ABSTRACT
Objective To investigate the effect of goal-directed fluid treatment (GDT) on prognosis during emergency operation for craniocerebral trauma patients.Methods Thirty craniocerebral trauma patients treated with emergency craniotomy from January 2015 to October 2015 were divided into control group (n =15) and GDT group (n =15),according to the random number table.In control group,the patients [ten males and five females,age of (40.3 ± 12.1) years and weighting (62.1 ± 9.1) kg] were given conventional fluid therapy based on the intraoperative mean arterial pressure,heart rate,central venous pressure,etc.In GDT group,the patients [eleven males and four females,age of (44.5 ± 9.6) years and weighting (64.0 ± 6.9) kg] received GDT based on the stroke volume variation (SVV) under Vigileo monitor.Serum levels of neuronspecific enolase (NSE) and S100-β were respectively detected by electrochemical luminescence and ELISA method before anesthesia induction (T1),1 h after dura incision(T2),immediately after surgery (T3),6 h after operation(T4),24 h after operation(T5) and 48 h after operation (T6).Intracranial pressure and cerebral perfusion pressure (CPP) were detected at all time points,and Glasgow Coma Score (GCS) at T1,T5 and T6.Postoperative infection,brain edema,hospital stay in ICU,total hospital stay and death rate were recorded.Results Compared with control group,levels of NSE in GDT group were decreased at T4,T5 and T6 and levels of S100-β in GDT group were decreased at T3,T4,T5 and T6 (all P ＜ 0.05).Intracranial pressure in GDT group was not significantly different from that in control group (P ＞ 0.05).GCS at T6 was higher in GDT group than that in control group (P ＜ 0.05).Length of ICU stay and length of total hospital stay in GDI group were (4.5 ± 2.1) d and (14.3 ± 3.6) d respectively,shorter than (6.3 ± 1.9) d and (18.3 ± 4.0) d in control group (P ＜ 0.05).None experienced infection,brain edema and death after operation.Conclusion Compared with conventional fluid therapy,GDT is beneficial to the prognosis of craniocerebral trauma patients undergoing emergency craniotomy without increasing intracranial pressure and brain edema,and GDT can reduce hospital stay.
ABSTRACT
Objective To evaluate the effect of hyperbaric oxygen therapy (HBOT) in patients with severe traumatic brain injury (STBI) after craniotomy,and evaluate the difference of HBOT effects on the patients whose Glasgow coma score (GCS) were 6-8 scores and 3-5 scores.Methods Using case-control study,61 neurosurgical in-patients with STBl from February 6,2009 to November 25,2010 were divided into two groups by random digits table,30 in HBOT group and 31 in control group.Their GCS at the periods on admission,before HBOT and when they finished HBOT were recorded,as well as the Glasgow outcome score (GOS) before HBOT,finished HBOT,and 3 months after admission (GOS3M).Results The GCS finished HBOT were (12.63 ±2.70) scores in HBOT group and (11.64 ±2.50) scores in GCS 3-5 subgroup,there were statistically differences than those in control group [ (10.61± 3.01 ),(8.44 ± 1.67)scores] (P ＜0.05).The mean rank of GCS finished HBOT improvement (△GOSf) and GOS scores 3months after admission ( △ GOS3M) in HBOT group was 35.37 and 35.87,which were significantly higher than those in control group (26.77 and 26.29) (P ＜0.05).Meanwhile,the mean rank of △GOSf and △ GOS3M in GCS 3-5 subgroup was 12.14 and 13.09,which were significantly higher than those in control group (8.05 and 7.33) (P ＜ 0.05 ).In GCS 6-8 subgroup,there was no significant difference in △ GOSf and △ GOS3M between HBOT group and control group (P ＞ 0.05).Conclusion Early HBOT is effective to improve the recovery of consciousness and prognosis of the postoperative patient with STBI,especially of the patients with the special STBI (GCS 3-5 scores ).
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Objective To disscuss the effect of traeheotomy on pneumonia in patients with severe cranial trauma. Methods The clinical information of 102 patients suffering severe cranial trauma after traeheotomy were analyzed retrospectively. Results The infection rate is lower than those of tracheotomy after 24 hours(P < 0.01 ) ; Infection control rate of server cranial trauma after tracheotomy in 24 hours was obviously higher than those of tra- cheotomy after 24 hours(P < 0.05) ; but contrary in control time ( P < 0.01 ). Conclusion Tracheotomy should be applied as soon as possible,it is important to prevent and cure pulmonary infection for patients who are suffering se- vere cranial trauma.
ABSTRACT
Objective To explore the significance, indicatinos and complications of emergency tracheotomy for patients with severe craniocerbral trauma. Methods The clinical data of 42 patients with severe craniocerbral trauma were retrospectively analyzed. Results Of them, 20 were basically cured (48%), 12 had improvement (29%) ,3 were released from the hospital(7 % ), 1 survived(2 % ) in a vegetative state,and 6 died(14%). Conclu- sion Emergent tracheotomy should be performed on patients with severe craniocerbral trauma to resolve respiratory tract obstruction, improve air current, prevent cerebral anoxia, prevent and treat pulmonary infection, increase the therapeutic efficacy.