ABSTRACT
Objective To investigate the effect of different optimization algorithms on accurate reconstruction of traffic accidents. Methods Non-dominated sorting genetic algorithm-II ( NSGA-II), neighborhood cultivation genetic algorithm (NCGA) and multi-objective particle swarm optimization (MOPSO) were used to optimize the multi-rigid body dynamic reconstruction of a real case. The effects of different optimization algorithms on convergence speed and optimal approximate solution were studied. The optimal initial impact parameters were simulated as boundary conditions of finite element method, and the simulated results were compared with the actual injuries. Results NCGA had a faster convergence speed and a better result in optimization process. The kinematic response of pedestrian vehicle collision reconstructed by the optimal approximate solution was consistent with the surveillance video. The prediction of craniocerebral injury was basically consistent with the cadaver examination. Conclusions The combination of optimization algorithm, rigid multibody and finite element method can complete the accurate reconstruction of traffic accidents and reduce the influence of human factors.
ABSTRACT
Objective:To investigate the predictive efficacy of global inhomogeneity (GI) index based on pulmonary electrical impedance tomography (EIT) in postoperative pulmonary infection of patients with craniocerebral trauma.Methods:A total of 90 patients with emergency craniocerebral trauma underwent surgery under general anesthesia in Suzhou Science & Technology Town Hospital. According to the complication of pulmonary infection at the 3rd day after operation, they were divided into the pulmonary infection group (P3 group) and non-pulmonary infection group (NP3 group), and according to the complication of pulmonary infection at the 7th day after operation, they were divided into the P7 group and NP7 group. The average GI index within 5 min before anesthesia induction (T 0) and 5 min after endotracheal intubation (T 1) and other clinical data in the perioperative period were collected. The prevalence of pulmonary infection at the 3rd and 7th days after operation was recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative GI index for pulmonary infection at the 3rd and 7th days after operation. Results:A total of 88 patients were included. Among them, 26 patients developed pulmonary infection within 3 days after operation, and the prevalence rate was 29.5%. Pulmonary infection occurred in 38 patients within 7 days after operation, and the prevalence rate was 43.2%. Within 3 days after operation, the preoperative Glasgow Coma Scale score in the P3 group was significantly lower than that in the NP3 group ( P < 0.05). Within 3 days after operation, GI index in the P3 group increased significantly at T 1 when compared with the NP3 group ( P< 0.001). Within 7 days after operation, GI index in the P7 group increased significantly at T 1 when compared with the NP7 group ( P < 0.05). GI index at T1 accurately predicted pulmonary infection within 3 days after operation (AUC = 0.857, P < 0.001), and the best intercept value was ≥0.4225 (sensitivity: 0.846, specificity: 0.823). GI index at T 1 predicted pulmonary infection within 7 days after operation (AUC = 0.667, P < 0.005), and the best intercept value was ≥0.4225 (sensitivity: 0.579, specificity: 0.780), but the prediction efficiency was poor. Conclusions:The average GI index within 5 min after endotracheal intubation can be used as an effective predictor of pulmonary infection within 3 days after operation.
ABSTRACT
Visual event-related potential (ERP) is an electrophysiological technique that objectively reflects the cognitive processing of stimulus from the perspective of detecting and recording neural electrophysiology responses using different paradigms of visual stimuli. Its endogenous components are closely related to advanced psychological activities. This article introduces the characteristics of main endogenous components including visual mismatch negativity (vMMN), N200 and P300, reviews the research progress of visual ERP in the sequelae of brain injury and objective evaluation of visual function, and prospects the application prospect of visual ERP in the field of forensic medicine.
