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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Objective To explore the relationship between different blood glucose levels and prognosis in patients with acute severe craniocerebral injury.Methods Clinical data of 120 patients with acute severe craniocerebral injury from Jun.2014 to Jun.2017 in Department of Neurosurgery,Tongren Hospital of Wuhan University were analyzed retrospectively.The patients were divided into the group of acute severe craniocerebral injury and the group of acute extra-severe craniocerebral injury according to the Glasgow coma score (GCS).Blood glucose levels were detected at the time of admission,the 1st day,the 3rd day,the 7th day and the 14th day after operation.According to the blood glucose levels on admission,the patients were divided into the normal blood glucose group,the blood glucose value of 6.1-10.0 mmol/L group,the blood glucose value ＞ 10.0 mmol/L group.The prognosis was evaluated by Glasgow Outcome Score (GOS) 3 months after discharge.The relationship between the blood glucose levels and GOS score in different groups was analyzed.Results The blood glucose levels in the group of acute extra-severe craniocerebral injury were higher than those in the group of acute severe craniocerebral injury,and the difference was statistically significant (P＜0.05).Of the patients with acute severe craniocerebral injury,54 had good prognosis,and 16 had poor prognosis.Of the patients with acute extra-severe craniocerebral injury,28 had good prognosis,and 22 had poor prognosis.The rate of good prognosis were 77.1％ and 56％ respectively,and the difference had statistical significance (P=0.014,x2=6.025).The good prognosis of patients with normal blood glucose group was 23 and the poor prognosis was 4,with a good prognosis rate of 85.2％ (23/27).Among patients with blood glucose of 6.1-10.0 mmol/L,30 had good prognosis and 8 had poor prognosis,with a good prognosis rate of 78.9％(30/38).Among patients with blood glucose ＞10.0 mmol/L,31 had good prognosis and 24 had poor prognosis,with a good prognosis rate of 56.4％ (31/55).With the increase of blood glucose,the good prognosis rate gradually decreased and the poor prognosis rate gradually increased,and the difference was statistically significant(P=0.010,x2=9.283).Conclusion Blood glucose level has influence on the prognosis of patients with acute severe craniocerebral injury,and the good prognosis of patients with acute severe craniocerebral injury is severely affected by hyperglycemia.
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Objective To observe the clinical therapeutic effect of Astragalus injection combined with sub-hibernation therapy for treatment of patients with severe craniocerebral injury.Methods A retrospective research method was conducted, and 89 cases with severe craniocerebral injury admitted to the Department of Critical Care Medicine of the First People Hospital of Baiyin in Gansu Province from January 2010 to December 2016 were enrolled. Astragalus injection combined with sub-hibernation was applied for treatment of 45 patients in the observation group, and for another 44 cases assigned in the control group, simply conventional treatment was used. The Glasgow coma score (GCS), coma time, ratio of cripple, mortality, incidences of pulmonary infection and urinary tract infection were compared between the two groups.Results After treatment, GCS scores were significantly higher than those before treatment in both groups, but the degree of increase was more marked on the 30 days after treatment in the observation group than that in the control group (13.15±2.53 vs. 8.79±1.59,P 0.05).Conclusions The treatment of Astragalus injection combined with sub-hibernation treatment can significantly improve the coma degree, shorten the time of coma, reduce the mortality and disability rate of patients with severe craniocerebral injury.
