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Objective:To explore the effect of diabetes specific Enteral Nutritional Suspension on patients with severe brain injury.Methods:from March 2018 to April 2021, 117 patients with severe brain injury were selected from the Department of Neurosurgery of Yantai Mountain hospital of Yantai city. They were divided into 2 groups according to the random number table. The control group received enteral nutrition (EN) preparation (n=59) , while the observation group was treated with diabetes specific Enteral Nutritional Suspension (n=58) for 2 weeks, and two groups of immunoglobulin A were compared. (IGA) , immunoglobulin G (IgG) , immunoglobulin M (IgM) , total cholesterol (TC) , low density lipoprotein (LDL) , triglyceride (TG) , glycosylated hemoglobin (HBAIC) , fasting blood glucose (FBG) , 2 h postprandial blood glucose (2hbg) and the positive rate of bacterial DNA in peripheral blood at each time period. The positive rate was analyzed by SPSS 22.0 software χ 2 test, repeated measurement was analyzed by analysis of variance, and pairwise comparison was performed by LSD-t test.Results:The positive rates of bacterial DNA in peripheral blood of the observation group were 10.34%, 5.17% and 0.00% on the 7th day and 14th day after treatment, which were lower than 25.42%, 16.95% and 8.47% in the control group (P = 0.034, 0.043 and 0.023) . 2 weeks after treatment, the levels of BG (7.46±1.22) mmol/L, FBG (5.26±1.11) mmol/L, HBAIC (6.33±0.45%) , TG (1.11±0.12) mmol/L, TC (4.22±0.68) mmol/L, LDL (1.39±0.13) mmol/L in the observation group were lower than those in the control group, 2hbg (10.69±1.57) mmol/L, FBG (8.18±1.46) mmol/L, HBAIC (7.46±0.34%) , TG (1.86±0.26) mmol/L, TC (6.65±1.17) mmol/L and LDL (2.79±0.41) mmol/L, ( P<0.001) , IgM, IgA and IgG were (1.57±0.26) g/L, (1.86±0.43) g/L, (10.13±1.46) g/L, and IgM, IgA and IgG were (1.86±0.47) g/L, (2.86±0.39) g/L, (13.28±1.96) g/L, respectively, 1 week after treatment. The improvement of all indexes were better than that of the control group The IgM, IgA and IgG of (0.86±0.13) g/L, (1.35±0.11) g/L, (8.66±1.57) g/L and 2 weeks after treatment were (1.10±0.11) g/L, (2.13±0.11) g/L and (10.45±1.46) g/L respectively ( P<0.001) . Conclusion:The special enteral nutrition suspension for diabetes patients with severe brain injury can improve the immune function and glucose and lipid metabolism of the body, and reduce the positive rate of bacterial DNA.
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Respiratory management in patients with acute severe brain injury is an important part of the integrated critical management.A series of special pathophysiological changes and clinical manifestations after brain injury make it different from non-central nervous system diseases.Lung protective ventilation strategy and evidence from clinical trials have challenged the traditional view of respiratory management:hypocarbonemia and low PEEP strategy are no longer routine options for respiratory management in patients with brain injury,but respiratory management still needs to follow the principle of "avoiding secondary injury".Multimodal neuromonitoring shows good prospects,which is helpful to achieve the precision of respiratory management by optimizing the targets of the management of intracranial pressure,cerebral perfusion and cerebral oxygen metabolism.
