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Objective:To investigate the effect of continuous intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) monitoring and guiding treatment after the application of standard large bone flap decompression and microhematoma removal in patients with severe traumatic brain injury (TBI). Methods:A retrospective analysis was done of 41 patients with TBI in Department of Neurosurgery in the Inner Mongolia People's Hospital from January 2018 to May 2020. Patients with Glasgow coma scale (GCS)<8 points were treatesd with microscopical removal of hematoma and contusion brain tissue and standard large bone flap decompression. Intraoperative intracranial pressure and brain tissue oxygen partial pressure monitoring probes were placed. Postoperatively, continuous intracranial pressure monitoring and partial oxygen pressure monitoring of brain tissue were performed, and target-based treatment under ICP and PbtO 2 monitoring was performed. According to the Glasgow Outcome (GOS) score after six months, patients were divided into a good outcome group (4-5 scores) and a poor outcome group (1-3 scores). There were 26 cases in good prognosis group and 15 cases in poor prognosis group. Linear regression analysis was used to further evaluate the relationship between PbtO 2, ICP and GOS score. The measurement data of normal distribution were compared by independent sample t-test. The counting data were expressed in cases (%), and the comparison between groups was adopted χ 2 inspection. The general linear bivariate Pearson correlation test was used. Results:The mean value of PbtO 2 (17.42±5.34) mmHg in the poor prognosis group was lower than that in the good prognosis group (24.65±5.61) mmHg, with statistical significance ( t=4.04, P<0.001). The mean value of ICP (22.32±3.45) mmHg in the poor prognosis group was higher than that (17.32±3.23) mmHg in the good prognosis group, with statistical significance ( t=4.15, P<0.001). Using PbtO 2 and ICP as independent variables and GOS score after 6 months as dependent variable, a regression equation was established ( Y=4.040 X+7.497; Y=-2.549 X+28.63). The mean value of PbtO 2 was positively correlated with GOS scores after 6 months in patients with severe head injury ( r=0.75, P<0.001). The mean value of ICP was negatively correlated with the prognosis of patients with severe head injury ( r=-0.87, P<0.001). Conclusion:The treatment guided by ICP combined with PbtO 2 monitoring is valuable in improving the prognosis of patients with severe traumatic brain injury after standard decompressive craniectomy, and may improve the prognosis 6 months after the injury.
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Objective:To investigate the application of continuous intracranial pressure (ICP) combined with regional cerebral oxygen saturation (rScO 2) monitoring in patients with hypertensive intracerebral hemorrhage before and after operation of the removal hematoma through small bone window and the effect on the prognosis of patients. Methods:The clinical data of 37 patients with supratentorial hypertensive intracerebral hemorrhage admitted to the neurosurgical intensive care unit of the people′s Hospital of Inner Mongolia Autonomous Region from April 2018 to October 2020 were retrospectively analyzed.ICP monitoring and near infrared spectroscopy (NIRS) were used to monitor the intracranial pressure and rScO 2 concentration before and after the operation, and the changes of intracranial pressure and rScO 2 before and after the operation were analyzed.According to Glasgow Outcome Score (GOS), patients with GOS score>3 were classified as good prognosis group (21 cases), and those with GOS score ≤3 were classified as poor prognosis group (16 cases). Results:The postoperative intracranial pressure((15.80±6.70) mmHg)of patientswith hypertensive intracerebral hemorrhage was lower than that before operation((20.40±5.80) mmHg), and the difference was statistically significant( t=3.226, P=0.002). The postoperative rScO 2 ((62.31±3.85)% )of patientswith hypertensive intracerebral hemorrhage was higher than that before operation((59.73±3.13)%), and the difference was statistically significant( t=3.171, P=0.002). The decrease of intracranial pressure in patients with good prognosis((6.53±2.21) mmHg)was more obvious than that in patients with poor prognosis((4.24±2.30) mmHg). The concentration of rScO 2 increased in both groups.But in the group with good prognosis, the rScO 2 increased((3.99±2.34)%)was significantly higher than that in poor prognosis group((2.32±2.25)%). Six months after operation, there were significant differences in preoperative and postoperative intracranial pressure and rScO 2 between good prognosis group and poor prognosis group, and the difference was statistically significant( t=3.090, 2.176; P=0.004, 0.036). Conclusion:Small bone window evacuation of intracerebral hematoma can significantly reduce the concentration of intracranial pressure and increase the concentration of rScO 2 in patients with intracerebral hemorrhage.The changes of intracranial pressure and rScO 2 before and after operation have potential value in judging the prognosis of patients.
