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Objective:To investigate the clinical application value of craniotomy with hematoma evacuation combined with decompressive craniectomy in the treatment of severe traumatic brain injury.Methods:Sixty-eight patients with severe traumatic brain injury who received treatment in China Coast Guard Bureau Hospital, China between June 2016 and June 2019 were randomly assigned to receive either craniotomy with hematoma evacuation combined with decompressive craniectomy (observation group, n = 34) or conventional craniotomy (control group, n = 34). Surgical value for severe traumatic brain injury and the occurrence of complications were compared between the observation and control groups. Results:Before treatment, there were no significant differences in intracranial pressure, National Institute of Health Stroke Scale score, activity of daily living between the observation and control groups (all P > 0.05). After 7 days of treatment, intracranial pressure in the two groups was significantly decreased compared with before treatment, and intracranial pressure in the observation group was significantly lower than that in the control group ( t = 17.284, P < 0.001). After treatment, Glasgow Coma Scores were significantly increased in the two groups, and Glasgow Coma Scores in the observation group were significantly higher than those in the control group ( t = 5.823, 7.185, 9.234, all P < 0.05). In addition, the numbers of patients with grade I, II and III severe traumatic brain injury in the observation group were significantly lower than those in the control group (all P < 0.05). The number of patients with grade V prognosis in the observation group was significantly higher than that in the control group [20 (58.8%) vs. 8 (23.5%), χ2 = 8.743, P < 0.05]. After treatment, severe traumatic brain injury was mitigated in the two groups. National Institute of Health Stroke Scale score in the observation group was significantly lower than that in the control group, and the activity of daily living in the observation group was significantly higher than that in the control group. The numbers of patients with delayed hematoma, a need for reoperation, hydrocephalus, acute encephalocele, epilepsy, and intracranial infection in the observation group were significantly lower than those in the control group. Conclusion:Craniotomy with hematoma evacuation combined with decompressive craniectomy for treatment of severe traumatic brain injury can greatly decrease intracranial pressure, reduce the degree of injury and improve prognosis.
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Objective@#To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia.@*Methods@#From June 2015 to June 2018, 86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods, they were divided into control group and treatment group, with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time, CD4+, CD8+, CD4+/CD8+ before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded.@*Results@#After treatment, the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group: (44.9±11.8)ng/L, (42.9±13.1)ng/L vs. (86.5±27.9)ng/L, (79.6±28.6)ng/L, control group: (71.5±14.2)ng/L, (65.9±22.6)ng/L vs. (87.1±28.6)ng/L, (78.8±29.1)ng/L, t=9.005, 7.650, 3.203, 2.295, all P<0.05]. The expression level of mHLA-DR in the treatment group after treatment [(44.8±5.7)%] was significantly higher than that before treatment [(27.1±3.4)%, t=17.487, P=0.000]. The changes of the indicators in the treatment group were significantly better than those in the control group (t=9.447, 5.773, 8.725, all P<0.05). After treatment, the CD4+ level of the two groups were higher than those before treatment, and the CD8+ levels of the two groups were significantly lower than those before treatment, the differences were statistically significant(t=3.050, 3.429, 6.965, 13.327, all P<0.05), and the CD4+/CD8+ of the two groups were significantly increased (t=0.370, 3.314, all P<0.05). The indicators of the treatment group were improved more significantly than the control group (t=4.416, 12.355, 3.089, all P<0.05). The bacterial clearance rate of the treatment group was 88.89% (32/36), which was significantly higher than that of the control group [67.65% (23/34), χ2=4.686, P=0.030]. The clinical efficacy of the treatment group was 93.02%(40/43), which was significantly higher than 76.74%(33/43) of the control group (χ2=6.095, P=0.047). The incidence of adverse reactions between the two groups had no statistically significant difference (χ2=0.212, P=0.645).@*Conclusion@#Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function, reduce the inflammatory response, improve the bacterial clearance rate and clinical efficacy, and will not increase the adverse reactions, so it is worthy of promoting.