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Objective To evaluate the effects on nutritional intakes and clinical outcomes of severe brain injury patients receiving percutaneous gastrojejunostomy (PEG-J) feedings. Methods The severe brain injury patients treated in ICU of Changshu No.1 Hospital from Jan 2013 to Dec 2016 were enrolled in the study. Patients were randomized into: control group, patients received nasoduodenal feedings and treatment group, patients received PEG-J feedings. The feeding speed was adjusted according to the amount of gastric residual or reflux vomiting. The daily dose of enteral nutrition in the first week, endocrine function, immune function, nutritional states and clinical outcomes were recorded. Results Totally 87 patients were enrolled in this study, 45 patients in the control group and 42 patients in the treatment group. The daily dose of enteral nutrition of the treatment group were significantly more than the control group from the fourth to the seventh days (P= 0.001, <0.01, 0.024), the CD4+T-lymphocyte percentage and CD4+/CD8+ ratio were significantly higher in the treatment group on day 7 (P=0.03, 0.01), levels of thyroidstimulating hormone, free triiodothyronine and free thyroxine of the treatment group were higher (P=0.036, 0.013, 0.025), and the level of hormonal was lower in the treatment group (P=0.004).The levels of albumin, prealbumin and insulin dosage were not significantly different between the two groups, neither did mortality, rates of organ failures. But the treatment group has a higher Barthel index scores (P=0.049), shorter length of mechanical ventilation and stay ICU (P=0.044, 0.048), and the lower incidence of vomiting and ventilator associated pneumonia (P=0.013, 0.037). Conclusions PEG-J could increase energy intake, improve immunity and endocrine function, promote the recovery of life ability, reduce the incidence of VAP, shorten mechanical ventilation time and ICU stay in severe brain injury patients.
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Objective:To explore the clinical effect of hyperbaric oxygen plus magnetic stimulation and Xingnaojing injection on the coma patients with severe brain injury.Methods:120 coma patients with severe brain injury who were treated in our hospital from September 2011 to March,2016 were enrolled in the present study.According to different therapies,they were divided into the observation group (55 cases) and control group (65 cases).Both groups received conventional therapy and Xingnaojing injection,on the the basis of which,the control group received the Hyperbaric Oxygen therapy,while the observation group received Magnetic Stimulation on the basis of control group.The GCS,level of inflammatory factors,clinical prognosis as well as memory function were compared between the two groups.Results:After the therapy,the GCS score of both groups were obviously increased and that of observation group was significantly higher than control group (P＜0.05);the serum level ofCRP,TNF-oα,IL-6 levels were significantly decreased compared with those before therapy,and those of observation group were obviously lower than the control group (P＜0.05);the total effective rate of ob servation group was 94.55％ (52/55),which was equivalent to the control group (89.23％,P＞0.05);the long term memory,short term memory,instantaneous memory and memory quotient of observation group were significantly higher than those of the control group.Conclusion:Hyperbaric oxygen plus magnetic stimulation and Xingnaojing injectionon was effective on the coma patients with severe brain injury,it could down-regulate the inflammatory response,promote awake and recovery of memory function.
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Objective:To evaluate the effect of early enteral nutrition supplemented with synbiotics on the levels of C reactive protein (CRP) and Procalcitonin(PCT)level of patients with severe brain injury.The clinical outcomes were also observed.Methods:Forty-seven patients with identified severe brain injury were randomized into study group (n =24) and control group (n =23).All patients received enteral nutrition via nasogastric tube within 24 to 48 h following admission.Patients in the study group were also given synbiotics.Fasting blood samples were collected for detecting the levels of CRP,PCT on day 1,4,7 and 15,respectively.The incidence of lung infection,the length of ICU stay,the cost,the GCS score,the APACHE Ⅱ score,and the mortality in 30 days after administration were collected and compared between 2 groups.Results:Patients in the study group had a lower level of PCT than control group on day 7 and 15 (P ＜0.05,P ＜0.05),and a lower level of CRP on day 15 (P ＜0.01)was also found in the study group.The incidence of lung infection of the study group was also significantly lower than the control group (P ＜ 0.05).A reduced length of hospital stay and a lower cost were found in the study group (P ＜0.05).The GCS scores in the study group was higher on day 15 when compared with that in the control group (P ＜ 0.05).However,There was no significant change in APACHE Ⅱ score and mortality in 30 days(P ＞ 0.05).Conclusion:Nutrition supplemented with synbiotics leads to a lower rate of infection,a shorter length of ICU stay,a reduced the cost,and a better outcome in patients with severe brain injury.
