Clinical efficacy of gradual decompression in the treatment of severe traumatic brain injury and its effects on the improvement of intracranial pressure / 中国基层医药

Objective:To investigate the clinical efficacy of gradual decompression in the treatment of severe traumatic brain injury and its effects on the improvement of intracranial pressure.Methods:The clinical data of 120 patients with severe traumatic brain injury who received treatment in the General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd. from January 2015 to January 2020 were retrospectively analyzed. The included patients were divided into decompressive craniectomy group (control group, n = 64) and gradual decompression group ( n = 56). Intracranial pressure was compared between the two groups at different time points (before surgery, during the surgery, immediately after surgery, 3 and 6 months after surgery). The patient's self-care ability, coma degree, and neurological deficits pre-surgery and 6 months after surgery were evaluated in each group. The incidence of complications throughout the surgery and within 6 months after surgery was calculated to evaluate the quality of life. Results:There was no significant difference in intracranial pressure pre-surgery between the two groups ( P > 0.05). Intracranial pressure in the gradual decompression group was (30.74 ± 2.51) mmHg, (25.11 ± 2.06) mmHg, (21.34 ± 2.01) mmHg, and (16.74 ± 1.54) mmHg respectively during the surgery, immediately after surgery, and 3 and 6 months after surgery, which was significantly lower than that in the control group [(34.31 ± 3.06) mmHg, (30.64 ± 2.57) mmHg, (26.33 ± 2.35) mmHg, (22.64 ± 1.95) mmHg, t = 12.88, 19.03, 12.40, 18.20, all P < 0.001]. There were no significant differences in scores of the Modified Barthel Index (MBI), the Glasgow Coma Scale (GCS), the National Institutes of Health Stroke Scale (NIHSS) pre-surgery between the two groups (all P > 0.05). At 6 months after surgery, the MBI and GCS scores increased and the NIHSS score decreased in each group. There were significant differences in the NIHSS, MBI, and GCS scores between the two groups ( t = 7.61, 6.26, 13.07, all P < 0.001). During the surgery and 6 months after surgery, the incidences of cerebral infarction, delayed cerebral hematoma, and acute encephalocele were significantly lower in the gradual decompression group than in the control group ( χ2 = 4.23, 4.35, 4.83, all P < 0.05). The Generic Quality of Life Inventory-74 Questionnaire scores in environment, psychological health, social relationship, and psychological health domains were significantly higher in the gradual decompression group than in the control group ( t = 8.16, 9.80, 8.68, 7.76, all P < 0.001) Conclusion:This study is the first to analyze the feasibility of gradual decompression for the treatment of severe traumatic brain injury in terms of intracranial pressure, quality of life, and short- and medium-term complications. Findings from this study confirm that gradual decompression can effectively lower intracranial pressure of patients with severe traumatic brain injury, improve neurological function, reduce complications, and improve patients' self-care ability and quality of life.

Medición de la vaina del nervio óptico mediante tomografía computarizada como predictor de mortalidad en pacientes con traumatismo craneoencefálico grave al ingreso a la Unidad de Cuidados Intensivos / Optic nerve sheath measurement through computerized scan as death predictor in patients with serious cranioencephalic trauma on entry to the Intensive Care Unit / Medição da bainha do nervo óptico por tomografia computadorizada como preditor de mortalidade em pacientes com trauma cranioencefálico grave internados na Unidade de Terapia Intensiva

