuation area after intracerebral hemorrhage were red blood cells with a small amount of hemolysis.Some red blood cells had morphological changes.After the red blood cells were lysed by the red blood cell lysate,the red blood cells decreased significantly.There was no significant difference in the whole blood cells of rabbits with different concentrations,and there was no obvious hemolysis and cell morphological changes after diluted with normal saline.2.Animal experiment(1)CT changes of rabbits with cerebral hemorrhage in hyperacute stage: the hematoma density of rabbits in normal hemorrhage group was relatively low at the first time,gradually increased with the extension of time,and turned to high density after about 30 minutes,and then changed little with the extension of time.The density of hematoma in the first CT scan of the active hemorrhage group was lower than that in the normal hemorrhage group.From the second CT scan,the density of hematoma in the two groups was similar.With the extension of time,the density gradually increased and stabilized after about 30 minutes.The density of hematoma in the first scan in the non-coagulation group was similar to that in the normal bleeding group,but it did not change with time.The comparison of CT values of the three groups showed that there was no significant difference in the CT values of the three groups at0 min.with the extension of time,the CT values of the conventional bleeding group and the active bleeding group increased gradually,and tended to be stable after about30 min,while the CT values of the non-coagulation group changed more smoothly.(2)The changes of CT value of rabbit cerebral hemorrhage model constructed by different blood components: two consecutive injections of whole blood in a short period of time failed to form blend sign,the first injection of whole blood,and then injection of different concentrations of diluted blood in adjacent parts could form blend sign,but the second injection of serum and plasma could not form clinical blend sign.Conclusion(1)Thrombin time TT(sec),red blood cell volume distribution width and lymphocyte absolute value were related to the occurrence of blend sign.;(2)After intracerebral hemorrhage in rabbits,when the blood presents liquid state,the hematoma presents hypo-density,and a single intracranial injection can form a blend sign.The rabbit model of intracerebral hemorrhage was established by autologous arterial blood injection.The CT value of intracerebral hematoma gradually increases from the beginning of intracranial injection,and which tends to be stable after about 30 minutes;(3)The formation of blend sign may be related to the adjacent blood and cerebrospinal fluid in the early stage of vascular rupture. |
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