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Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.
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Objective To explore the clinical features of acute ischemic bowl disease in order to guide clinical treatment and avoid the severe complications.Methods 25 cases diagnosed as ischemic bowl disease were enrolled retrospectivly analysed the clinical features of symptoms,signs,laboratory test results,abbominal enhanced CT and CTA,enteroscopes of these patients.Results Among the 25 cases accorrding to first presentation of first contacts,the cardinal symptoms were spectively abdomial pain 20 (80％),abdomial distension 16 (64％),diarrhea 18 (72％),vomiting 13 (52％),hemafecia 6 (24％),bloody purulent stool 8 (32％),watery stool 7 (28％),fever 11 (44％) and physical signs were spectively local tenderness 12(48％),peritonitis sign 9(36％),active bowl sound 7 (28％),weak or disappeared bowl sound 5 (20％).22 of 25 cases were positive with ocult blood test of stool and 23 of 25 cases showed elevated D-dimer concentration(more than 500μg/L) within 24 hours after first contacts.All the 25 cases were dignosed with CTA and 1 case was performed with enteroscopy which showed that local mucosa of sigmoid colon was congestive,edema,submucosal extravasated blood and some part was bleeding.Conclusion The patient with high risk factors who suffered from the tetralogy of severe abdominal pain,intense evacuation symptoms,highly elevated D-dimer concentration and positive ocult blood test,is stongly suggested to be a ischemic bowl disease and should be performed the abdomial CTA or DSA examination in time to avoid missing the golden opportunity to cure.
ABSTRACT
Objective To evaluate prognostic indicators in severe traumatic brain injury and intracania hamatomas with hernia and analyze which is the most important indicator.Methods Data of 84 cases with severe traumatic brain injury were retrospectively analyze .Age,GCS,pupil reflex,midline shift,compression of the cisteme,decompression time and complex injury were considered as possible prognostic indicators.SPSS13.0 was employed to analyze the data,Logistic regression(Forward conditional)analysis was done to confirm which are the most important prognostic indicators for severe traumatic brain injury and to evaluate the practical value in predicting prognosis(X2= 22.92,P＜ 0.01).Results 48 patients died and 36 survived.56(67%)patients had a bad prognosis(GCS≤3)and 28(33%)had a good prognosis(GCS ＞3).Those who had a shorter decompression time(≤3h)had a better prognosis than those who had a longer decompression time(＞3h),with the mortality rate of 11% and 67% respectively.Lesser cisteme compression predicts better outcome.GCS,pupil reflex,midline shift,and complex injury didn' t enter the logistic regression equation.According to compression time,90.5% of the cases' prognosis was accurately predicted,according to compression time and cisterne compression,95.2% was accurately predicted.Conclusion The mortality rate of severe traumatic brain injury with hernia was high and surgical intervention was effective.Decompression time and cisteme compression were the most important factors affecting prognosis in severe traumatic brain injury and they could predict prognosis of most cases correctly.