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Abstract: Introduction: Traumatic brain injury (TBI) is a medical-surgical condition characterized by brain involvement secondary to a traumatic lesion. Patients with severe TBI are at high risk of mortality and this will depend on different factors such as the presence of intracranial hypertension, age, origin of the injury and score on the Glasgow coma scale. Measurement of the optic nerve sheath diameter (ONSD) appears to be a good indirect indicator of intercranial hypertension and therefore, a good predictor of mortality. Objective: To determine the most appropriate cut-off point, as well as the measurement of the ONSD usefulness as a prognostic indicator of mortality in patients with severe TBI in the Intensive Care Unit (ICU). Material and methods: This is an analytical, descriptive, and retrospective study. The universe of study consists of all the case/files with TBI. For the sample selection, all available records of patients with severe TBI sent to the ICU during the period from March 1 to August 31, 2021, will be included. Within the inclusion criteria patients with a Glasgow scale score of < 8 points on entry and with a computerized scan done. The dependent variables to considerer are the outcome understood as death or survival of the patient, the days hospitalized in the ICU, the presence of complications; among the dependent variables is the diameter of the optic nerve sheath measured by computerized tomography. Intervening variables were also considered such as the presence of comorbidities and overweight/obesity, the age and sex of the patient. The project consisted of four phases: 1) request for authorization and access to files, 2) application of selection criteria, 3) performance of ONSD measurements and 4) creation of the database. Finally, once the database is formed, the statistical analysis will proceed; for the descriptive part, prevalence's, means (standard deviation) and medians (percentiles) will be calculated for the variables by sex and by outcome, subsequently the diagnostic capacity of the ONSD will be analyzed through the area under the ROC curve (receiving operating characteristics) for the outcome. Afterwards the performance of this and other cut-off points are compared using the Youden index. Results: Sixty records of TBI patients admitted to the ICU were studied, 51 were men (85%), 45 patients survived (75%) and 15 patients died (25%). The average age was of 50.5 ± 10.6 years, the average Glasgow score on admission was 6.6 ± 1.6 points, the average BMI was 26.42 ± 4.10 kg/m2, and the average number of days spent in the ICU was 9.03 ± 6.4. The diameter of the optic nerve was not a predictor of mortality, but if the Glasgow coma scale was, with an AUC of 0.775 (95% CI: 0.648-0.901, p = 0.002), the best cut-off point was 7 with a sensitivity of 93% and specificity of 54%. The bivariate linear regression model points to low Glasgow coma score and long hospital stay as predictors of mortality. Conclusions: The results of this study infer that, consistent with current scientific evidence, the sociodemographic characteristics of our population are similar to those reported by other authors, with men over 50 years of age being the most affected by this entity. On the other hand, the measurement of the diameter of the optic nerve sheath has been considered a good prognostic indicator of intracranial hypertension, which in turn is associated with increased mortality. However, in the present study there is no association between the diameter of the optic nerve sheath and the prognosis of mortality.

Resumo: Introdução: O traumatismo cranioencefálico (TCE) é uma condição médico-cirúrgica caracterizada por lesão cerebral secundária a uma lesão traumática. Pacientes com TCE grave apresentam alto risco de mortalidade e isso dependerá de diversos fatores, como presença de hipertensão intracraniana, idade, origem da lesão e pontuação na Escala de Coma de Glasgow. A medida do diâmetro da bainha do nervo óptico (DBNO) parece ser um bom indicador indireto de hipertensão intracraniana e, portanto, um bom preditor de mortalidade. Objetivo: Determinar o ponto de corte mais adequado, bem como a utilidade da medida do DBNO como indicador prognóstico de mortalidade em pacientes com TCE grave na Unidade de Terapia Intensiva. Material e métodos: Trata-se de um estudo analítico, descritivo e retrospectivo. O universo de estudo é composto por todos os prontuários de casos/pacientes com TCE grave. Para a seleção da amostra foram incluídos todos os prontuários disponíveis de pacientes com TCE grave encaminhados à Unidade de Terapia Intensiva no período de 1o de março a 31 de agosto de 2021, dentro dos critérios de inclusão foram considerados pacientes com escala de Glasgow < 8 pontos na admissão e com uma tomografia computadorizada realizada. As variáveis ​​dependentes consideradas são o desfecho entendido como óbito ou sobrevida do paciente, os dias de internação na UTI, a presença de complicações; dentro das variáveis ​​independentes está o diâmetro da bainha do nervo óptico medido por tomografia computadorizada. Também foram consideradas variáveis ​​intervenientes, como presença de comorbidades e sobrepeso/obesidade, idade e sexo do paciente. O projeto consistiu em três fases: a) Pedido de autorização e acesso aos prontuários, b) Aplicação dos critérios de seleção, c) Desenvolvimento da base de dados. Por fim, uma vez formada a base de dados, procedeu-se à análise estatística. Para a parte descritiva, foram calculadas as prevalências, médias (desvio padrão) e medianas (percentis) das variáveis ​​por sexo e por desfecho. Posteriormente, a capacidade diagnóstica do DBNO foi analisada pela área sob a curva ROC (Receiving Operating Characteristics) para o resultado. Posteriormente, o desempenho deste e de outros pontos de corte foi comparado pelo índice de Youden. Resultados: Foram estudados 60 prontuários de pacientes com TCE que deram entrada na UTI, 51 eram homens (85%), 45 pacientes sobreviveram (75%) e 15 pacientes morreram (25%). A média de idade foi de 50.5 ± 10.6 anos, a média de Glasgow na admissão foi de 6.6 ± 1.6 pontos, a média de IMC foi de 26.42 ± 4.10 kg/m2 e a média de dias de internação na UTI foi de 9.03 ± 6.4. O diâmetro do nervo óptico não foi preditor de mortalidade, mas a Escala de Coma de Glasgow sim, com AUC de 0.775 (IC 95%: 0.648-0.901, p = 0.002), o melhor ponto de corte foi 7 com sensibilidade de 93% e especificidade de 54%. O modelo de regressão linear bivariada aponta para baixo escore de coma de Glasgow e longa permanência hospitalar como preditores de mortalidade. Conclusões: Os resultados deste estudo inferem que, de acordo com as evidências científicas atuais, as características sociodemográficas de nossa população são semelhantes às relatadas por outros autores, sendo os homens com aproximadamente 50 anos de idade os mais acometidos por essa entidade. Por outro lado, a medida do diâmetro da bainha do nervo óptico tem sido considerada um bom indicador prognóstico de hipertensão intracraniana, que por sua vez está associada ao aumento da mortalidade. No entanto, no presente estudo não há associação entre o diâmetro da bainha do nervo óptico e o prognóstico de mortalidade.