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Objective To explore the influence of different methods of bandaging on the postoperative intracranial pressure of patients with severe brain injury patients after decompression craniectomy. Methods The standard decompressive craniectomy was use for the 36 cases of severe traumatic brain injury patients, and the intracranial pressure monitoring sensor probe was indwelled in operaion. Two different dressing methods of elasticity mesh cap and applicator were used for the patients respectively at 0h, 72h, 120h and 168h after operation, and the value of intracranial pressure was monitored and recorded. Result The intracranial pressure of elastic cap were significantly higher than the applicator respectively in operation immediate postoperative 72h, 120h and 168h (P<0.05), the difference was statistically significant. Conclusions The intracranial pressure of elastic cap is significantly higher than the applicator at different times after the surgery group.
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Objective To investigate and evaluate the diagnostic value of transcranial doppler ultrasound (TCD) on brain death in patients with severe craniocerebral injury.Methods Forty-two cases of severe craniocerebral injury from Affiliated Hospital of Jining Medical University were divided into brain death group and survival group,according to the clinical prognosis.TCD was conducted to examine brain blood flow numerical and changed characteristics of the spectrum.Average blood flow velocity (Vm),pulse index (PI),diastolic blood flow in reverse (reverberating flow) and small systolic peaks in early systole (wave of spikes)were documented.TCD parameters were compared between the two groups with t test.Results In the brain death group,frequency of reverberating flow was 86.67％ and frequency of wave of spikes was 13.33％.In survival group,frequency of reverberating flow was 14.81％ and no wave of spikes was recorded.The difference in frequencies of reverberating flow and wave of spikes between the two groups was significant(x2 =28.25,P ＜0.01).The average speed of bilateral middle cerebral artery blood flow in brain death group((20.02±13.96) cm/s) was significantly reduced compared with survival group((56.81± 16.84) cm/s,t=2.30,P＜0.05).Pulse index (PI) values in brain death group (4.02±3.49)were significantly increased compared with survival group (1.24±1.03) (t=2.10,P＜0.05).Conclusion Reverberating flow or wave of spikes is an important marker for brain death in patients with severe craniocerebral injury.TCD may be applied to clinically confirm the diagnosis of brain death.
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Objective To observe the clinical efficacy of endovascular -hypothermia in treatment of severe brain injury.Methods 40 cases of severe brain injury were given the endovascular -hypothermia treatment and the basic treatment accordingly.The time to reach target temperature and the stability to maintain target temperature were observed.The patients'ICP at different points were recorded .The cases were estimated by Glasgow Coma Scale (GCS) before and after treatment and their complications during treatment were observed .Results The time to reach target temperature was (136 ±42)min and only (6.20 ±1.68)% of the measurement time deviated from target tempera -ture.ICP was reduced as the temperature fell and maintained in normal range after re -warming process.The ICP af-ter treatment was significant difference (p <0.05).The GCS was also significant higher after treatment than before (p <0.05).The complications of the patients were fewer and can be controlled after corresponding treatments .Conclu-sion In the endovascular -hypothermia treatment, the time to reach target temperature was short and the stability to maintain target temperature was strong.The endovascular -hypothermia treatment can reduce patients 'ICP and improve their awareness.There was no serious complication during treatment .This treatment can be safe and reliable.
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Objective:To explore the participation mode of clinical pharmacists in anti-infective therapy. Methods:Clinical phar-macists provided rational medication suggestions for anti-bacterial and antifungal therapy, and carried out pharmaceutical care for one patient with lung and intracranial infection after decompressive craniotomy for severe brain injury. Results: According to the sugges-tions of clinical pharmacists, fluconazole therapeutic regimen and amphotericin B therapeutic regimen was applied in turn respectively with the treatment course of 32d and 28d. During the treatment, the pharmacists also provided therapy advice on the infection induced by Staphylococcus epidermidis and Pseudomonas stutzeri, ADR warning and monitoring of fluconazole and amphotericin B, and adjust-ment of anti-infective therapy according to the results of antimicrobial susceptibility testing. The therapeutic effect was significant. Conclusion:The participation of clinical pharmacists in drug treatment can optimize medical therapy, which contributes to the coopera-tion between doctors and pharmacists.
