ABSTRACT
<p><b>PURPOSE</b>To investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling.</p><p><b>METHODS</b>Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment.</p><p><b>RESULTS</b>Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group.</p><p><b>CONCLUSION</b>External ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Brain , Brain Edema , Therapeutics , Brain Injuries , Cerebrovascular Circulation , Drainage , Hemodynamics , Retrospective StudiesABSTRACT
Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma (ISS≥20) from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group (MD group, n =54) and non-missed diagnosis group (NMD group, n =378) for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was (42.97±10.94) points in MD group, with statistical difference compared with NMD group (P < 0.05). The patients with GCS≤8 in MD group was more than those in NMD group (P < 0.05). Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of "life first" and repeated and systemic physical examination.
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OBJECTIVE: To summarize the therapeutic experience of 24 patients of traumatic head injuries with GCS score of 3. METHODS: Twenty-four most severely head-injured patients with GCS score of 3 who were admitted to our department from Jan 1995 to Mar 1998 were retrospectively analyzed. RESULTS: Twelve cases (50.0%) survived, of which 7 cases (29.2%) had good recovery or moderate disability and 5 cases with severe deficits (20.8%), and the other 12 died (50.0%) after therapy. CONCLUSIONS: The prognosis of most severely head-injured patients with GCS score of 3 could be improved by early intracranial hematoma removal with large decompressive craniotomies, early moderate hypothermia therapy, early assistant ventilation and effective prevention and treatment of complications.
ABSTRACT
Objective: To investigate the prophylactic effect of EEN on pulmonary infection in patients with severe traumatic brain injury.Methods: 60 cases of young adults with severe brain injury were randomized into the early enteral nutrition group(experimental group) or the control group.The experimental group was feeded 12～24 hours after injury or surgery and the control group was feeded 24 h～5 d after injury or surgery.The double-sugar test method was used for determination of intestinal barrier function,and the duration of pulmonary infection was recorded.Results: The lactulose/mannitol ratio in experimental group was significantly lower than in control group on the 7th postoperative day.The average body temperature and duration of pulmonary infection in experimental group were significantly lower than in control group.According to ADL scores,the daily capacity of convalescent patients in experimental group was significantly better than in control group.Conclusion: The early enteral nutrition can improve mucosal barrier function,reduce the incidence of pulmonary infection and improve overall prognosis in patients with severe traumatic brain injury.