Presión de perfusión cerebral en pacientes pediátricos con traumatismo craneoencefálico grave

RESUMEN Introducción: La mortalidad por traumatismo craneoencefálico grave (TCE g) en el paciente pediátrico, crece de forma directamente proporcional con la severidad de la injuria inicial. Se estima entre el 1 y 7 % de menores de 18 años afectados por dicha enfermedad en el mundo. La incidencia de muerte por esta causa oscila entre 2,8 y 3,75 por cada 100 000 niños anualmente. Metodología: Se realizó un estudio descriptivo de tipo correlacional en el servicio de cuidados intensivos pediátricos del Hospital General Docente "Roberto Rodríguez" de Morón, Ciego de Ávila, Cuba, en el período entre enero de 2003 y diciembre de 2017. Se incluyeron pacientes menores de 18 años. Las intervenciones fueron monitorización continua de la presión intracraneal, a través de una ventriculostomía al exterior y de la presión de perfusión cerebral y las variables presión intracraneal y presión de perfusión cerebral. Resultados: Se estudiaron 41 niños. Predominaron aquellos entre 5 y 17 años con 35 casos (85,3 %). La presión de perfusión cerebral en menores de 1 año fue >47mmhg en los dos casos estudiados, de 1-4 años >47mmhg en 2 casos y de 50mmhg en 23 casos (65,7 %) y 50mmhg se asoció con el grado V de la escala de resultados de Glasgow. Discusión: El control de la presión de perfusión cerebral con valores diferentes ajustados a los diferentes grupos de edades, a través de la manipulación de la presión intracraneal y la presión arterial media en el niño, mostró una adecuada relación con los resultados favorables.

ABSTRACT Introduction: Mortality from severe head injury (TBI g) in pediatric patients increases in direct proportion to the severity of the initial injury. It is estimated between 1 and 7% of children under 18 years of age affected by this disease in the world. The incidence of death from this cause ranges from 2.8 to 3.75 per 100,000 children annually. Methodology: A correlational descriptive study was carried out in the pediatric intensive care service of the General Teaching Hospital "Roberto Rodríguez" in Morón, Ciego de Ávila, Cuba, in the period between January 2003 and December 2017. Minor patients were included of 18 years. The interventions were continuous monitoring of intracranial pressure, through an external ventriculostomy and cerebral perfusion pressure and the variable intracranial pressure and cerebral perfusion pressure. Results: 41 children were studied. Those between 5 and 17 years old predominated with 35 cases (85.3%). Cerebral perfusion pressure in children under 1 year of age was> 47mmhg in the two cases studied, from 1-4 years> 47mmhg in 2 cases and 50mmhg in 23 cases (65.7%) and 50mmhg was associated with grade V on the Glasgow Outcome Scale. Discussion: The control of cerebral perfusion pressure with different values adjusted to the different age groups, through the manipulation of intracranial pressure and mean arterial pressure in the child, showed an adequate relationship with the favorable results.