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Objective:To observe the expression of glucose regulated protein 78 (GRP78) in glioma and its clinical value in evaluating clinical prognosis.Methods:A total of 163 patients with glioma who were surgically removed and confirmed after surgery in the People′s Hospital of Inner Mongolia Autonomous Region were collected from March 2012 to October 2015. Immunohistochemical staining was used to observe the expression of GRP78 in patients with different WHO grades of glioma. Chi square test was used to compare the expression of GRP78 in glioma patients with different age, gender and WHO grade. Whether COX regression analysis GRP78 can be used as an independent prognostic indicator was investigated. Time series test and Kaplan Meier analysis were used to analyze the survival time of patients with different GRP78 expression levels.Results:The expression of GRP78 was up-regulated in glioma, and the patients with high expression of GRP78 (positive expression/strongly positive expression) were more common in stage Ⅲ/Ⅳ than in stage Ⅰ/Ⅱ. The expression of GRP78 was not statistically significant in different age and gender groups ( P>0.05), but was statistically significant in different WHO stages ( P<0.01). GRP78 was an independent prognostic factor for glioma ( P = 0.045). The median survival time of patients with glioma was 28 months (95% CI 37.594 to 47.046), of which the survival time of patients with high expression of GRP78 was 15 months (95% CI 12.922 to 40.801); the survival time of patients with low expression of GRP78 was 35 months (95% CI 39.807 to 51.352), and the difference was statistically significant ( P<0.01). The survival time of patients with high expression of GRP78 was significantly shorter than that of patients with low expression of GRP78 ( χ2 = 13.588, P<0.01). Conclusions:The expression level of GRP78 in glioma is significantly increased; high expression of GRP78 is more common in Ⅲ/Ⅳ glioma, and GRP78 can be used as an effective index to evaluate the poor prognosis of glioma.
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Objective:To investigate the effects of continuous monitoring intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) on the prognosis of patients with severe craniocerebral injury. Methods:A prospective randomized controlled trial was conducted. Seventy patients with severe craniocerebral injury with a Glasgow coma score (GCS) 4-8 admitted to the neurosurgical intensive care unit (NICU) of the People's Hospital of Inner Mongolia Autonomous Region from January 2017 to May 2020 were enrolled, and they were divided into ICP monitoring group and ICP+PbtO 2 monitoring group by random number table. Patients in ICP monitoring group received ICP monitoring and were given traditional treatment of controlling ICP and cerebral perfusion pressure (CPP), the therapeutic target was ICP < 20 mmHg (1 mmHg = 0.133 kPa) and CPP > 60 mmHg. Patients in ICP+PbtO 2 monitoring group were given ICP and PbtO 2 monitoring at the same time, and oxygen flow was adjusted on the basis of controlling ICP and CPP to maintain the PbtO 2 > 20 mmHg, and the therapeutic target of ICP and CPP was the same as the ICP monitoring group. ICP and PbtO 2 values were recorded during monitoring in the two groups, the results of CPP, GCS and arterial blood gas analysis were recorded, and the prognosis at 3 months and 6 months after injury was compared by Glasgow outcome scale (GOS) score between the two groups. GOS score > 3 was considered as good prognosis. Kaplan-Meier survival curve was drawn, and the 3-month and 6-month cumulative survival rates of the two groups were analyzed. Linear regression analysis was used to further evaluate the relationship between PbtO 2 and GOS score. Results:Finally, a total of 70 patients with severe craniocerebral injury were enrolled in the analysis, 34 patients received ICP combined with PbtO 2 monitoring and guided therapy, and 36 patients received ICP monitoring alone. The average ICP of ICP+PbtO 2 monitoring group was significantly lower than that of ICP monitoring group (mmHg: 13.4±3.2 vs. 18.2±8.3, P < 0.01). Although the CPP in both groups was great than 60 mmHg, the average CPP of ICP+PbtO 2 monitoring group was significantly higher than that of ICP monitoring group (mmHg: 82.1±10.5 vs. 74.5±11.6, P < 0.01). No significant difference was found in average GCS score or arterial partial pressure of carbon dioxide (PaCO 2) between the ICP+PbtO 2 monitoring group and ICP monitoring group [GCS score: 5.3±2.3 vs. 5.2±2.2, PaCO 2 (mmHg): 33.5±4.8 vs. 32.6±5.2, both P > 0.05]. The average arterial partial pressure of oxygen (PaO 2) of ICP+PbtO 2 monitoring group was obviously higher than that of ICP monitoring group (mmHg: 228.4±93.6 vs. 167.3±81.2, P < 0.01). Compared with the ICP monitoring group, the good outcome rates of 3 months and 6 months after injury in the ICP+PbtO 2 monitoring group were significantly higher (3 months: 67.6% vs. 38.9%, 6 months: 70.6% vs. 41.7%, both P < 0.05). Kaplan-Meier survival curve showed that the 3-month and 6-month cumulative survival rates of ICP+PbtO 2 monitoring group were significantly higher than those of ICP monitoring group (3 months: 85.3% vs. 61.1%, Log-Rank test: χ2 = 5.171, P = 0.023; 6 months: 79.4% vs. 55.6%, Log-Rank test: χ2 = 4.511, P = 0.034). Linear regression analysis showed that PbtO 2 was significantly correlated with GOS score at 3 months and 6 months after injury in patients with severe craniocerebral injury ( r values were 0.951 and 0.933, both P < 0.01). Conclusions:PbtO 2 compared with ICP monitoring guiding therapy is valuable in improving the prognosis of patients with severe craniocerebral injury. It can improve the prognosis at 3-6 months after injury.