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Objective To study curative efficacy of tanreqing injection in treatment of severe craniocerebral injury in patients with pulmonary infection pathogen and its effects on Inflammatory factor.Methods80 patients of severe craniocerebral injury who received therapy from April 2012 to April 2015 in our hospital were selected as research objects.There were pulmonary wheezing, wheezing, shortness of breath, fever and other clinical symptoms.According to draw method,those patients were divided into the experimental group (n=40) and the control group (n=40).Two groups were given drug sensitivity test to give the corresponding antibacterial drugs, treatment for 2 weeks, The control group was treated with routine treatment, while the experimental group was on the basis of the control group, treated with tanreqing injection, every time 30ml, add 5% glucose Injection 250ml after mixing, intravenous infusion, 1 times a day.Then the curative effect, body temperature, pulmonary rales disappeared, cough disappeared time, the infection rate of pathogenic bacteria, neutrophils, white blood cell count, procalcitonin, high sensitivity C reactive protein recovery time, interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) level of two groups were compared.ResultsAfter treatment, the total effective rate of the experimental group was significantly higher than the control group[95.00%(38/40) vs 70.00%(28/40)] (P<0.05);Body temperature, pulmonary rales disappeared, cough and expectoration disappeared time was significantly shorter than the control group[(4.90±1.02)d vs (9.06±2.16)d,(6.02±1.21)d vs (10.85±2.37)d,(5.79±1.03)d vs (9.65±1.68)d](P<0.05);The positive rate of pathogenic bacteria was significantly lower than the control group[5.00%(2/40)vs 47.50%(19/40)](P<0.05);The recovery time of neutrophil, white blood cell count, procalcitonin and high sensitive C reactive protein was significantly shorter than the control group[(6.10±1.20)d vs (9.06±1.68)d,(4.72±0.97)d vs (7.34±1.23)d,(7.67±1.26)d vs (11.93±1.57)d,(7.21±1.02)d vs (11.29±1.73)d](P<0.05);IL-6、TNF-α level was significantly lower than the control group[(85.91±9.03)ng/L vs (102.08±10.42)ng/L,(17.38±1.01)ng/L vs (24.05±1.37)ng/L] (P<0.05).ConclusionTanreqing injection is well for severe craniocerebral injury,which can improve the clinical symptoms, protect the brain tissue, significantly reduce the pathogenic bacteria of pulmonary infection, and regulate the expression of inflammatory factors.
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Objective To explore the effect of failure mode and effect analysis (FMEA) on reducing the unplanned extubation rates for patients with severe craniocerebral injury. Methods FMEA model was used to analyze the main reasons of unplanned extubation patients with severe craniocerebral injury, 7 failure modes with higher RPN scores was selected. The nursing intervention for the fixation of the catheter were improved. The control group with 181 cases of patients without FMEA application were given routine care. FMEA group owning 196 cases were given the optimization process. The incidence rate of unplanned extubation of two groups was compared. Results After improvement of the nursing process of patients with severe craniocerebral injury for fixing the catheter, the RPN of 7 failure modes was lowered. Compared with the control group, the total rate of unplanned extubation in FMEA group decreased to 1.1% (9/832), less than 5.1% (40/779) of the control group. The statistical difference was significant (χ2=22.410, P 0.05). Conclusions The FMEA model can be effective in reducing the rate of unplanned extubation .
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Objective To explore independent risk factors of ventilator associated pneumonia (VAP) on severe craniocerebral injury patients, and propose nursing intervention measures to reduce occurrence of VAP. Methods A retrospective analysis was conducted on 73 severe craniocerebral injury patients with VAP postoperatively from January 2013 to June 2015, and 80 severe craniocerebral injury patients underwent mechanical ventilation without VAP postoperatively at the same time were selected as the control group. Through literature review, questionnaire was designed to collect potential impact factors of VAP in both two groups, the single factor analysis and Logistic regression analysis were applied to explore the VAP independent risk factors, and nursing intervention countermeasures were proposed to improve VAP clinical prevention. Results VAP incidence rate of severe craniocerebral injury patients postoperatively was 23.0%(73/317) , from which 81 strains were detected, the first three strains of strain spectrum were Klebsiella pneumonia (21.0% ), Bauman Acinetobacter (17.3% ) and pseudomonas aeruginosa bacteria (14.8% ). Single factor analysis showed there were significant differences on composition of two groups in age, preoperative Glasgow Coma Scale (GCS) score, operation times, artificial airway type, postoperative mechanical ventilation time, daily airway humidification frequency, daily sputum suction frequency compound injury, daily oral care times (χ2=1.809-11.936, P < 0.01 or 0.05). Logistic regression models showed duration of mechanical ventilation (OR≥7d=3.013; OR≥14d=3.695), secondary surgery (OR =3.111) , preoperative GCS score (OR =2.989), daily airway humidification frequence (OR =2.280), age (OR=2.237) had remarkable influence on occurrence of postoperative VAP (P<0.01 or 0.05). Conclusions The incidence rate of VAP in severe craniocerebral injury patients is higher, age, mechanical ventilation duration, preoperative GCS score, airway humidification degree, second surgery are the independent risk factors of VAP.
