| Hypertensive intracerebral hemorrhage (HICH) is a clinically common and severe disease in Neurology Department, its mobidity and mortality following intracerebral hemorrhage remain the highest among all forms of cerebrovascular diseases, with a 30-day mortality rate of 35～52%, with 50% of the deaths occurring in the first 2 days, HICH is a devastating form of stroke with the high mortality two fold to six fold higher than that for ischemic stroke, therefore HICH is characterized by high mobidity rate, high mortality rate and high disability rate. The main reason of high mortality rate in the acute phase conclude space occupying effect of hematoma, peripheral edema of hematoma and cerebral hernia caused by intracranial hypertension. Therefore, surgical operation is one of the most important measures for decreasing the mortality rate of hypertensive intracerebral hemorrhage. With the development of the microneurosurgery techniques, minimally invasive removal of intracranial hematoma technology is a combination of the microneurosurgery techniques and the stereotaxy techniques, because of its advantages of the minor injuries and the high clearance rate, minimally invasive removal of intracranial hematoma technology is extensively applied in the treatment of hypertensive intracerebral hemorrhage.Objective:To study the dynamical fluctuation of the fibrinolytic activity in hypertensive intracerebral hemorrhage patients with minimally invasive surgery(MIS) through measuring the levels of plasminogen activator inhibitor-1 (PAI-1) antigen and tissue-type plasminogen activator (t-PA). Methods:Choose 89 patients with hypertensive cerebral hemorrhage in basal ganglia area who are in Shandong Provincial Hospital and Shandong Communication Hospital during 2008-2009, quantity of bleeding from 30-90ml, these patients were divided into minimally invasive surgery patient group and non-minimally invasive surgery patient group, both two groups of patients meet the diagnostic criteria and exclusion criteria. Two groups of patients were conventionally given dehydration, blood pressure control, infection control, water and electrolyte balance control and other supporting treatment, within 7-24h after onset and agreed by the family, minimally invasive surgery patient group were given the hematoma minimally invasive surgery with a fit length YL-I type one-time intracranial hematoma puncture needle under local anesthesia in strict accordance with "minimally invasive removal of intracranial hematoma technology standardized treatment guidelines". Blood samples were obtained on days 1,3,7 and 14 after the onset in 46 patients with MIS and 43 patients with non-minimally invasive surgery, and 48 normal controls group, centrifugal extraction of serum placed in the upper -80℃refrigerator prepared test. The levels of plasminogen activator inhibitor-1 (PAI-1) antigen,tissue-type plasminogen activator (t-PA) were measured with an enzyme linked immunosorbent assay (ELISA), neurological function degree were evaluated on days 1,3, 7 and 14 after the onset between minimally invasive surgery patient group and non-minimally invasive surgery patient group. All the analyses were performed using SPSS 11.5 software, Test significance level of P<0.05.Results:1. Changes of serum t-PA and PAI-1 content The level of t-PA in MIS patient group at 1d,3 d and 7 d after onset were significantly higher than those in control group (P<0.05), and there was no significant difference between surgery group and control group at 14 d; The levels of PAI-1 in MIS patient group at 3d, and 7d were significantly higher than those in control group (P< 0.05); The level of t-PA in MIS patient group at 3 d and 7 d were significantly lower than those in non-minimally invasive surgery patient group (P<0.05), The level of PAI-1 in MIS patient group at 3 d and 7 d were significantly higher than those in non-minimally invasive surgery patient group (P<0.05).2. Changes of NIHSS score NIHSS score in MIS patient group at 3d,7d and 14d after onset were significantly lower than those at 1d after onset in MIS patient group (P<0.05), and there was no significant difference between MIS patient group and non-minimally invasive surgery patient group.3. Correlation between the level of t-PA and PAI-1 and NIHSS score in MIS patient group The correlation analysis showed that the level of t-PA in MIS patient group at 1d,3 d and 7 d after onset are positively correlated with the day of NIHSS score, the level of PAI-1 in MIS patient group at 1d,3 d and 7 d after onset are negatively correlated with the day of NIHSS score; The results showed that no significant relativity between the level of t-PA and PAI-1 and NIHSS score in MIS patient group at 14d.Conclusion:Our results support that certain fluctuation regularity of fibrinolytic activity in hypertensive intracerebral hemorrhage patients with minimally invasive surgery exist. The level of t-PA and PAI-1 can be used as the biomakers for clinical outcome in patients with minimally invasive surgery. |
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