Subject(s)
Humans , Brain Injuries, Traumatic/complications , Evoked Potentials , Brain Injuries , Forensic MedicineABSTRACT
OBJECTIVES@#To reconstruct the cases of acceleration craniocerebral injury caused by blunt in forensic cases by finite element method (FEM), and to study the biomechanical mechanism and quantitative evaluation method of blunt craniocerebral injury.@*METHODS@#Based on the established and validated finite element head model of Chinese people, the finite element model of common injury tool was established with reference to practical cases in the forensic identification, and the blunt craniocerebral injury cases were reconstructed by simulation software. The cases were evaluated quantitatively by analyzing the biomechanical parameters such as intracranial pressure, von Mises stress and the maximum principal strain of brain tissue.@*RESULTS@#In case 1, when the left temporal parietal was hit with a round wooden stick for the first time, the maximum intracranial pressure was 359 kPa; the maximum von Mises stress of brain tissue was 3.03 kPa at the left temporal parietal; the maximum principal strain of brain tissue was 0.016 at the left temporal parietal. When the right temporal was hit with a square wooden stick for the second time, the maximum intracranial pressure was 890 kPa; the maximum von Mises stress of brain tissue was 14.79 kPa at the bottom of right temporal lobe; the maximum principal strain of brain tissue was 0.103 at the bottom of the right temporal lobe. The linear fractures occurred at the right temporal parietal skull and the right middle cranial fossa. In case 2, when the forehead and left temporal parietal were hit with a round wooden stick, the maximum intracranial pressure was 370 kPa and 1 241 kPa respectively, the maximum von Mises stress of brain tissue was 3.66 kPa and 26.73 kPa respectively at the frontal lobe and left temporal parietal lobe, and the maximum principal strain of brain tissue was 0.021 and 0.116 respectively at the frontal lobe and left temporal parietal lobe. The linear fracture occurred at the left posterior skull of the coronary suture. The damage evaluation indicators of the simulation results of the two cases exceeded their damage threshold, and the predicted craniocerebral injury sites and fractures were basically consistent with the results of the autopsy.@*CONCLUSIONS@#The FEM can quantitatively evaluate the degree of blunt craniocerebral injury. The FEM combined with traditional method will become a powerful tool in forensic craniocerebral injury identification and will also become an effective means to realize the visualization of forensic evidence in court.
Subject(s)
Humans , Finite Element Analysis , Biomechanical Phenomena , Wounds, Nonpenetrating , Head , Craniocerebral TraumaABSTRACT
Objective:To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury, so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods:Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method. According to the random number table method, patients were divided into 4 different negative pressure sputum aspiration groups: 75 mmHg (1 mmHg=0.133 kPa) group, 100 mmHg group, 150 mmHg group, 200 mmHg group, with 30 patients in each group. The levels of intracranial pressure and SpO 2, sputum cleaning time and mucosal injury were observed and compared in 4 groups: 1 min before sputum aspiration, 1 min after sputum aspiration and during sputum aspiration. Results:Comparison of intracranial pressure and SpO 2 in sputum aspiration among the four groups: intracranial pressure in 200 mmHg group was (22.23 ± 4.80) mmHg, which was higher than 75 mmHg group (16.33 ± 2.71) mmHg, 100 mmHg group (17.70 ± 2.32) mmHg, 150 mmHg group (17.20 ± 2.11) mmHg ( q=8.29, 6.58, 7.23), and SpO 2 was 0.906 ± 0.048, which was lower than 0.956 ± 0.013, 0.946 ± 0.018, 0.952 ± 0.023 in the other three groups ( q=7.81, 6.08, 6.69), with statistical significance (all P<0.01). There were statistically significant differences in intracranial pressure ( F=10.55) and SpO 2 ( F=36.57) among the four groups 1 min after sputum aspiration ( P<0.01);the 200 mmHg group had the highest intracranial pressure (15.63 ± 3.64) mmHg; the 100 mmHg group was (12.50 ± 1.48) mmHg and 150 mmHg group was (12.60 ± 1.00) mmHg, which had lower intracranial pressure than the 75 mmHg group (14.03 ± 2.86) mmHg. The sputum cleaning time was (35.53 ± 5.71) s in 75 mmHg group which was the longest and the shortest in 200 mmHg group (24.27 ± 3.22) s, with statistical significance among the four groups ( F=47.81, P<0.01). The incidence of airway mucosal injury in 200 mmHg group was 33.33% (10/30),which was higher than that in the other three groups, and the difference was statistically significant ( χ2=15.41, P<0.01). Conclusions:For patients with severe craniocerebral injury, artificial airway sputum viscosityⅠ-Ⅱ degree, suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure, control the decline of SpO 2 and prevent the damage of airway mucosa, and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.
