ABSTRACT
Objective To discuss the risk factors of progressive hemorrhagic injury(PHI)in patients with craniocerebral injury.Methods Clinical data of 149 patients with closed craniocerebral injury were retrospectively analyzed,and the patients were divided into PHI group (42 cases)and non -PHI group (107 cases)according to PHI appeared or not.The patients were immediately given CT scan after admitted,the first CT review was given in the non -PHI group within routine 4 -8h after first CT scan,and due to deterioration of clinical symptoms,the PHI group was given CT review in advance.The intracranial hematoma volume changes between first CT and first CT review in the two groups were observed,then clinical symptoms,signs,biochemical indicators and CT performance in the two groups were compared,and analyzed risk factors of PHI.Results The intracranial hematoma volume showed in CT scan,first CT review and increment volume of the PHI group were significantly higher than the non -PHI group [(14.59 ±4.60)mL vs.(7.28 ±2.94)mL,(25.92 ±8.84)mL vs.(8.35 ±3.41)mL,(10.20 ±3.45)mL vs. (2.10 ±0.65)mL],the differences were significant (t =6.796,11.894,9.367,all P 10mL were major risk factors of PHI (P 50 years old,mydriasis,conscious disturbance,intracranial hematoma volume >10mL in first CT scan.
ABSTRACT
Objective To observe the therapeutic effect and prognosis of patients with severe traumatic craniocerebral injury treated by Lund program combined with Angong Niuhuang pill. Methods A prospective study was conducted. Forty-nine patients with severe traumatic craniocerebral injury were divided into two groups:combined treatment group (25 cases) and control group (24 cases). All the patients in the two groups received conventional therapy. Additionally, the combined treatment group was treated by the Lund program combined with Angong Niuhuang pill, the patients after admission into the intensive care unit (ICU), indwelling of gastric tube was immediately given (the tube inserted and retained through mouth in cases with cranial base bone fracture), one pill of Angong Niuhuang was fed nasally twice a day for consecutive 15 days. Before and after treatment, the intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) score, the mean flow velocity of middle cerebral artery (MCA), and the incidence of complication, clinical efficacy and prognosis in the two groups were observed. Results There were no statistically significant differences in the levels of ICP, CPP, GCS score and the average flow velocity of MCA before treatment and the first day after treatment between the two groups. Beginning from 3 days after treatment, the degrees of improvement in the above indexes in the combination treatment group became much better than those in the control group [ICP (mmHg, 1 mmHg=0.133 kPa):16.78±4.50 vs. 18.80±5.67, CPP (mmHg):71.35±1.63 vs. 58.11±1.47, GCS score:9.53±0.38 vs. 8.23±0.44, the mean blood flow velocity (cm/s):152.23±3.33 vs. 178.86±5.23, all P0.05). The rate of good therapeutic effect in combination treatment group was obviously higher than that of the control group [72.0% (18/25) vs. 33.3% (8/24), P < 0.05], while the mortality was markedly lowered [8.0% (2/25) vs. 33.3% (8/24), P < 0.05]. Conclusions The combination of Lund program and Angong Niuhuang pills for treatment of patients with severe traumatic craniocerebral injury can reduce the degree of increase of ICP at early stage, ameliorate cerebral edema and its development, elevate CPP and improve cerebral ischemia and hypoxia. In the aspects of controlling hyperpyrexia, decreasing limbs twitches and the incidence of hernia, elevating the quality of patients' life, reducing mortality and improving prognosis, the therapy has relatively good therapeutic effects.
ABSTRACT
Traumatic craniocerebral injury is one of serious injury which can cause great damage to human life and health even lead to disability or death.Making an objective and accurate judgement of severity and prognosis for traumatic craniocerebral injury in children,which might play an important role in the clinical treatment and prognosis.As a physical scoring indicator system of traumatic craniocerebral injury,the earliest and most widely used one is Glasgow Coma Scale.The Children Coma Scale is particularly used for children under 4 years old and the Trauma Infant Neurologic Score for infants with traumatic craniocerebral injury.Thus,these 3 scoring systems present advantage and representative in clinical application.Here we make a brief review on these 3 scoring systems based on the current studies and applications.