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The clinical characteristics of the pneumonia includes hyperthermia, cough and pectoralgia, etc with simultaneous mixed signs of inflammatory infiltration, consolidation, cavity/air sac and abscess in pulmonary CT scan, and these signs change rapidly. Respiratory failure and septic shock frequently occur in severe such patients, resulting in refractory management and relatively long therapeutic course. The timely diagnosis, use of sensitive antibiotics, respiratory and nutritional support, etc comprehensive effective measures can elevate the rescue success rate with severe hematogenous staphylococcus aureus pneumonia.
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Objective To explore the therapeutic methods and effects of orbital blow-out fractures.Methods Thirty-three cases (36 eyes) of orbital pure blow-out fracture were treated by surgery from January 2007 to July 2013.The features of orbital fractures were determined with three-dimensional computed tomography scans.The area of fractures was exposed through sub-ciliary incision,the herniated orbital contents were released and reduced to the orbital cavity.The fractured orbital walls were repaired precisely with autologous bone or Medpor.Results After 6 to 12 months followup,there were no serious complications such as infection of bone graft,exposure of implants in all 33 cases,and all the cases got satisfactory appearance of eyelids and orbit,of which the diplopia disappeared and eyeball movement function recovered normally.The protrution of eyeball in 29 cases were symmetrical,but 4 cases presented mild enophthalmos at affected side.Conclusions The orbital volume enlarges and orbital content herniating into paranasal sinuses is caused by orbital blow-out fracture.Implanting autogenous grafts and Medpor to restore orbital volume are proved to be effective.Early CT examination is an effective method for the diagnosis.In order to avoid complications,the orbital blow-out fracture should be subjected to surgical treatment as soon as possible.
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Objective To investigate the application of nasal jejunal tube and nasogastric tube of two different catheter ways in improving the severe craniocerebral injury and the low temperature condition and the role of early enteral nutrition support and compare the difference between its curative effect.Methods A total of 120 patients with severe craniocerebral injury underwent normal and low temperature treatment were selected,and they were divided into nasal jejunal tube enteral nutrition(nasal jejunal tube group,60 cases)and nasogastric tube enteral nutrition(nasogastric tube group,60 cases)by simple random sampling.After implement nasogastric tube and nasal jejunal tube,normal pressure using enteral nutrition elemental diet and/or enteral nutrition multi polymerization agent produced the best nutrient solution implementation of early enteral nutrition support,two groups of subjects under the condition of bowel function exists,within 48 h starting enteral nutrition,compared two groups of various nutrition indicators as well as adverse reactions and complications,and Glasgow Coma Scale(GCS)score,Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score,etc.Results The patients with severe craniocerebral injury after early nutrition,the various nutrition indicators had improved in two groups.The rise extent of triceps skinfold thickness,arm muscle circumference,serum albumin,prealbumin,transferrin,hemoglobin and other indicators in nasal jejunal tube group was higher than that in nasogastric tube group on the 14th,28th day after admission,and there was significant difference(P ＜ 0.05).The incidence of diarrhea,bloating,vomiting,and stomach contents reflux retention in nasal jejunal tube group was lower than that in nasogastric tube group [5.0％(3/60)vs.18.3％(11/60),10.0％(6/60)vs.21.7％(13/60),5.0％(3/60)vs.21.7％(13/60),15.0％(9/60)vs.16.7％(10/60),11.7％(7/60)vs.48.3％(29/60),8.3％(5/60)vs.21.7％(13/60)],and there was significant difference(P ＜ 0.05).The incidence of complications in nasal jejunal tube group was lower than that in nasogastric tube group [16.7％(10/60)vs.76.7％(46/60)],and there was significant difference(P ＜0.05).The changes of GCS score,APACHE score in nasal jejunal tube group was more obvious than that in nasogastric tube group,and there was significant difference(P ＜ 0.05).Conclusions Early nasal jejunal tube enteral nutrition for the severe craniocerebral injury after the low temperature condition in clinical enteral nutrition implementation is feasible and reasonable,compared with a nasogastric tube feeding,can obviously reduce the complications of enteral nutrition and reach goals earlier nutritional therapy,can improve the prognosis.