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Objective To evaluate the effect of mild hypothermia combined with hypbaric oxygen (HBO) treatment on secondary brain injury in patients with severe craniocerebral injury.Methods A prospective study was conducted in this study.Forty-two patients with severe craniocerebral injury admitted to hospital within 8 hours were randomly divided into sub-hypothermia combined with HBO treatment group and conventional HBO control group,21 cases in either group.Cerebral hemorrhage and brain edema were calculated by reviewed head CT on the 1st day,15th day and 30th day after injury.GCS (Glasgow Coma Scale) score was calculated at the same time.The number of cases of cerebral infarction was counted in the two groups.GOS (Glasgow Outcome Score) prognosis was scored for both groups of patients six months after injury.Two groups of sample rates were compared using a chi-square test with continuous correction,The intergroup comparisons were analyzed by independent sample t test by using SPSS version 13.0 software.Differences were considered statistically significant if P ＜ 0.05.Results (1) The amount of cerebral hemorrhage and edema in the treatment group were significantly lower than those in the control group on the 15th day and 30th day after injury [(21.71 ±4.3) vs.(26.33 ±5.23);(14.33 ± 1.93) vs.(16.86 ±2.86),P ＜0.05].(2) The GCS score of the treatment group was higher than that of the control group on the 15th day and 30th day after injury [(4.62 ±0.49) vs.(2.49 ±0.56);(9.76 ± 1.37) vs.(8.57 ± 0.92),P ＜ 0.05];(3) There were 2 cases of traumatic cerebral infarction in the treatment group and 9 cases in the control group (x2 =4.434,P =0.035).The GOS score in the treatment group was higher than that in the control group six months after injury [(4.29 ± 0.84) vs.(3.38 ± 0.74),P =0.001].Conclusions Mild hypothermia combined with hyperbaric oxygen treatment can reduce the secondary brain injury and improve the prognosis of patients with severe craniocerebral injury.It is worth further study,the mechanism of hypothermia remains to be further studied.
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Objective To observe the effect of electroacupuncture on early enteral nutrition (EEN) support in patients with severe craniocerebral injury.Methods A prospective, randomized, controlled study was conducted, 50 patients with severe craniocerebral injury admitted to the the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Ningbo from January 2014 to October 2016 were enrolled, and they were randomly divided into electroacupuncture experimental group (26 cases) and conventional treatment control group (24 cases) by randome number table. Enteral nutrition (EN) support was implemented in 24 - 48 hours after admission for all the patients, additionally, the electroacupuncture experimental group was treated by electroacupuncture stimulating acupoint from the 1st day after admission, once 30 minutes daily for consecutive 10 days. The levels of EN calorie reaching standard situation and the parenteral nutrition (PN) necessary for addition were recorded on 3 days and 5 days after admission; the nasal feeding amount of the two groups was recorded on the 1, 4, 7 days; the incidences of complications during EN support period were observed in both groups.Results The proportion of EN calorie reaching the standard in electroacupuncture experimental group was significantly higher than that in the conventional treatment control group in 5 days of treatment [92.3% (24/26) vs. 70.8% (17/24),P < 0.05]. The proportions necessary for addition of PN support were lower in electroacupuncture experimental group than those in the conventional treatment control group on 3 days and 5 days of treatment [3 days: 19.2% (5/26) vs. 25.0% (6/24), 5 days: 7.7% (2/26) vs. 16.7% (4/24)], but there were no significant statistical differences between the two groups (bothP > 0.05). The nasal feeding amounts in electroacupuncture experimental group were significantly higher than those in the conventional treatment control group on 4 days and 7 days of treatment [4 days (mL): 1292.31±123.04 vs.1204.17±139.81,7 days (mL):1342.31±113.75 vs.1275.00±103.21, bothP < 0.05]. The incidence of complications of the electroacupuncture experimental group was significantly lower than that of the conventional treatment control group in 10 days of treatment [26.92% (7/26) vs. 41.67% (10/24),P < 0.05].Conclusions Application of electroacupuncture has a certain clinical value during implementing EN support for treatment of patients with severe craniocerebral injury, early intervention of electroacupuncture can effectively improve the patients' gastrointestinal function and elevate the successful rate of EN, and the therapy is simple, effective and safe without any obvious adverse reactions.