Factores pronósticos del traumatismo craneoencefálico grave / Prognostic factors for severe head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno frecuente, asociado a elevadas tasas de morbilidad. Clásicamente se ha prestado más atención al traumatismo craneal grave o severo, dada la trascendencia del problema sanitario. Objetivo: Describir una serie de pacientes mayores de 14 años, que sufrieron TCE grave atendidos en el Hospital Universitario de Getafe entre los años 1993 y 2015 (n = 86), estudiar el perfil epidemiológico de presentación, y analizar el diagnóstico y tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas en Consultas Externas. Resultados: El TCE grave es más frecuente en varones, y el mecanismo causante más común en nuestro medio es el accidente de tráfico. En este estudio, las variables que han resultado más determinantes de la evolución adversa en el paciente que sufre trauma craneal grave son la edad, el tamaño y la reactividad pupilar, la peor puntuación obtenida por el paciente en la escala de Glasgow para el Coma y las lesiones encontradas en la Tomografía Computarizada (TC) de cráneo. Conclusiones: Las lesiones en el trauma craneal grave se pueden categorizar en nueve patrones patológicos de acuerdo con la información aportada por la TC. Estos patrones presentan un perfil anatómico, clínico y una significación pronóstica bien definidos, asociándose a su vez a un patrón de comportamiento de la PIC característico. Los hematomas extra-axiales puros son las lesiones que presentan mejor pronóstico, siendo la lesión axonal difusa asociada a hinchazón cerebral y las contusiones múltiples bilaterales las que conllevan peor evolución. La Escala de Rimel se ajusta correctamente a la severidad del traumatismo craneal. La Escala de Glasgow para el Coma se relaciona bien con el pronóstico final del paciente con trauma craneal grave.

Introduction: Head injury is a very frequent event, associated with high morbidity rates. Classically, more attention has been paid to severe trauma. This paper describes a large series of patients, all ≥14 years old, who suffered severe head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by in-house neurosurgical consultations to determine final outcomes. Results: In this study, the variables that were most determinant of poor outcomes in patients with severe head injuries were patient age, the initial size and reactivity of their pupils, their worst Glasgow Coma Scale score, and lesions found on brain computed tomography (CT). Conclusions: Severe head injuries can be categorized into nine pathological patterns, based upon brain CT findings. Each pattern has a distinct anatomical and clinical profile and well-defined prognostic significance, in turn associated with behavior patterns characteristic of intracranial pressure (ICP). Pure extra-axial hematomas are associated with the best prognosis, with diffuse axonal lesions associated with brain swelling and multiple bilateral contusions the worst. The Rimel Scale accurately adjusts to the severity of head trauma. The Glasgow Coma Scale is a good predictor of ultimate outcomes in patients with severe head injuries.

Efficacy Observation of Bifid Triple Viable Capsules Combined with Early Enteral Nutrition in Patients with Severe Head Injury / 中国药师

Objective:To discuss the efficacy of bifid triple viable capsules combined with early enteral nutrition in the patients with severe head injury. Methods:Totally 80 cases of patients with severe head injury were divided into the observation group and the control group at random. The patients in the observation group were given bifid triple viable capsules combined with early enteral nutri-tion supporting treatment, while the patients in the control group were only given early enteral nutrition supporting treatment. The oc-currence rates of alteration of intestinal flora and diarrhea in the two groups were observed after the 10-day medical treatment, and the changes of GCS,SOFA and APACHE scores,serum ALb,Hb and adverse reactions were compared before and after the medical treat-ment. Results:After the 10-day medical treatment, the GCS score of patients in the two groups was increased when compared with that before the treatment,while SOFA and APACHE scores were lower than those before the treatment (P0. 05). Conclusion:Bifid triple viable capsules combined with early enteral nutrition have favorable curative effect with good safety in the patients with se-vere head injury.