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Objective To evaluate the application of small dural window exposure strategy for removal of subdu-ral hematomas and decompressive craniectomy in patients with severe brain injury. Methods Eighty patients with an ad-mission Glasgow Coma Scale score of 8 or less were randomly divided into two groups:Routine craniectomy group (42 pa-tients) and small dural window exposure strategy group (38 patients). The clinical outcomes were compared between these two groups. Results The average quantity of blood transfusion (erythrocyte suspension)at 24 h was 2.85 ± 1.98 and 1.43±1.40 unit in the routine craniectomy group and small dural window exposure strategy group, respectively. The num-bers of the delayed intracranial hematomas, traumatic epileptic seizure as well as acute encephalomyelocele were 10, 12 as well as 9 in the routine craniectomy group and 2, 3 as well as 1 in the small dural window exposure strategy group. However, the time of operate duration and the incidence of cerebral infaction were not significantly different between two groups (P>0.05). After 6-month follow-up, there were 16 cases with favorable outcomes including 10 with good recov-ery and 6 with mild disability and 26 cases with unfavorable outcomes, including 7 with severe deficits, 6 with persistent vegetative status and 13 dead in the routine craniectomy group. In contrast, there were 23 cases with favorable outcomes including 12 good recovery and 11 mild disability and 15 cases with unfavorable outcome including 6 with severe deficits, 4 with persistent vegetative status and 5 dead in the small dural window exposure strategy (P﹤0.05). Conclusion small dural window exposure strategy is an excellent technique for the complete evacuation of the traumatic intracranial hemato-ma, especially those with massive intraoperative swelling .
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Objective To study the risk factors and to provide preventive measures of pulmonary infection for patients with severe brain injury.Methods A total of 320 patients with severe brain injury were analyzed with hospital-based case-control study method.A total of 101 patients complicated with lung infection were set as the experimental group.Another 101 patients with no pulmonary infection according to the proportion of 1:1 choice over the same period were set as the control group.The related factors were analyzed with the univariate analysis and the multiple factors Logistic regression analysis.Results Univariate analysis showed that the occurrence of pulmonary infection of patients with severe brain injury was closely related to the old age,low GCS score,long time stay in the bed,long time hormone application,long time antibiotic application,the combined underlying disease,use of mechanic ventilation,long-term smoking history and indwelling gastric tube.Multivariable Logistic regression analysis showed that the application of mechanic ventilator,the combined underlying disease and long time stay in bed were the independent risk factors for pulmonary infection of patients with severe brain injury,but GCS score was a protective factor.Conclusions The occurrence of lung infection were related to the ventilator application,the combined underlying disease,long time stay in bed and low GCS score.Considering these risk factors,the medical staffs should take preventive measures early to control lung infection.
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Objective To evaluate the application effect of evidence-based nursing in reducing ventilator-associated pneumonia (VAP) of patients with severe head injury. Methods 100 patients with severe head injury using mechanical ventilation were randomly divided into the control group and the observation group with 50 patients in each group.The observation group explored evidence from nursing of ventilator tube,oropharyngeal and sound sects care,airway care,balloon sleeves care to prevent biofilm on the endotracheal tube(ETT-BF) to fall off,enteral nutrition care,decubitus care,ward environment and the hand disinfection of medical staff and was given evidence- based nursing.The control group took routine care.The incidence of VAP,off-line time and mortality rate of the two groups were compared during the same time period. Results The incidence of VAP,off-line time,mortality rate showed significant difference between the two groups.The observation group showed better effect. Conclusions Implementation of evidence-based nursing can significantly reduce the off-line time of patients with severe traumatic brain injury using mechanical ventilation.It can decrease the incidence of VAP and mortality rate,improve the prognosis and reduce medical cost.
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Objective To discuss and summarize nursing measures of elderly patients with severe brain injury after tracheotomy. Methods A retrospective analysis was carried out in 60 elderly patients with severe traumatic brain injury after tracheotomy in our hospital from July, 2009 to August, 2010, all patients were given holistic nursing care, including close observation of patients' condition, controlling the suction time, methods and techniques, strict aseptic technique, to effectively prevent infection. Results In the implementation of the patient-centered holistic care, the results were significant, 49 cases survived the acute phase and finally removed tracheal tube. Only 5 patients had pulmonary infection, accounting for 8.3%. 3 patients died due to brain injury and 5 cases were discharged against advice, 3 patients did not gain extubation due to severe brain stem injury. Conclusions The patients with severe head injury need tracheotomy to maintain airway patency, timely call-back, suction, effective airway humidification, prevention of pulmonary infection, reduction of respiratory tract injury is key to successful treatment. The patientcentered holistic care is worthy of wide clinical application.