ABSTRACT
Objective:To investigate the clinical efficacy and adverse reactions of Xingnaojing injection combined with insulin pump in treatment of severe craniocerebral injury (STBI) complicated with diabetes mellitus.Methods:Data of 102 patients with STBI combined with diabetes mellitus admitted from Jan. 2017 to Jan. 2020 in the Surgical Intensive Care Unit of Yantaishan Hospital were prospectively analyzed. Their average age was (48.27±4.20) years. They were randomly divided into group A (34 cases, treated with simple decompression) , group B (34 cases, treated with insulin pump combined decompression) and group C (34 cases, treated with Xingnaojing injection and insulin pump combined decompression) . Fasting blood glucose (FPG) , 2 h postprandial blood glucose level (2 h PG) , interleukin 2 (IL-2) , interleukin 6 (IL-6) , serum high sensitivity C-reactive protein (hs CRP) and glasgow coma scale (GCS) was different, and the incidence of adverse reactions was recorded. SPSS 23.0 statistical software was used for data processing. The measurement data were mean±standard deviation, and t test was used; the counting data were expressed in (%) and χ 2 inspection was used. Results:After treatment, there was no significant difference in 2 h PG, FPG, IL-2, IL-6, hs CRP or GCS scores between group A and group B ( P>0.05) . After treatment, the levels of 2 h PG and FPG were (8.89±1.74) mmol/L and (7.53±1.59) mmol/L in group C, (7.30±1.62) mmol/L and (6.25±1.50) mmol/L in group A, (7.32±1.64) mmol/L and (6.29±1.56) mmol/L in group B. The levels in group C were higher than those in group A and group B ( P<0.05) . The levels of IL-2, IL-6 and hs CRP in group C were (792.74±86.58) ng/L, (8.82±1.73) ng/L and (7.95±1.44) mg/L respectively. The three indexes were (880.85±90.29) ng/L, (13.85±2.20) ng/L and (14.02±2.28) mg/L respectively in group A; (875.37±89.72) ng/L, (13.34±2.18) ng/L, and (13.37±2.26) mg/L respectively in group B. Group C was lower than group A and group B ( P<0.05) . The GCS score of group C was 11.45±2.23 (points) , and that of group A and group B were 8.09±1.52 (points) and 8.73±1.56 (points) respectively. Group C was higher than that of group A and group B ( P<0.05) . Compared with group A and group B, the incidence of adverse reactions in group C was lower, and the difference was statistically significant ( P<0.05) . Conclusion:Xingnaojing injection and insulin pump combined with decompression are of great significance in reducing adverse reactions and improving the safety of clinical treatment.
ABSTRACT
In this study, Tabu search algorithm was used to analyze the drug combination of Xingnaojing Injection in the treatment of brain injury and complications in the real world, and the clinical drug combination of Xingnaojing Injection in the treatment of brain injury and complications was selected and summarized. The combination of Xingnaojing Injection, Namefen and Citicoline were recommended in the treatment of brain injury and complications. For brain edema and nerve injury, Mannitol/Glycerol Fructose/Furosemide+Tetrahexose Monosialate Ganglioside Sodium should be recommended. For those with pulmonary infection, Xingnaojing Injection+Xiyanping+Ambroxol Hydrochloride+Tanreqing Injection should be recommended. For those with shock, Hydroxyethyl Starch+Dopamine Hydrochloride/Dobutamine Hydrochloride+Sodium Bicarbonate should be recommended. The combination reflected the characteristics of Chinese and Western medicine. The above medication regimen was only for clinicians' reference. The clinical application should be based on patients' specific conditions, clinical benefits and risks, as well as the incompatibility. On the basis of the findings, further studies can be carried out for prospective clinical efficacy evaluation and safety evaluation for a specific subgroup module.
Subject(s)
Humans , Algorithms , Drugs, Chinese Herbal , Injections , Medicine, Chinese Traditional , Prospective StudiesABSTRACT
ABSTRACT Objective To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. Methods Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. Results The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). Conclusion The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.