Serial Brain CT Scans in Severe Head Injury without Intracranial Pressure Monitoring / 대한신경손상학회지

OBJECTIVE: The intracranial pathologies after head trauma should be usually progressed. It is clearly visualized in the non-invasive brain CT. The invasive monitor such as intracranial pressure (ICP) monitoring may be accompanied with the complications. This study aims whether the patients with severe head injury could be managed with serial CT scans. METHODS: The medical records of 113 patients with severe head injury in the prospectively enrolled trauma bank were retrospectively analyzed. After the emergency care, all the patients were admitted to the intensive care unit for the aggressive medical managements. Repeat brain CT scans were routinely taken at 6 hours and 48 hours after the trauma. ICP monitoring was restrictively applied for the uncertain intracranial pressure based on the CT. The surgical intervention and the mortality rate were analyzed. RESULTS: Immediate surgical intervention after the initial CT scan was done in 47 patients. Among the initially non-surgical patients, 59 patients were managed with the serial CT scans and 7 with the ICP monitoring. Surgical interventions underwent eventually for 10 patients in the initially non-surgical patients; 1 in the ICP monitoring and 9 in the serial CT. The mortality rate was 23.7% in the serial brain CT and 28.6% in the ICP monitoring. There was no statistical difference between two groups in the aspect of mortality (p=0.33). CONCLUSION: Serial CT scans in time could be a good way to monitor the intracranial progression in the severe head injury and reduce the implantation of an invasive ICP probe.

Hiperglicemia na admissão é um preditor confiável da evolução de crianças com traumatismo cerebral grave / Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

OBJETIVO: Identificar a relação entre hiperglicemia na admissão e desfecho das crianças com traumatismo cerebral grave na alta hospitalar e 6 meses depois. MÉTODO: Análise retrospectiva da glicemia de 61 crianças com traumatismo cerebral grave admitidas na unidade de tratamento intensivo pediátrico entre 1/11/2005 e 30/10/2009. Foi considerado um ponto de corte de > 150 mg/dL para o diagnóstico da hiperglicemia, com base na literatura. A evolução foi avaliada pela escala de resultados de Glasgow na alta hospitalar e 6 meses após a alta. O óbito também foi analisado como uma evolução. RESULTADOS: A glicemia média dos pacientes na admissão foi de 251 mg/dL (68-791). Verificou-se hiperglicemia na admissão em 51 pacientes (83,6 por cento). Encontrou-se uma correlação positiva moderadamente significativa entre glicemia na admissão e gravidade do traumatismo craniano segundo a escala abreviada de injúrias (r = 0,46). A glicemia média dos não sobreviventes foi significativamente maior (207 mg/dL versus 455 mg/dL, p < 0,001). A glicemia média dos pacientes com má evolução foi significativamente maior, comparada à daqueles com boa evolução, na alta hospitalar e 6 meses após a alta (185 mg/dL versus 262 mg/dL, p < 0,15 e 184 mg/dL versus 346 mg/dL, p < 0,04, respectivamente). CONCLUSÕES: A hiperglicemia pode ser considerada um marcador de lesão cerebral e, quando presente na admissão, pode refletir um dano cerebral extenso, frequentemente associado a desfecho negativo e mortalidade. São necessários mais estudos para investigar o efeito do controle rigoroso da glicemia sobre a mortalidade e a evolução.

OBJECTIVE: To identify the relationship between admission hyperglycemia and outcome in children with severe brain injury at hospital discharge and 6 months later. METHOD: A retrospective analysis of blood glucose levels was conducted in 61 children with severe brain injury admitted to the Pediatric Intensive Care Unit between November 1, 2005 and October 30, 2009. Hyperglycemia was considered for a cut off value of > 150 mg/dL, based on literature. Outcome was measured with the Glasgow Outcome Scale at hospital discharge and 6 months after discharge. Death was also analyzed as an outcome measure. RESULTS: Mean admission blood glucose of the patients was 251 mg/dL (68-791). Hyperglycemia was noted on admission in 51 (83.6 percent) patients. A moderately significant positive correlation was found between admission blood glucose and severity of head trauma according to Abbreviated Injury Score (r = 0.46). Mean admission glucose level of non-survivors was significantly higher (207 mg/dL vs. 455 mg/dL, p < 0.001). Mean blood glucose level of the patients in bad outcome group was found significantly higher compared to that of the patients in good outcome group at hospital discharge and 6 months after discharge (185 mg/dL vs. 262 mg/dL, p < 0.15 and 184 mg/dL vs. 346 mg/dL, p < 0.04, respectively). CONCLUSIONS: Hyperglycemia could be considered as a marker of brain injury and, when present upon admission, could reflect extensive brain damage, frequently associated with mortality and bad outcome. Further studies are needed to investigate the effect of strict glycemic control on mortality and outcomes.