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Objective To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia.Methods From June 2015 to June 2018,86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods,they were divided into control group and treatment group,with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time,CD4+,CD8+,CD4+ /CD8 + before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded.Results After treatment,the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group:(44.9 ± 11.8)ng/L,(42.9 ± 13.1) ng/L vs.(86.5 ± 27.9) ng/L,(79.6 ± 28.6) ng/L,control group:(71.5 ± 14.2)ng/L,(65.9 ±22.6)ng/L vs.(87.1 ±28.6)ng/L,(78.8 ±29.1)ng/L,t =9.005,7.650,3.203,2.295,all P ＜ 0.05].The expression level of mHLA-DR in the treatment group after treatment [(44.8 ± 5.7) ％] was significantly higher than that before treatment [(27.1 ± 3.4) ％,t =17.487,P =0.000].The changes of the indicators in the treatment group were significantly better than those in the control group (t =9.447,5.773,8.725,all P ＜ 0.05).After treatment,the CD4+ level of the two groups were higher than those before treatment,and the CD8+ levels of the two groups were significantly lower than those before treatment,the differences were statistically significant(t =3.050,3.429,6.965,13.327,all P ＜ 0.05),and the CD4 +/CD8 + of the two groups were significantly increased (t =0.370,3.314,all P ＜0.05).The indicators of the treatment group were improved more significantly than the control group (t =4.416,12.355,3.089,all P ＜ 0.05).The bacterial clearance rate of the treatment group was 88.89％ (32/36),which was significantly higher than that of the control group [67.65％ (23/34),x2 =4.686,P =0.030].The clinical efficacy of the treatment group was 93.02％ (40/43),which was significantly higher than 76.74％ (33/43) of the control group (x2 =6.095,P =0.047).The incidence of adverse reactions between the two groups had no statistically significant difference (x2 =0.212,P =0.645).Conclusion Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function,reduce the inflammatory response,improve the bacterial clearance rate and clinical efficacy,and will not increase the adverse reactions,so it is worthy of promoting.
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Objective To study the effects of acute coronary comprehensive syndrome with PCI therapy after secondary HIT-Ⅱ give sulphur of liver fondaparinux therapy clinical comprehensive effect.MethodsDecimation in 66 patients with acute coronary syndrome after PCI patients was applied on the basis of drug therapy and postoperative anticoagulation.Study group (33 cases) in the postoperative secondary HIT Ⅱ after being diagnosed with stop heparin and give sulphur of fondaparinux, bleeding in the coagulation indexes, within 30 days event and 6months heart vascular pieces efficacy evaluation.ResultsThe use of heparin before.The index of blood coagulation in study group were normal, confirmed HIT Ⅱ when the index change significantly (P<0.05) and the discontinuation of heparin 24h, 3d, 7d indexes compared at diagnosis were restored (P<0.05) and 14 days of heparin to stop with the use of heparin levels.The patients in the study group, the incidence of bleeding events was 9.1%, compared to 15.2% in the control group no significant difference.The patients in the study group of adverse cardiovascular events occurred rate was 12.1%, compared to 18.2% in the control group no significant difference.ConclusionAcute coronary syndrome after PCI HIT-Ⅱ to grant the sulphur of fondaparinux treatment had no significant effect on blood coagulation function and safety.
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Objective To investigate the effect and safety of Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients.Methods 40 cases with severe craniocerebral injury stasis resistance qing qiao were enrolled in the study,and they were divided into two groups randomly,each group had 20 cases.Patients in the monotherapy group received routine western medicine treatment,while the combination group was added the treatment of Tongqiaoxingnao soup,200mL per day for 4 weeks.GCS scores and the persistent time of coma were analyzed.After treatment for 4,8,14 days of intracranial pressure and cerebral edema were recorded and analyzed,the total effective rate and the incidence of adverse reactions were compared between two groups.Results GCS score of the combination group was (13.7 ±4.2)points,and it was obviously higher than the monotherapy (9.2 ±3.5)points (t =2.86,P 0.05 ).Conclusion Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients has clinical curative effect,can shorten the coma time,reduce intracranial pressure and relieve cerebral edema,and has high security,it is worthy of populari-zation and application.