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Objective To investigate the relationship between plasma albumin and hemoglobin(Hb) levels and prognosis in patients with severe craniocerebral trauma. Methods The clinical data of 124 patients with severe craniocerebral trauma form January 2010 to January 2014 were analyzed retrospectively. The relationship between plasma albumin and Hb levels and prognosis were analyzed. Hb level was obtained in 3 days of admission, and then the patients were divided into Hb 110 g/L group, and also were albumin 31 g/L group according to the mean albumin level. Multifactor Logistic regression analysis was used to analyze the relationship between Hb, albumin levels and prognosis. Results Among 124 patients, 37 patients (29.8%) were given red blood cell (RBC) transfusion, and 28 patients (22.6%) received albumin treatment. The hospital mortality was 20.2% (25/124). The age, scores of Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ ), and hospital mortality in different Hb level groups had no significant differences (P>0.05). The age, scores of GCS score and APACHEⅡ score in different albumin level groups had no significant differences (P>0.05), but the hospital mortality in different albumin level groups had significant difference: 31.2%(10/32), 24.2%(8/33), 9.7%(3/31), 14.3%(4/28), P31 g/L group than that in albumin 29-31 g/L group. Conclusions 29-31 g/L albumin level is the best for severe craniocerebral trauma patients. There is no significant impact of Hb on the prognosis for severe craniocerebral trauma patients.
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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.
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Objective To investigate the application value of methylene blue excretion test in early reasonable nutritional support for severe traumatic brain injury.Methods One hundred and thirty-three cases of severe traumatic brain injury admitted to hospital from January 2010 to June 2012 were chosen as treatment group,while the 127 cases of similar patients admitted to hospital from January 2007 to December 2009 were chosen as control group.Patients in treatment group underwent methylene blue excretion test in 3 days,8 days,15 days after injury,and the nutritional support ways were determined according to the elimination time of methylene blue in patients' urine.The control group conventionally receive enteral nutrition support therapy firstly,after 15 days if they still cannot be tolerant of the enteral nutrition,then parenteral nutrition therapy were adopted.The weight,serum albumin and hemoglobin circumstances of the two groups were determined and the complications were recorded.Glasgow coma score (GCS) of 3 months after injury were followed up.Results There was no significant difference on the average body weigh between these two groups before treatment.The average body weight of the treatment group was significantly higher than that of control group after 3 months treatment((56.3 ± 5.5) kg vs.(52.6 ± 5.3) kg,t =5.93,P ＜ 0.01).The serum albumin and hemoglobin of 14 d,21 d after injury were significantly higher than those of the control group (serum albumin of 14 d:(32.7 ±3.4) g/L vs.(28.8 ±3.1) g/L; serum albumin of 21 d:(34.3 ±3.8) g/L vs.(30.7 ±3.3) g/L;hemoglobin of 14 d:(113.4±12.5) g/L vs.(102.2 ±11.6) g/L;hemoglobin of 21 d:(118.5 ±13.3) g/L vs.(106.7 ± 12.4) g/L.Nutritional status of treatment group was significantly better than that of the control groupall P ＜ 0.05).After three months,the effective rate of treatment group (93.23％ (124/133)) was significantly higher than that of the control group (84.25％ (107/127)),the difference was statistically significant (x2 =5.29,P ＜ 0.05).Conclusion Determining the early reasonable nutrition support ways for patients with severe traumatic brain injury according to the elimination time of methylene blue in the urine,can provide comprehensive nutrition to patients,enhance their body resistance,reduce the incidence of complications,and create an important clinical value for improving prognosis.
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Objective To investigate the clinical effects of early aneurysm surgery clipping in the treatment of intracranial aneurysm.Methods 72 patients with intracranial aneurysms were selected.42 patients (44 aneurysms) were taken microsurgical clipping( clipping group),30 patients( 33 aneurysms ) were taken vascular embolization(embolization group).The prognostic evaluation and clinical indicators of two groups were observed.Results There were no significant differences in GOS evaluation when discharge and mRS evaluation after postoperative 3 months in two groups(all P ＞0.05 ).The length of stay,hospital cost and complete occlusion rate of clipping group was ( 17.1 ± 3.2 ) d,( 5.5 ± 1.2) ten thousand yuan,100.0％,respectively,and better than those of embolization group [ (9.1 ± 2.6) d,( 12.1 ± 2.6) ten thousand yuan,83.3 ％ ] ( all P ＜ 0.05 ).There were no significant differences in cerebral aneurysms rupture rate and complication rate between the two group ( x2 =0.01,0.02,all P ＞ 0.05 ).Conclusion The microsurgical clipping has the therapeutic equivalence with embolization group,and has respective advantages and disadvantages.The microsurgical clipping could be the preferred treatment method,especially suitable for application in the primary hospital.