Relationship between oxyhemoglobin saturation in internal jugular vein (cerebral extraction of oxygen) and prognosis of head injury / 中华急诊医学杂志

Objective To observe blood gas analysis of internal carotid artery and internal jugular vein to calculate the cerebral extraction of oxygen, and to investigate the relationship between oxyhemoglobin in internal jugular vein, cerebral extraction of oxygen, and the prognosis of patients with head injury. Method Seventy patients with acute severe head injury in ICU of Taizhou People Hospital were studied, and another 80 patients with mild head injury were enrolled as controls. Twenty-four hours after first aid such as keeping airway open and circulatory and ventilation support, and emergency craniotomy, the blood samples from internal carotid artery and internal jugular vein were collected for blood gas analysis including SaO2, PaO2, SjvO2, PJVO2 > PaCO2, PJVCO2, SaO2-SjvO2, Pa-jvCCO2, CaO2-CjvO2 and Ca-jvO2/CaCO2 (CEO2, cerebral oxygen extraction). Results There were significant differences in SjvO2, PjvO2, Sa-jvO2, Pa-jvO2 Ca-jvO2 and CEO2 between two groups. Conclusions The SjvO2 and CEO2 represent the cerebral oxygen uptake and oxygen consumption precisely, and they can be used to predict the outcome of patients with severe craniocerebral trauma commendabiy.

Influence of probiotics on the gut microflora,digestive enzymes and intestinal motility in rats with severe head injury / 中国实用护理杂志

Objective To study the influence of probiotics on the gut microflora,digestive enzymes and small intestinal propulsive rate of rats with severe head injury. Methods The rat model of severe head injury was prepared, SD rats were randomly divided into group A (enteml nutrition) , group B (enteral nutrition plus probiotics) , and group C (normal diet) . The intestine mucesa and faeces were collected on the third day,7th day and 14th day after head injury in order to detect gut microflora,digestive enzymes and small intestinal propulsive rate. Results Compared with group C, the number of Lactobacillus and Bacillus bifidus group in group A and group B declined in two weeks after trauma, however, the number of Escherichia coli increased significantly. Bacillus bifidus amounts of group A were significantly lower than that of group B at every time point, the diversity of Escherichia coli was opposite. No difference was seen in content of Lactobacillus 7 days after trauma in group A and B. The level of disaecharidases, Na+- K+- ATPase and small intestinal propulsive rate declined significantly at every time point, compared with group C.Though the contents of digestive enzymes was higher in group B than that of group A, and small intestinal propulsive rate was higher in group A and B than that in group C, but the two groups showed no difference. Conclusions Probiotics can alleviate the in-testine microflora disorder,modulate the activities of digestive enzymes, therefore lessen malabsorption of rats with severe head injury.

Observation in effect of early oxygen atomizing inhalation with oxygen mask on correction of hy-poxemia of patients with severe head injury / 中国实用护理杂志

Objective To explore the feasibility and safety of early oxygen atomizing inhalation with oxygen mask on correction of hypoxemia of patients with severe head injury in order to promote the early recov-ery of patients. Methods 98 cases of patients with severe head injury were randomly divided into the obser-vation group(48 cases) and the control group(50 cases), the observation group received conventional treatment as well as oxygen atomizing inhalation with oxygen mask, the control group used nasal catheter with wet gauze covering mouth and nose for oxygen supply. Results The arterial oxygen saturation rate, partial pressure of oxygen markedly improved in the observation group. Significant difference existed in mortality rate between the two groups, while no significant difference was seen in heart rate, blood pressure, pH and PaCO2 between the two groups. Conclusions Oxygen atomizing inhalation with oxygen mask can quickly and effectively correct the hypoxic state and correct hypoxemia of patients with severe head injury.