RESUMO Objetivo Investigar as expressões da cistatina C plasmática (Cys-C), dímero-D (D-D) e proteína C-reativa hipersensível (hs-CRP) em pacientes com lesão hemorrágica progressiva intracraniana (IPHI) após lesão craniocerebral e seus significados clínicos. Métodos Quarenta e dois pacientes com IPHI e 20 indivíduos saudáveis (controle) foram incluídos. A gravidade e o resultado do IPHI foram determinados de acordo com a Escala de Coma de Glasgow (GCS) e Escala de Resultados de Glasgow (GOS), e os níveis plasmáticos Cys-C, hs-CRP e D-D foram detectados. Resultados Os níveis plasmáticos de Cys-C, D-D e hs-CRP no grupo IPHI foram significativamente maiores do que no grupo controle (P <0,01). Houve diferença significativa entre os níveis plasmáticos de Cys-C, D-D e hs-CRP entre os diferentes pacientes com IPHI de acordo com a GCS e entre os diferentes pacientes com IPHI de acordo com o GOS, respectivamente (todos P <0,05). Em pacientes com IPHI, os níveis plasmáticos de Cys-C, D-D e hs-CRP foram positivamente correlacionados entre si (P <0,001). Conclusão O aumento dos níveis plasmáticos de Cys-C, D-D e hs-CRP pode estar envolvido no IPHI após trauma crânio-encefálico. A detecção precoce desses índices pode ajudar a entender a gravidade e o resultado do IPHI.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , C-Reactive Protein/analysis , Fibrin Fibrinogen Degradation Products/analysis , Intracranial Hemorrhage, Traumatic/blood , Cystatin C/blood , Reference Values , Case-Control Studies , Trauma Severity Indices , Risk Factors , Intracranial Hemorrhage, Traumatic/physiopathology , Glasgow Outcome ScaleABSTRACT
Objective@#To analyze the effect of detail nursing in enteral nutrition in patients with severe craniocerebral injury.@*Methods@#A total of 96 patients with severe craniocerebral injury admitted to ICU department were divided into 2 groups of 48 cases according to the Stochastic numerical table method. Both groups were treated with enteral nutrition. During the treatment, the control group was given routine care, and the observation group was given detailed nursing, and the two groups were compared.@*Results@#The incidence of abdominal distension, constipation and diarrhea in the observation group was 4.17% (2/48) and 2.08% (1/48) lower than 16.67% (8/48) and 16.67% (8/48) in the control group, the difference was statistically significant (χ2=4.019, 4.414, P<0.05). The Glasgow Coma Scale (GCS) score was 9.45±1.42, which was significantly higher than 7.19±1.36 of the control group (t=7.963, P<0.05). Compared with the control group, the serum total protein (62.67±3.69) g/L, serum albumin (35.56±2.08) g/L, and peripheral lymphocyte count (1.68±0.15)×109 were significantly higher than (59.15±3.55) g/L, (31.62±2.17) g/L, (1.49±0.26)×109 in the control group (t=4.763, 9.081, 4.385, P<0.05).@*Conclusion@#During the period of enteral nutrition therapy for patients with severe craniocerebral injury, detailed nursing is helpful to reduce the related complications, improve the degree of illness, and improve the nutritional status of the body.
ABSTRACT
Objective@#To systematically evaluate the effects of hyperbaric oxygen on the hemodynamics and intracranial pressure of patients with severe craniocerebral injury (STBI).@*Methods@#Reports of randomized and controlled trials applying hyperbaric oxygen in the treatment of STBI were retrieved from the Pubmed, Cochrane Library, Embase, CBM, CNKI, VIP and Wan Fang databases. Each report found was evaluated by two researchers independently applying pre-defined inclusion and exclusion criteria. The data were extracted and combined and a meta-analysis was performed.@*Results@#Eight trials involving 725 patients were included in the meta-analysis. They combined to demonstrate that intracranial pressure, oxygen uptake and scores on the Glasgow coma scale improved significantly more in the hyperbaric oxygen group than in the control group after between 3 and 10 days of treatment.@*Conclusion@#Hyperbaric oxygen therapy is effective in treating severe craniocerebral injury and it is worthy of clinical application.
