ABSTRACT
Objective To investigate the effects of nasojejunal feeding plus nasogastric tube decompression in severe hypertensive intracerebral hemorrhage complicated with gastroparesis.Methods Fifty-six cases of severe hypertensive intracerebral hemorrhage complicated with gastroparesis admitted to hospital from January 2011 to June 2014 were chosen as study group, while the 52 cases of similar patients admitted to hospital from January 2007 to December 2010 were chosen as control group.Nasojejunal feeding and nasogastric tube decompression were given to the study group.Nasogastric enteral nutrition support therapy was firstly given to the control group conventionally,after 15 days if they still could to be tolerant of the enteral nutrition,then parenteral nutrition therapy were adopted.The weight, serum albumin, prealbumin and hemoglobin circumstances of the two groups were determined and the complications were recorded.The patients were followed up according to activity of daily liying(ADL) after 3 months.Results There was no significant difference on the average body weigh between two groups before treatment.The average body weight of the study group was significantly higher than that of the control group after 4 weeks treatment((57.2±5.3) kg vs.(52.8±4.9) kg,t=4.33,P＜0.01).The serum albumin, pre albumin and hemoglobin of 3 week, four week after treatment were significantly higher than those of the control group(serum albumin of 3 week: (34.5±3.3) g/L vs.(30.7±3.1) g/L;erum albumin of four week:(37.8±3.8) g/L vs.(34.1 ± 3.4) g/L;serum prealbumin of 3 week:(202.3± 16.7) g/L vs.(179.6 ±15.2) g/L;serum prealbumin of four week: (216.9±17.1) g/L vs.(203.1±15.4) g/L;hemoglobin of 3 week : (119.4± 12.1) g/L vs.(107.7 ± 11.3) g/L;hemoglobin of four week : (126.2± 12.8) g/L vs.(113.5 ±11.9) g/L).Nutritional status of study group was significantly better than that of the control group(t=6.16, 5.32,7.37,4.85,5.18,5.32;P＜0.01), and complications was significantly less than that of the control group (P＜0.05).After three months, the good prognosis rate of study group (80.36％ (45/56)) was significantly higher than that of the control group (6 1.54％ (32/52)), the difference was statistically significant (x2 =4.67, P ＜0.05).Conclusion Nasojejunal feeding plus nasogastric tube decompression for patients with severe hypertensive intracerebral hemorrhage with gastroparesis can improve nutritional status, enhance their body resistance, reduce the incidence of complications, and improve their prognosis.
ABSTRACT
Objective To investigate the clinical effect of early application of nimodipine on a large area cerebral infarction after severe traumatic brain injury operation.Methods Fifty-one patients with severe head injury after large area cerebral infarction were as treatment group who hospitalized from January 2009 to January 2012,and 48 hospitalized cases as the control group from January 2005 to January 2008.The patients in control group were received drugs to decrease intracranial pressure,and enhance nerve nutrition therapy,while in the treatment group,beside the therapy method of control group,were received nimodipine intravenously by micro-pump for 10 days,and then oral administration for 10 days.Plasma endothelin-1 was detected at 0,5th,7th,14th day days after hospitalization.Dopple was pplied to record the middle cerebral artery (MCA) peak systolic velocity(Vp) of the injured side for 7 d.Glasgow outcome score(GOS) was recorded in the 3 months follow-up.The awakening time was recorded consciousness.Results At 21 st day after treatment,22 cases were died in the treatment group and survival patients with cerebral vasospasm were 14 cases (48.28％,14/29).However,30 cases were died in control group and cerebral vasospasm(CVS) of survival patients was 15 cases (83.33％,15/18),significantly higher than that in treatment group (x2 =5.78,P ＜ 0.05).The variable tendencies of Vp,plasma endothelin-1 and the intracranial pressure were significantly different between the treatment group and the control group (Vp:F group =276.27,Ftime =603.54,F interactive =85.68 ; plasma endothelin-1:F grouP =281.16,F time =608.32,F interactive =87.45 ; intracranial pressure:F grouP =326.58,F time =78.63,F interactive =27.39 ; P ＜ 0.05).Mter 3 months of treatment,the value of GOS was significandy higher in treatment group than that of control group (x2 =4.76,P ＜ 0.05).Furthermore through three months treatment,the effective rate in treatment group was higher than that in the control group (52.94％ (27/51) vs.(31.25％ (15/48)),the awakening periods was shorter than that in control group((20.7 ±6.5) d vs.(27.8 ± 7.6) d,t =3.19,P ＜ 0.05)).Conclusion Early applications of nimodipine treatment after severe traumatic brain injury patients with massive cerebral infarction can significantly improve the clinical efficacy and shorten the duration of coma.