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Objective:To investigate the influence of bundled ligation of the pancreatic stump on postoperative pancreatic fistula (POPF) of distal pancreatectomy (DP).Methods:The retrospective case-control study was conducted. The clinical data of 60 patients with diseases in pancreatic body and tail who underwent DP in the Affiliated Hospital of Inner Mongolia Medical University from January 2011 to August 2018 were collected. There were 24 males and 36 females, aged from 19 to 68 years, with a median age of 45 years. Of the 60 patients, 36 cases undergoing dissection of pancreas with Endo-GIA stapler were allocated into non-bundled group, and 24 cases undergoing bundled ligation of the pancreatic stump with No.10 or No.7 suture at the site over 1 cm of the resection site before dissection of pancreas were allocated into bundled group. Observation indicators: (1) postoperative situations; (2) analysis of risk factors for POPF of DP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test or ANOVA test. Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted using the Logistic regression model. Results:(1) Postoperative situations: the amylase concentration, cases with biochemical fistula, cases with grade B pancreatic fistula, cases with complications, time to extubation, duration of postoperative hospital stay, total hospital expenses were (2 629±592)U/L, 14, 5, 7, (11.9±0.7)days, (13.6±0.7)days, (49 430±1 626)yuan in non-bundled group and (683±312)U/L, 3, 1, 2, (9.7±0.6)days, (11.3±0.5)days, (44 767±1 163)yuan in bundled group, respectively. There were significant differences in the amylase concentration, cases with biochemical fistula, time to extubation, duration of hospital stay, total hospital expenses between the two groups ( t=2.528, χ2=1.512, t=2.341, 2.311, 2.111, P<0.05), and there was no significant difference in the cases with grade B pancreatic fistula or cases with complications between the two groups ( χ2=1.512, 1.394, P>0.05). (2) Analysis of risk factors for POPF of DP. Results of univariate analysis showed that tumor diameter and bundled ligation of the pancreatic stump were related factors of patients undergoing pancreatic fistula after DP ( χ2=4.462, 5.061, P<0.05). Results of multivariate analysis showed that bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP ( odds ratio=0.187, 95% confidence interval as 0.037-0.954, P<0.05). Conclusions:Bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP. Bundled ligation of the pancreatic stump can effectively reduce the incidence of POPF, especially biochemical fistula, the time to extubation, duration of postoperative hospital stay and total hospital expenses, and promote patient recovery after DP.
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Objective:To investigate the role of multimodal neuronavigation intraoperative and sodium fluorescein-guided techniques in microsurgery for intracranial malignant neoplasm.Methods:A retrospective analysis was conducted on 50 patients with intracranial malignant tumors treated by microsurgery from 2016 to 2019 in Inner Mongolia People′s Hospital. Preoperative imaging included computed tomography (CT), computed tomographic angiography (CTA), magnetic resonance imaging (MRI), MRI: MRA, MRV, DWI, PWI, DTI, DTI, MRS sequence scan, and before the operation, they were fused with the functional nervous system navigation workstation of Bo Yilai to make the navigation plan. During the operation, the functional navigation was combined with low dose fluorescein sodium (2 mg/kg) for operation. Intraoperative neuronavigation was used to determine the location of the tumor and its spatial relationship with the pyramidal tract of the main fiber conduction tract and the large blood vessels, and intraoperative yellow fluorescence mode of pentero900 Zeiss microscope showed the boundary between the tumor and normal brain tissue for tumor resection.Results:There were 38 cases of glioma, 10 cases of brain metastasis of lung cancer, 1 case of brain metastasis of renal clear cell carcinoma and 1 case of spindle cell tumor. The accuracy of preoperative neuronavigation was 95%. Compared with the preoperative lesions, MRI of the head was reexamined 3 days after operation to judge the degree of tumor resection. In this group, 38 cases (76%) were totally resected and 12 cases (24%) were subtotal resected. The 6-month survival rate was 85.9%, the 12-month survival rate was 53.1%, the 18-month survival rate was 24.5%, and the survival time was (15.0 ± 3.2) months.Conclusion:Multimodal functional neuronavigation combined with fluorescein sodium staining can locate and label tumors in real time, improve tumor resection rate, and improve the prognosis of brain cancer patients.