1.
Advantages of Small Bone-Window Craniotomy Under Microscope Combined Post-operative Intracranial Pressure (ICP) Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage (HICH)
Men D, Huang Z, Yin Y, Wu W, Li W, Liu H, Xu C
The Journal of craniofacial surgery. 2020
Abstract
OBJECTIVE The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients. METHODS One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed. RESULTS The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05). CONCLUSION Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.
2.
Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tranexamic acid or a combination?
Xu C, Wu A, Yue Y
Archives of Orthopaedic & Trauma Surgery. 2012;132((1):):25-31.
Abstract
BACKGROUND Adolescent idiopathic scoliosis surgery is often associated with significant blood loss and blood transfusion. In this clinical trial, the authors investigated the efficacy of reducing blood loss and allogeneic blood transfusion by using batroxobin, tranexamic acid (TXA) and the combination of the two agents. METHODS 80 adolescent patients undergoing scheduled idiopathic scoliosis surgery were randomly divided into four groups to receive 0.9% saline (group A), batroxobin (group B), TXA (group C), and both two agents in the same manner (group D). The amounts of blood loss, transfusion requirements, frozen fresh plasma (FFP) and overall drainage were assessed. The hemoglobin concentration (Hb), hematocrit and platelet counts were recorded preoperative y, postoperatively and on the first operative day. The coagulation parameters were measured meanwhile. Deep vein thrombosis (DVT) was diagnosed by ultrasound. RESULTS Blood loss of group B and group C decreased similarly by 35.3 and 42.8% (p = 0.212) compared with group A, while group D was reduced by 64.5, 45.1 and 37.8% compared to group A, B and C, respectively. The amount of allogeneic blood transfusion of group B and group C was comparably reduced by 57.6 and 72.4% compared to group A (p = 0.069), while group D decreased by 94.7, 87.5 and 80.9% compared to group A, B and C. Overall drainage of group B, C and D decreased by 23.0, 45.1 and 67.9% compared with group A, respectively, while group C was reduced by 28.7% compared with group B (p < 0.001). The FFP of group B, C and D was reduced by 63.4, 80.2 and 95.0% as compared with group A, while group C decreased by 45.9% as compared to group B (p = 0.025). There were no urgent coagulation disorders or DVT reported. CONCLUSIONS In our study, batroxobin and TXA can markedly reduce the blood loss and the transfusion requirements equivalently. However, TXA performs better in minimizing FFP and the overall drainage than batroxobin. The combination seems to achieve best results and was more effective than either of the two drugs alone. No apparent adverse events were detected in these groups.