Bilateral cortical atrophy after severe brain trauma and extradural homatoma

We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.

Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões.

Systematic therapy on severe head injury with brain herniation / 中国康复理论与实践

@#Objective To explore the treat methods in severe head injury (SHI) with brain herniation.Methods 73 patients suffered from SHI with brain herniation, who were undertaken system therapy in every different phase of post-trauma, were analyzed retrospectively.Results There were 17 patients died and 14 patients was GOS Ⅴ grade.Conclusion The systematic therapy in every different phase can enhance the synthetic therapeutic level of SHI and reduce the mortality and elevate the quality of life.

Effect of L-arginine supplemented enteral nutrition on cellular immunological function in rats with severe head injury / 肠外与肠内营养

Objectives:The study was designed to observe the effects of L-arginine(Arg) supplemented enteral nutrition on cellular immunological function in rats with severe head injury.Method:The severe head injury of rats was produced by gas percussion.Thirty rats were divided randomly into 3 groups(n=10): normal control group,enteral nutrition(EN)group and EN+Arg group.Rats in groups EN and EN+Arg were supplemented with tyrosine at the does of 0.8g?kg~(-1)?d~(–1)and Arg at the dose of 0.8g?kg~(-1)?d~(–1)for 7days,respectively.Blood samples were collected after 7 days.PMN phagocytosis rate was observed by phagocytosis Candida albicans count.CD4~(+)cells and CD8~(+) cells were analyzed by SABC.The concentration of serum IL-2 level was measured by radioimmunoassay.Results:Decreased cellular immunolgical function was found on 7~(th) day after severe head injury.However,CD4~(+),CD4~(+)/CD8~(+),IL-2 level and PMN phagocytosis rate in EN +Arg group were better than that in EN group.There was significant difference in each immunological index(P

Effect of arginine-enriched enteral nutrition on cellular immunological function and protein metabolism in rats with severe head injury / 第三军医大学学报

0.05),but significant difference existed on the 7th day after injury. The Cor content of group Arg was noticeably lower than that of group EN on each time point(P

Mechanism of acute lung injury secondary to isolated severe head injury in rats / 第三军医大学学报

Objective To study the mechanism of acute lung injury secondary to isolated severe head injury.Methods Twenty-two male SD rats were randomly divided into normal group(NG,n=4),and trauma group(TG,n=18)which were sacrificed respectively on day 1,3,7.The pathomorphological changes were observed by light and electron microscope.The levels of tumor necrosis factor-alpha(TNF-?)and interleukin-8(IL-8)in bronchoalveolar lavage fluid(BALF)were investigated by radioassay(RIA).The level of soluble intercellular adhesion molecule-1(sICAM-1)in BALF was measured by enzyme linked immunosorbent assay(ELISA).Results Capillary congestion,inflammatory cell infiltration and thickening of alveolar septum were detected in TG from day 1 to 7 by light microscope.The histological score of lung on day 3 in TG was significantly higher than that on day 1 and 7.The ultramicroscopic structure of lung showed swelling of vascular endothelial cells,infiltration of polymorphonuclear neutrophil and monocyte,injury of pulmonary epithelial cells in TG from day 1 to 7.The levels of TNF-?,IL-8 and sICAM-1 in BALF in TG were significantly higher than that in NG and the peak values were on day 3.The histologic score in TG was positively correlated with the levels of TNF-?,IL-8 and sICAM-1 in BALF.Conclusion Isolated severe head injury could induce acute lung injury that reached the most severe degree on day 3.The elevation of such proinflammatory cytokines as TNF-?,IL-8 and sICAM-1 in BALF plays an important role in the development of excessive inflammatory response of lung injury secondary to isolated severe head injury.

Investigation of potential predictors in severe head injuries

Among 162 patients with head injury treated in Cho Ray Hospital. Mortality 36.3% of the whole. Multivariant regressive analysis showed that: Glasgow coma scale score (p<0.001), pupil reflex (p=0.027), subdural hematoma on CT (p=0.001) were strongly correlated with the outcome 48 hours after the injury.