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Objective To evaluate the influence of early entemal nutrition and parenteral nutrition support on gastric juice pH in patients with severe brain injury. Methods Totally 168 patients with severe brain injury ( Glasgow Coma Scale ≤ 8 ) admitted to our hospital from January 2007 to May 2009 were equally and randomly divided into early enternal nutrition (EEN) group and parenteral nutrition (PN) group. Gastric juice pH and upper gastrointestinal hemorrhage were monitored on admission and on the 3rd, 5th, and 7th day after admission. Results The gastric juice pH was significantly decreased in patients with severe brain injury. In addition, it was significantly higher in EEN group than in PN group on the 3rd, 5th, and 7th day after admission ( P ＜ 0. 001 ). The alimentary tract hemorrhage incidence showed no difference on admission between two groups but was significantly lower in the EEN group on the 3rd, 5th, and 7th day ( P ＜ 0. 05 ). Conclusions Hypersecretion of gastric acid may occur in patients with severe brain injury. EEN can neutralize gastric acid and increase gastric juice pH,which may lead to the decrease of upper gastriontestiual hemorrhage. Monitoring of the gastric juice pH also can provide a warning message of stress ulcer bleeding.
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Objective To investigate the characteristics of pathogenic bacteria and drug resistance and susceptible factors of pulmonary infection in patients with severe brain injury and to provide a guideline for the prevention and control of infection.Methods Bacteria culture results combined with clinical data of pulmonary infection in patients with severe brain injury were analyzed retrospectively in our hospital from Jan.2004 to Dec.2008.Results The patients with severe brain injury were often complicated by pulmonary infection.Gramnegative bacilli were main pathogenic bacteria leading to pulmonary infection ( 74.8% ),including pseudomonas aeruginosa ( 21.0% ),Escherichia coli ( 16.5% ),baumanii ( 13.6% ),pneumobacillus ( 7.7% ),enterobacter cloacae (6.3% ) and others.Thirty-nine Gram-positive bacilli were observed including Staphylococcus anreus,coagulase negative staphylococcus,enterococcus and others.There were 21 fungus infection observed.Conclusions Overall and systematically monitoring the condition of pathogenic bacteria distribution and drug resistance of pulmonary infection in patients with severe brain injury have important significance to select antibiotics and effectively prevent and control pulmonary infection.
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@#ObjectiveTo explore the effects of hyperbaric oxygen (HBO) on severe brain injury. Methods60 patients with severe brain injury were divided into control group and treatment group. They were treated with neurosurgical conventional therapy, and HBO for treatment group in addition. They were assessed with Glasgow Coma Scale (GCS) before and after treatment, and Glasgow Outcome Scale (GOS) 3 and 6 months after treatment. ResultsCompared with control group, there is significant improvement in GCS (P<0.05) and GOS (P<0.05) in treatment group. ConclusionHBO has immediate and long-term efficiency on severe brain injury.
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Objective To explore the measures to prevent acute encephalocele during the decompressive craniotomy in the patients with severe brain injury.Methods The clinical data of 28 patients with severe brain injury,who were treated by extended fronto-temporo-prietal craniotomy were analyzed retrospectively.The sequential dural ineision(SDI)was performed during the operation in all the patients.Results The catastrophic encephalocele did not occur in all the cases even if very hish intracranial pressure wag caused by fulminant brain swelling in some cases.The total removal of hematomas was achieved in 19 cases,but there still was extensive hemorrhage in the operative fieId in 4 eases and secondary intracranial hematomas in the other regions in 5 cases observed on postoperative CT scan.The disappeared basal cistern and the third ventricle could be observed again in 12 eases.According to GOS,9 patienm obrained good recovery,5 was moderately disabled,4 were severely disabled,2 vegetatively survived,and 8 died.Condusion The encephalocele,which is easily produced by rapid decompression,is prevented by eontrollable decompression as early as possible and SDI in the patients with especially severe brain injury.