ABSTRACT
Objective To investigate the effect of progressive decompression on neurological function, long-term prognosis and complications in patients with severe craniocerebral injury undergoing modified large trauma craniotomy. Methods From January 2015 to January 2017, ninety patients with severe craniocerebral injury treated in Leizhou Shi People Hospital were selected and were randomly divided into the observation group (45 cases) and the control group (45 cases). The patients in the control group were treated with conventional decompression during the modified large bone flap decompression, and the patients in the observation group were treated with progressive decompression in the modified large bone flap decompression. The Glasgow Coma Scale (GCS) was used to evaluate the degree of damage before treatment and at 1d,3d,5 d,7d,14d, 30d after treatment,the intracranial pressure was monitored before treatment, at the surgical end, and at 1 d, 3 d, 5 d after surgery, the Glasgow′s prognostic score (GOS) was evaluated at 3 months after treatment. the neurobehavioral cognitive state checklist score ( NCSE) and the daily living ability score ( Barthel index ) were performed at 6 months after the operation, and the incidence of postoperative complications was recorded. Results The GCS scores of the observation group and the control group at 3d after treatment were respectively (5.70±0.82) points and (5.05±0.70) points], at 5d after treatment were (7.45±1.12) points and (5.81±0.82) points, at 7d after treatment were (9.38±0.52) points and (6.64±0.65) points, at 14 d after treatment were (10.31±0.79) points and (7.86±0.53) and at 30 d after treatment were (12.79±1.03) points and (10.13±1.31 points),which significantly higher than those before operation ((4.11±0.40), (4.15±0.42) points)(P＜0.05), and the scores of the observation group were significantly higher than those of the control group at each time interval ( P＜0.01). The intracranial pressure in the observation group and the control group were (26.64 + 3.02) and (29.79±2.57) mmHg respectively, (22.88±2.49) and (26.03±3.75) mmHg respectively at 1d after operation, (17.36±1.73) and (24.40±3.07) mmHg at 3d after operation.(14.20±1.18)mmHg and(21.06±2.64)mmHg at 5s after operation, All of them were significantly lower than that before operation (( 31.36 + 4.30) , ( 31.30 ±4.11) mmHg) (P＜0.05), and each time of the observation group was significantly lower than that of the control group (P＜0.01). The good recovery rate of the observation group was 22.22%(10/45), which was significantly higher than that of the control group (6.67%(3/45)). The difference between the two groups was statistically significant (χ2＝4.406, P＜0.05), the plant survival rates in the two groups were 4.44%(2/45) and 20%(9/45) respectively, the mortality rates were 13.33%(6/45) and 31.11%(14/45) respectively, and the two groups had statistical significance.(χ2＝5.050, 4.114, P＜0.05).The NCSE of the observation group and the control group were (69.24±8.42) points and (51.57±6.35) points at 6 months after operation, and the Barthel index was (76.97±5.57)points and (68.24±6.02)points respectively. The observation group was significantly higher than the control group ( t＝10.524, 8.713, P＜0.05). The total incidence of complications in the observation group was 24.44%( 11/45), which was significantly lower than that in the control group (60%) (27/45), and the difference was statistically significant (χ2＝11.660, P＜0.05). Conclusion It is more valuable to use progressive decompression in modified large bone flap decompression for severe craniocerebral injury, which can effectively protect the nerve function, reduce the incidence of complications in the perioperative period, and improve the effect of long－term prognosis.
ABSTRACT
Objective To analyze the effect of detail nursing in enteral nutrition in patients with severe craniocerebral injury. Methods A total of 96 patients with severe craniocerebral injury admitted to ICU department were divided into 2 groups of 48 cases according to the Stochastic numerical table method. Both groups were treated with enteral nutrition. During the treatment, the control group was given routine care, and the observation group was given detailed nursing, and the two groups were compared. Results The incidence of abdominal distension, constipation and diarrhea in the observation group was 4.17% (2/48) and 2.08% (1/48) lower than 16.67% (8/48) and 16.67% (8/48) in the control group, the difference was statistically significant ( χ2=4.019, 4.414, P<0.05). The Glasgow Coma Scale (GCS) score was 9.45 ± 1.42, which was significantly higher than 7.19 ± 1.36 of the control group (t=7.963, P<0.05). Compared with the control group, the serum total protein (62.67±3.69) g/L, serum albumin (35.56±2.08) g/L, and peripheral lymphocyte count (1.68 ± 0.15)×109 were significantly higher than (59.15 ± 3.55) g/L, (31.62 ± 2.17) g/L, (1.49 ± 0.26)×109 in the control group (t=4.763, 9.081, 4.385, P<0.05). Conclusion During the period of enteral nutrition therapy for patients with severe craniocerebral injury, detailed nursing is helpful to reduce the related complications, improve the degree of illness, and improve the nutritional status of the body.
