ABSTRACT
Objective To evaluate the influence of early entemal nutrition and parenteral nutrition support on gastric juice pH in patients with severe brain injury. Methods Totally 168 patients with severe brain injury ( Glasgow Coma Scale ≤ 8 ) admitted to our hospital from January 2007 to May 2009 were equally and randomly divided into early enternal nutrition (EEN) group and parenteral nutrition (PN) group. Gastric juice pH and upper gastrointestinal hemorrhage were monitored on admission and on the 3rd, 5th, and 7th day after admission. Results The gastric juice pH was significantly decreased in patients with severe brain injury. In addition, it was significantly higher in EEN group than in PN group on the 3rd, 5th, and 7th day after admission ( P ＜ 0. 001 ). The alimentary tract hemorrhage incidence showed no difference on admission between two groups but was significantly lower in the EEN group on the 3rd, 5th, and 7th day ( P ＜ 0. 05 ). Conclusions Hypersecretion of gastric acid may occur in patients with severe brain injury. EEN can neutralize gastric acid and increase gastric juice pH,which may lead to the decrease of upper gastriontestiual hemorrhage. Monitoring of the gastric juice pH also can provide a warning message of stress ulcer bleeding.
ABSTRACT
Objective To examine the barbiturate infusion for intractable intracranial hypertension and its effect on brain tissue oxygen ( PbtO2 ). Method 60 patients with intractable intracranial hypertension were divided into tow groups, experimental group and control group. PbtO2 and intracranial pressure (ICP) were continuous monitored. Follow-up was more than 3 months and the prognosis was compared between two groups. Results When pentobarbital administration began, the mean PbtO2 [ 72 h: (26. 7 ±6. 7)mmHg] at 24h, 48h and 72h in experimental group were significantly higher than that of control group [ 72 h: ( 21. 1 ± 7. 2) mmHg ] ( P < 0. 05 ). The mean ICP [ 5 d: (2. 48 ± 1.11 ) kPa ] in the third and fifth day of experimental group were lower than that of control group [ 5 d: (3. 12 ± 1.09 ) kPa ]. Prognosis of pentobarbital group was better than control group( P < 0. 05 ). Conclusions Pentobarbital can effectively reduce intracranial pressure in patients with refractory intracranial hypertension and improve brain tissue oxygen. PbtO2 is an ideal monitoring marker, and it can predict prognosis to a certain extent.
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Objective To investigate the changes of leptin level in patients with intracerebral hemorrhage and the relationship between leptin level and insulin resistance(IR). Methods 57 patients with hypertensive cerebral hemorrhage (group A ), 50 patients with hypertension (group B), 41 healthy people (group C) were selected to determine the value of fasting blood-glucose ( FBG), fasting blood-insulin( FBI), leptin levels as well as insulin sensitivity index (ISI). Results The level of FNS and leptin was significantly higher (P ＜ 0.05 ) while the level of ISI was lower (P ＜ 0.05 ) in group A than those in group B and C. Correlation analysis showed that leptin level in HCH patients was negatively correlated with ISI, and positively correlated with FNS. Conclusion The results indicate that higher level of leptin and IR may play an important role in the occurrence of hypertension complicated cerebral hemorrhage.
ABSTRACT
Objective: To evaluate the effect of early enteral nutrition(EEN) on gastric acid secretion in patients with severe brain injury.Methods: 168 patients with severe brain injury(GCS≤8)were divided randomly into two groups.84 patients were given EEN by naso-gastric tube as EEN group and 84 patients were treated with parenteral nutrition(PN)as PN group.Gastric juice pH and upper gastrointestinal hemorrhage were monitored on admission,the 3rd,5th and 7th day after admission.Results: The gastric juice pH was significantly lowered in EEN group.Conclusion: EEN could neutralize gastric acid and increase the gastric juice pH in patients with severe brain injury.