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BACKGROUND: Disorders of water and sodium balance are frequently seen in patients with severe brain injury (SBI), and may worsen their prognosis. PURPOSE: To evaluate vasopressin (AVP) serum levels and sodium and water balance disorders during the first week post-injury in patients with SBI. METHOD: Thirty-six adult patients with SBI (admission Glasgow Coma Scale score < 8) and an estimated time of injury < 72 hours were prospectively studied. Clinical and laboratory data were recorded and AVP was measured in venous blood samples collected on the 1st, 2nd, 3rd and 5th days following inclusion. RESULTS: AVP serum levels remained within the normal range in SBI patients (either traumatic or non-traumatic), although tended to be greater in non-survivor than in survivor patients (p=0.025 at 3rd day). In-hospital mortality was 43 percent (15/36), and serum sodium and plasma osmolality variabilities were greater in non-survivor than in survivor patients during the observation period (p<0.001). CONCLUSION: AVP serum levels remained within the normal range values in these SBI patients, but those who died have shown higher incidence of abnormal sodium and water balance during the first week post-injury.
ANTECEDENTES: Desordens do balanço de água e sódio são frequentemente vistas em pacientes com lesão cerebral grave (LCG), podendo agravar o prognóstico. OBJETIVO: Avaliar os níveis séricos de vasopressina (AVP) e a incidência de distúrbios da água e sódio na primeira semana pós-lesão em pacientes com LCG. MÉTODO: Trinta e seis pacientes adultos com LCG (pontuação inicial na escala de coma de Glasgow < 8) e tempo estimado de lesão < 72h foram estudados prospectivamente. Dados laboratoriais e clínicos foram registrados e os níveis séricos de AVP foram mensurados no 1º, 2º, 3º e 5º dias pós-inclusão. RESULTADOS: A AVP manteve-se dentro da faixa de normalidade nestes pacientes, mas mostrando-se proporcionalmente mais elevada nos pacientes que não sobreviveram (p=0,025 no 3º dia). A mortalidade intra-hospitalar foi 43 por cento (15/36) e as variações do sódio e osmolalidade plasmáticos foram maiores nos pacientes que não sobreviveram durante o período de observação (p<0,001). CONCLUSÃO: Os níveis séricos de AVP mantiveram-se dentro da faixa de normalidade nestes pacientes com LCG, mas aqueles não sobreviventes mostraram maior incidência de anormalidades do balanço de água e sódio durante a primeira semana de evolução.
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Adult , Female , Humans , Male , Brain Injuries/blood , Vasopressins/blood , Water-Electrolyte Imbalance/complications , Acute Disease , Biomarkers , Brain Injuries/complications , Brain Injuries/urine , Case-Control Studies , Glasgow Coma Scale , Osmolar Concentration , Prospective Studies , Sodium/blood , Sodium/urineABSTRACT
Objective To study the changes of blood arginine vaso-pression(AVP)levels in patients with severe brain injury after treated with mild hypotherima.Methods Seventy-eight patients with severe brain injury were divided into mild hypothermia(33～35℃)group and normothermia group.The blood AVP levels and CSF AVP levels were determined at the third and the seventh day after brain injury.Results The AVP levels in blood and CSF of mild hypothermia group were lower than those of the normothermia group at the third and seventh day after brain injury(P＜0.05).According to GOS,prognosis of the mild hypothermia group was better than that of the nonnotbcrmia group(P＜0.05).Conclusion The mild hypothermia treatment may have inhibitive effects on the production of blood AVP,CSF AVP,and brain edema.Mild hypothermia is an effective method in the treatment of acute severe brain iniury in reducing the mortality and in increasing the survival rate.
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Objective To investigate the curative effect of acute severe brain injury complicated ARDS, Methods 31 patients who had acute severe brain injury complicated ARDS were divided into two groups:A group was early discovery of ARDS and given treatment.B group was late discovery of ARDS and treated late.Then the curative effects were compared.Results A group was significantly higher than B group in blood gas analysis(P