ABSTRACT
AIM:To study the effects of basic fibroblast growth factor (bFGF) on brain edema, nerve function damage and autophagy related proteins in rats with head injury.METHODS:The rat model of craniocerebral injury (CI) was constructed.The rats were divided into control group, CI group, and low-, middle-and high-dose bFGF groups (n=10).The CI model was established in CI group, while the rats in control group were not given epidural impact.The rats in low-dose, middle-dose and high-dose bFGF groups were given bFGF at 2, 4 and 6μg, respectively, by intraperitoneal injection after 30 min.The neurological function in the rats was evaluated by improved neurological function scoring.The rat brain tissues were taken, and the water content was detected.The levels of tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6) and IL-1βin the brain tissue were measured by ELISA.The malondialdehyde (MDA) content was analyzed by thiobarbituric acid method.The activity of superoxide dismutase (SOD) was examined by WST-8 assay.The glutathine peroxidase (GSH-Px) activity was detected by colorimetric method.The protein levels of autophagy related proteins LC3-II and beclin-1 in the brain tissues were determined by Western blot.RESULTS:The neurological function score was increased significantly of the rats in CI group.The rat model of craniocerebral injury was successfully constructed.Neurological function scores in the rats in low-dose, middle-dose and high-dose bFGF groups were reduced, the water content of the brain tissue was also reduced (P<0.05).The levels of TNF-α, IL-6 and IL-1βwere decreased in the brain tissues (P<0.05) , the content of MDA was declined (P<0.05) , the activities of SOD and GSH-Px were increased (P<0.05) , the protein levels of LC3-II and beclin-1 were decreased, compared with the untreated rats in CI group (P<0.05).CON-CLUSION:bFGF improves the nerve function of the rats with craniocerebral injury, reduces the water content of the brain tissue, reduces the expression of autophagic protein LC3-II and beclin-1.The mechanism is related to the inhibition of inflammatory reaction and oxidative damage.
ABSTRACT
Objective To explore the effect of cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring on prevention of intraoperative intracranial swelling in patients with acute severe craniocerebral injury. Methods According to the inclusion and exclusion criteria, 90 patients with acute severe craniocerebral injury were randomly divided into study group (48 cases) and control group (42 cases). Patients in the study group underwent ventricular intracranial pressure probe placement, and then the standard decompressive craniectomy. During the operation, cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring was applied to prevent brain swelling. Patients in the control group underwent standard decompressive craniectomy combined with controlled decompression to prevent brain swelling. The incidence of intraoperative brain swelling and cerebral infarction within 3 d after surgery, and the mortality within 1 month after surgery were evaluated. Prognosis was evaluated by GOS score after 3 months of follow-up. Results The brain swelling rate, cerebral infarction rate, mortality within 1 month, and Glasgow Coma Scale (GOS) score at 3 months after operation in the study group were better than those in the control group with statistical significance:10.4％(5/48) vs. 28.6％(12/42), 29.2％(14/48) vs. 64.3％(27/42), 18.8％(9/48) vs. 35.7％(15/42)], (2.83 ± 1.08) scores vs.(1.83 ± 0.76) scores, P<0.05. Conclusions Cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring can reduce the incidence of intraoperative brain swelling and improve the prognosis of patients with acute severe craniocerebral injury.
ABSTRACT
Objective To investigate the effect of acceptance and commitment therapy intervention on post-traumatic growth of patients with concomitant brain injury in group context. Methods From January 2016 to January 2017, 40 patients with recovery from craniocerebral injury such as car accidents and work-related injuries were set as the control group, and regular health education and guidance were conducted twice a week for 6 times. From February to February 2018, 42 patients with recovery from craniocerebral injury such as car accidents and work-related injuries were set as observation groups. The observation group was given a 3-week group acceptance and commitment therapy intervention on the basis of the control group. Before and after the intervention, the simplified Chinese version of the post-traumatic growth rating scale was used for evaluation. Results After intervention, the total scores of life perception, personal strength, new possibility, relationship with others, self-transformation and post-traumatic growth were (18.68 ± 3.86), (11.35 ± 2.67), (10.49 ± 2.48), (14.35 ± 2.95), (10.49 ± 2.32), (65.36 ± 14.28) points in the observation group, and were (13.23±3.10), (9.46±2.41), (6.82±1.72), (11.81±2.06), (7.91 ± 1.89), (49.23 ± 11.18) points the control group, the difference between the two groups were statistically significant (t=7.325-8.289, both P<0.05). Conclusions Group acceptance and commitment therapy intervention can improve the post-traumatic growth level of patients with recovery period of craniocerebral injury, and provide a reliable basis for clinical medical staff to promote positive psychological adjustment of patients with recovery period of craniocerebral injury.
