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ObjectiveTo explore the treatment desicions of Contusion and laceration of the brain at temporal lobe and frontal lobe with small hematoma and base pond changes. MethodsAccording to three grades of consciousnee,areas of brain contusion or quantity of hematoma,and changes of base pond,it divided 274 patients into different types,then analyzed treatments and retrospect to them. Results33 cases of Type Ⅰ:33 cases had operated immediatelly and 3 cases had died;44 cases of Type Ⅱ:17 cases had delayed operations and 1 case had died;27 cases without operations.Type Ⅲ: 15 cases without operations. ConclusionThese "three-3" method of grade could be regarded as the quantification index of treatment desicions before deterioration.
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Objective To investigate the choice and efficacy of surgury in treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 278 cases of hypertensive cerebral hemorrhage were retrospectively analyzed. These cases respectively used CT Stereotactic puncture and drainage, minimally invasive craniotomy and Craniotomy hematoma surgical treatment. According to the GCS cores and hematoma volume,they were divided into 3 groups so as to comparatively analyze the efficacy of different surgical methods. Results Hypertensive cerebral hemorrhage CT stereotactic puncture good prognosis group was 74 cases(59.6% ) ,minimally invasive craniotomy group of good prognosis ,48 cases(56.4% ) ,there was no significant difference between the two groups(P＞ 0.05). Craniotomy mortality is 15 cases (21.7% ). Conclusion Three surgical treatment of hypertensive cerebral hemorrhage had their own characteristics:CT stereotactic puncture and drainage characteristics with less trauma,faster recovery,timely and effectively discharge brain compression. It was a simple and effective treatment for hypertensive intracerebral hemorrhage. In many cases, CT sterotactic puncture and drainage could replace invasive hematoma evacuation.
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Objective To explore the the rapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage so as to find out their indications. Methods Admittedin to 218 eases of hypertensive intracerebral hemorrhage since, which treated by tereotaetie aspiration or eraniotomy through small bone window or eraniotomy through bone flap was divided into three subgroups according to GCS scores and hematoma volume indications and trerapeutic outcomes of these three surgical methods were analyzed comparatively. Results Satisfactory prognosis was found in 64(60.4%) patients of brain hematoma puncture drainage. Satisfactory prognosis was found in 35(54.7%) patients of small windowing skull. No significant was occurred between the two groups (P＞0.05). The mortality rate decreased obviously in the bone-flap eraniotomy group with greathematoma volume (29.2%). Conclusions Puncture drainagc has small wound and instauration quickly. And valid for time to relief encephalothlipsis. In most circumstances, puncture drainage can replace the small hole craniotomy. Bone flap craniotomy can lower a great deal of apoplexy death rate.
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Objective To investigate the effect of severe eraniocerebral injury patients with hypernatremia.Methods Review and analysis of 356 cases of severe craniocerebral injury and 185 cases of hypernatremia. Analysis on the relationship between hypernatremia and prognosis. Results The 185 eases of severe craniocerebral injury with hypernatremia, the incidence is 52 %. Including 136 death cases, the mortality rate was 73.5 %. Hypernatremia appeared after admission since 1～18 days,the average days for this were 4.1 days. 69 cases appeare hypernatremia in 24 hours,60 cases in 48 hours,16 cases in 72 hours,145 cases of hypematremia appeared after admission within 3 days,about 78%. Blood sodium level was 148～196mmol/L, average was 172mmol/L, duration time was 1～25 days, average was 5.4 days. Conclusion It seems that almost hypernatremia appeared, when severe crartiocerebral was injuried in 3 days. The mortality is very high.
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Objective To discuss the pathogenesis,diagnosis and treatment of delayed traumatic intracerebral hematoma.Methods The clinic data of traumatic delayed intracranial hematoma patients in this hospital were retro- spectively analyzed.According to clinic observation and CT re-examination,47 cases were diagnosed as delayed trau- matic intracranial hematoma(45 cases by operative treatment,and the other 2 by conservative treatment).Results There were 21 cases of recovery,10 cases of slight disability,8 cases of severe disability,8 cases of death.The total mortality rate was 17 %.Conclusion Brain contusion,subarachnoid hemorrhage and skull base fracture were impor- tant factors of DTICH.Fine-observation and prompt CT re-examination offered excellent results for DTICH.
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Objective To study the causes for dysphoria and discuss the medication methods of controlling the dysphoria in craniocerebral injury patients. Methods First, craniocerebral injury patients were grouped to analyze the causes for their dyshoria. Then, the patients were injected with Tramadol (1 mg/kg), Droperidol (0.05 mg/kg) and Midazolam (0.1 mg/kg). Successively, analgestic pump containing combined Tramadol that included Tramadol (15 mg/kg), Droperidol (0.15 mg/kg), Midazolam (0.4 mg/kg) and 100 ml 10 g/L Procaine was used for 50 hours, (1.5-2.5) ml/h, continuously. The medication time ranged from 40 hours to 160 hours. Results Of 71 patients with dysphoria, 43 patients with grades Ⅰ and Ⅱ dysphoria were under complete control, 19 with grade Ⅲ dysphoria (eight were injected with more load) under basic control, one with grade Ⅳ dysphoria under control and eight degraded to grade Ⅱ dysphoria but needed additional load. Of all, 63 patients were successfully controlled (89%) and eight (11%) got better, with effectiveness rate of 100%. Blood pressure, heart rate and breath remained clam, which was good for oxygen transferring to brain and reducing of encephalic pressure. Conclusions The causes for dysphoria in craniocerebral injury patients include stimulation of pain and acute psychopathic impediment. Continuous injection of Tramadol via analgesic pump is an ideal medication methhod for analgesia and sedation, for it can not only hold blood and medicament in invariableness, but also make the patients quiet, without bad reaction or affecting process of regaining consciousness.
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Objective To discuss the pattern of pre-hospital and in-hospital first aid of craniocerebral injury. Methods A retrospective study was carried out on 4 311 cases with craniocerebral injuries, who were directly sent into the emergency room of the department of neurosurgery, classified and cured by special doctors according to corresponding procedures. Results A total of 2 992 mildly and mediumly injured cases were cured. In 1 319 severely injured cases, 164 died within 24 hours and the other 1 155 were evaluated by GOS, showing that 750 got good recovery plus moderate disability (64.94%), 132 resulted in severe disability (11.43%), 44 in vegetation (3.81%) and 229 died (19.83%). The total fatality rate was 29.80%. Conclusions It is beneficial to cure of the severe craniocerebral injury by utilizing the following ways, ie, pre-hospital care, immediate sending into the wards, special diagnosis according to first aid procedures, operation and ICU.