Prognostic Factors in Patients with Severe Head Injury

OBJECTIVE: To elucidate the problems that must be dealt with in the prognosis of patients with severe head injury and to find out the prognosis factors related to severe head injury. METHODS: A clinical analysis was carried out retrospectively with 292cases of severe head- injured patients (Glasgow coma scale score 3-8) admitted to the our department for 10 years from January 1987 to December 1996. RESULTS: Patients who were classified as having severe brain injury belonged to 13.1% of all craniocerebral trauma cases among which sixty-three cases had diffuse brain injury. The causes of head injuries were motor vehicle accident, falls from heights, bicycle and other causes in order of frequency. Pediatric patients showed better outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients with high initial GCS score(6-8, 47.9%) had significantly better outcome than the patients with low initial GCS socre(3-5, 16.9%) (p<0.0001). Fifty point three percents of patients with good motor response had good outcome, whereas only 15.8 percent in patients with poor motor response. The cases with diffuse head injury without basal cistern compression had significantly higher percentage of good outcome(74.0%) than those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary reaction had significantly higher percentage of good outcome(50.3%) than those with bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had good outcome(48.1%), compare to 20.3% of patients without skull fracture(p<0.0017). CONCLUSION: The good prognostic factors in this study were young age, initial high Glasgow coma scale, good motor response, diffuse brain injury type I, II, bilaterally intact light reflex, with skull fracture. Individual prognostic factor is significant to indicate the patient's outcome and may be utilized for assessing the relative efficacy of the alternative treatment and prognosis.

Effects of total parenteral nutrition in the treatment of severe head injuries / 肠外与肠内营养

Twenty- five patients with severe head injury underwent early total parenteral nutrtion (TPN) support,and the blood glucose,serum albumin,body nutritional index and nitrogen balance were monitored in our case- controll study.We find that the patients with severe head injury could get more energy and protein from TPN than from enteral nutrition (EN) ,the mortality of the patients with TPN was significantly lower than the patients with EN.The total nutrient admixture(TNA) in our study can provide sufficient energy and protein,but cannot raise blood glucose,so it can make a good condition for the recovery of the severe head injuries.

Prognostic Factors and Its Utility in Severe Head Injured Patient

The prognosis of severe head injured patients (Glasgow coma scale 3 to 8) was assessed through clinical prognostic factors in 209 cases, retrospectively. Severe head injured patients were 9.1% of all head trauma and 55% of cases were diffuse brain injury. Mechanism of injury were motorvehicle accident, falls, bicycle, and others. The patients with normal pupillary reaction had a significantly higher percentage of good outcome (77%) than the patient with bilateral 3rd nerve palsy (14.2%)(p<0.0001), 79% of good motor responsive patients had a good outcome compared to none of patients with poor motor response(p<0.0001). The patients with short duration of unawareness(within 30days) significantly higher percentage of good outcome(98%) than the patients with long duration of unawaereness(24%)(p<0.0001). The patients with initial high GCS score(6-8 score) had a significantly higher good outcome(58%) than the patients with low GCS score(3-5 score)(p<0.0001), 87% of pediatric patients had a good outcome compared to 38% of adults(p<0.0001). The diffuse head injured patients without basal cistern compression had a significantly hgher percentage of good outcome(83%) than the patients with basal cistern compression(41%)(p<0.0001), 62% of patients with skull fracture had a good outcome compared to 39% of patients without skull fracture(39%)(p<0.0017). Individual prognostic factors affect to patient's outcome and utilize to be powerful tool for assessing the relative efficacy of alternative treatments as well as patient's prognosis.

Modern Treatment of Severe Head Injury

Recently advanced treatment of head injury has substantially improved result. Aggressive and intensive treatment has not only saved lives but has also reduced morbidity. This article elucidates the problems that must be dealt with in the management of severe head injury patients and develops guidelines in basic principles of modern treatment of head injury in making surgical decision. The rapid establishment of adequate ventilation and circulation is the first step. Next is followed by rapid evacuation of space-occupying mass lesions. Intensive monitoring of intracranial pressure and cerebral perfusion pressure is important. Finally deteriorating secondary injuries should be avoided. Many drugs have been claimed to be beneficial in animal studies, including lipid peroxidation inhibitors, free radical scavengers, NMDA receptor blockers, calcium channel blockers, monosialic gangliosides, and polyamine. New agents with efficacy either in lowering raised ICP or protecting the nervous system are introduced, and the results of their application are to be included.