ABSTRACT
Objective To observe the influence of edaravin combined with cerebroside-kinin on the level of glial fiber acidic protein (GFAP) and ubiquitin carboxyl terminal-L1 (UCH-L1) in the treatment of severe craniocerebral injury.Methods From January 2016 to December 2017,a total of 123 patients with severe craniocerebral injury were selected in our hospital,and randomly(random number) assigned to the observation group (61 cases) and control group (62 cases).Patients in the control group were given cerebroside-kinin,and patients in the observation group were given cerebroside-kinin and edaravone.The acute physiology and chronic health evaluation score (APACHE Ⅱ),activities of daily living (ADL) score,serum malonaldehyde (MDA),superoxide dismutase (SOD),myeloperoxidase (MPO),matrix metalloprotein 9 (MMP-9),GFAP and UCH-L1 before and after treatment were observed.The side effects were also recorded.Results The APACHE Ⅱ score was significantly reduced in both groups after treatment (P=0.008;P=0.003),and was lower in the observation group than that in the control group (P=0.013).The ADL score of both groups increased after treatment (P=0.025;P=0.008),and was higher in the observation group than that in the control group (P=0.012).After treatment the levels of MDA,SOD and MPO in the observation group were significantly higher than those in the control group (P＜0.05);the level of MMP-9 in the observation group was significantly lower than that in the control group (P=0.012);the levels of GFAP and UCH-L 1 in the observation group were significantly higher than those in the control group (P=0.014;P=0.035).There was no significant difference of the total side effect incidence between the observation group and the control group (8.06％ vs 9.83％,x 2=0.088,P=0.719).Conclusions The treatment by edaravone combined with cerebroside-kinin on severe craniocerebral injury may effectively protect the nerve cells,improve nerve function,clinical efficacy and the body's antioxidant capacity,reduce the serum levels of GFAP,UCH-L1,and have better safety.
ABSTRACT
Objective To explore the effects of improved emergency nursing intervention on complications and clinical prognosis of severe patients with craniocerebral injury accompanied by cerebral hernia, and provide evidence for clinical nursing. Methods The patients with severe craniocerebral injury accompanied by cerebral hernia were enrolled in Dongguan People's Hospital from January 2016 to December 2018. According to the admission time, the patients were divided into routine nursing group (Admission from January 2016 to June 2017) and improved emergency nursing methods group (Admission from July 2017 to December 2018). To analyze the effect of two different nursing methods on the prognosis of patients by improving first aid nursing measures and routine nursing. Both groups of patients underwent craniotomy, the conventional nursing group was treated with routine operating room care, the improved emergency nursing methods group was given improved emergency care interventions based on the conventional nursing, the operation preparation time, operation time, intra-operative blood loss and the incidence of postoperative complications, clinical prognosis of the two groups were observed; the self-made questionnaire was used to evaluate the scores of the patient's satisfaction and compliance. Results The operation preparation time, operation time and intra-operative blood loss of the improved emergency nursing methods group (40 cases) were significantly lower than those in the conventional nursing group [40 cases, operation preparation time (minutes): 25.03±5.47 vs. 36.73±5.83, operation time (minutes): 52.56±10.63 vs. 92.10±10.73, intra-operative blood loss (mL): 218.73±20.74 vs. 402.66±23.70, all P < 0.05]; the clinical good prognosis rate, rate of satisfaction to nursing, treatment compliance score of the improved emergency nursing methods group were significantly higher than those of the conventional nursing group [clinical good prognosis rate: 20.0% (8/40) vs. 12.5% (5/40), rate of satisfaction to nursing: 95.0% (38/40) vs. 82.5% (33/40), treatment compliance scores: 95.83±4.09 vs. 81.27±5.04, all P < 0.05]; the complication rate of the improved emergency nursing methods group was significantly lower than that of the conventional nursing group [32.5% (13/40) vs. 55.0% (22/40), P <0.05]. Conclusion The improved emergency nursing intervention can significantly improve the clinical prognosis and reduce the incidence of complications in patients with severe craniocerebral injury accompanied by cerebral hernia, so that the clinical application value is relatively high.
ABSTRACT
Objective: To compare the timeliness of catheter in interval and screw-type catheters for enteral nutrition of patients with severe craniocerebral injury. Methods: 120 patients with severe craniocerebral injury were divided into observation group and control group as different catheter method. Patients of observation group received catheter in interval and that of control group received screw-type catheter. The success rate of catheterization, complication and beginning time of enteral nutrition between the two groups were compared. Results: The waiting time of observation group was significantly lower than that of control group (x2=94.925, P<0.05). During intubation, the difference of incidence of mild bleeding of nasal mucosa between the two groups was no significant. The respiratory tract ectopic or digestive tract perforation and other complications didn't appear in the two groups. Besides, the success rate of catheterization in 48h of observation group was significantly higher than that of control group (x2=40.752, P<0.05). Conclusion: The new method has higher timeliness for implementing enteral nutrition of patients with severe craniocerebral injury. And it is safe and effective.
ABSTRACT
OBJECTIVE: To explore the effects of Xingnaojing injection combined with modified large bone flap decompression on postoperative intracranial pressure (ICP) and serum inflammatory factors in patients with severe traumatic brain injury (STBI).METHODS: In retrospective analysis, STBI patients were selected from Wuhan Municipal Third Hospital during May 2014-Nov. 2016, and then divided into control group and observation group according to therapy plan, with 32 cases in each group. Control group received modified large bone flap decompression and rountine postoperative infection. Observation group was given Xingnaojing injection 30 mL, once a day, after modified large bone flap decompression, for consecutive 30 d. ICP levels and GCS score were compared between 2 groups 3, 5, 7 d after surgery. The levels of serum inflammatory factors (hs-CRP, TNF-α, IL-2, IL-6) were compared before surgery and 7 d after surgery. SF-36 score were observed before surgery and one month after surgery. GOS grading and the incidence of complication were observed one month after surgery. RESULTS: There was no statistical significance in baseline information between 2 groups (P>0. 05). Before surgery, there was no statistical significance in GCS score, serum inflammatory factor level or SF-36 score between 2 groups (P>0. 05). GOS grading of observation group was better than that of control group after surgery (P<0. 05). Compared with control group, the levels of ICP in observation group were decreased significantly 3, 5, 7 d after surgery (P<0. 05), while GCS score was increased significantly (P<0. 05); 7 d after surgery, the levels of serum inflammation factors were decreased significantly (P<0. 05). SF-36 score was increased significantly one month after surgery (P<0. 05), and the incidence of incisional hernia and acute encephalocele were decreased significantly (P<0. 05); there was no statistical significance in the incidence of delayed hematoma, hydrocephalus or interstitial brain edema (P>0. 05). CONCLUSIONS: Prognosis effect of Xingnaojing injection combined with modified large bone flap decompression may be better than modified large bone flap decompression alone in the treatment of STBI, and there is difference between them.
ABSTRACT
OBJECTIVE:To evaluate clinical efficacy of Angong niuhuang pill combined with chemical drug in the treatment of severe craniocerebral injury and its effect on the concentration of Mg2+ in peripheral blood,and to provide evidence-based reference in clinic.METHODS:Retrieved from Chinese Journal Full-text Database,China Science and Technology Journal Database,China Bxdxiology Medicine disc,Wanfang Database,Chinese Clinical Trial Registry,PubMed,Excerpta Media Database,The Cochrane Library,Web of Science,Clinical Trials,and related literatures of intemet searched by Google Scholar,randomized controlled trials (RCT) about Angong niuhuang pill combined with chemical drug (trial group) vs.chemical drug (control group) in the treatment of severe craniocerebral injury and its effects on the concentration of Mg2+ in peripheral blood were collected.After literature screening,data extraction,quality evaluation with modified Jadad scale,meta-analysis of Glasgow Coma Scale (GCS) scores and Mg2+ concentration in peripheral blood were conducted by using Rev Man 5.3 statistical software after 7 d of treatment.RESULTS:A total of 6 RCTs were included,involving 773 patients.Results of meta-analysis showed that GCS [MD=2.87,95％CI (1.64,4.10),P＜0.01] and Mg2+ concentration in peripheral blood [MD=0.11,95％CI(0.06,0.16),P＜0.01] of trial group were significantly higher than those of control group,with statistical significance.CONCLUSIONS:Therapeutic efficacy of Angong niuhuang pill combined with chemical drug is better than that of chemical drug alone in the treatment of severe craniocerebral injury,can improve clinical symptom and prognosis.