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OBJECTIVE:To explore clinical efficacy and safety of Ulinastatin injection combined with Xingnaojing injec-tion in the treament of severe craniocerebral injury(CCI). METHODS:A total of 120 severe CCI patients selected from our hospital during Sept. 2014-Nov. 2015 were divided into ulinastatin group,Xingnaojing group and combination group according to therapy plan,with 40 cases in each group. Three groups were given routine treatment timely after admission. On the basis of routine treatment,Ulinastatin group additionally received Ulinastatin injection 200 000 U,ivgtt,bid;Xingnaojing group addi-tionally received Xingnaojing injection 20 mL,ivgtt,qd;combination group additionally received Ulinastatin injection com-bined with Xingnaojing injection,same usage as above(with 1 h intervals). Three groups received therapy for consecutive 14 d. Serum inflammatory factors(CRP,IL-1,IL-6,TNF-α),serologic indexes of craniocerebral injury [neuron specific enolase (NSE),myelin basic protein(MBP),S100B protein(S100B)] and GCS scores before and after treatment as well as GOS scores after treatment were all observed in 3 groups. The occurrence of ADR was recorded during treatment. RESULTS:Before treatment,there was no statistical significance in serum inflammatory factors,serologic indexes of craniocerebral injury or GCS scores among 3 groups(P>0.05). Compared to before treatment,inflammatory factors of 3 groups were decreased signifi-cantly after treatment,the ulinastatin group was significantly lower than the Xingnaojing group,combination group was signifi-cantly lower than two single drug groups,with statistical significance(P<0.05). Levels of serologic indexes of craniocerebral injury and GCS scores of 3 groups were improved significantly,and the combination group was significantly better than the two single drug groups,with statistical significance(P<0.05). There was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). Six months after treatment,GOS score of combination group(4.17±0.81)was significantly better than those of ulinastatin group(3.05±0.97)and Xing-naojing group(2.97 ± 0.89),with statistical significance (P<0.05);there was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). During treatment,the incidence of ADR in combination group(27.50%)was significantly lower than ulinastatin group(50.00%)and Xingnaojing group(42.50%),with statistical significance(P<0.05);there was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). CONCLUSIONS:Ulinastatin injection combined with Xingnaojing injection can sig-nificantly decrease serum inflammatory factor levels,relieve craniocerebral injury,protect cerebral tissue and improve short-term prognosis with good safety.
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OBJECTIVE:To explore clinical efficacy and safety of Ulinastatin injection combined with Xingnaojing injec-tion in the treament of severe craniocerebral injury(CCI). METHODS:A total of 120 severe CCI patients selected from our hospital during Sept. 2014-Nov. 2015 were divided into ulinastatin group,Xingnaojing group and combination group according to therapy plan,with 40 cases in each group. Three groups were given routine treatment timely after admission. On the basis of routine treatment,Ulinastatin group additionally received Ulinastatin injection 200 000 U,ivgtt,bid;Xingnaojing group addi-tionally received Xingnaojing injection 20 mL,ivgtt,qd;combination group additionally received Ulinastatin injection com-bined with Xingnaojing injection,same usage as above(with 1 h intervals). Three groups received therapy for consecutive 14 d. Serum inflammatory factors(CRP,IL-1,IL-6,TNF-α),serologic indexes of craniocerebral injury [neuron specific enolase (NSE),myelin basic protein(MBP),S100B protein(S100B)] and GCS scores before and after treatment as well as GOS scores after treatment were all observed in 3 groups. The occurrence of ADR was recorded during treatment. RESULTS:Before treatment,there was no statistical significance in serum inflammatory factors,serologic indexes of craniocerebral injury or GCS scores among 3 groups(P>0.05). Compared to before treatment,inflammatory factors of 3 groups were decreased signifi-cantly after treatment,the ulinastatin group was significantly lower than the Xingnaojing group,combination group was signifi-cantly lower than two single drug groups,with statistical significance(P<0.05). Levels of serologic indexes of craniocerebral injury and GCS scores of 3 groups were improved significantly,and the combination group was significantly better than the two single drug groups,with statistical significance(P<0.05). There was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). Six months after treatment,GOS score of combination group(4.17±0.81)was significantly better than those of ulinastatin group(3.05±0.97)and Xing-naojing group(2.97 ± 0.89),with statistical significance (P<0.05);there was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). During treatment,the incidence of ADR in combination group(27.50%)was significantly lower than ulinastatin group(50.00%)and Xingnaojing group(42.50%),with statistical significance(P<0.05);there was no statistical significance between ulinastatin group and Xingnaojing group(P>0.05). CONCLUSIONS:Ulinastatin injection combined with Xingnaojing injection can sig-nificantly decrease serum inflammatory factor levels,relieve craniocerebral injury,protect cerebral tissue and improve short-term prognosis with good safety.
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Objective To investigate the effect of midazolam on inflammatory response in patients with moderate and severe craniocerebral injury and its protective effect on the brain and mechanism.Methods A prospective study was conducted.One hundred and twenty patients with moderate and severe craniocerebral injury admitted to the Intensive Care Unit (ICU) of Jiangsu Subei Peoples' Hospital from April 2013 to July 2016 were enrolled,and they were divided into a conventional treatment group (58 cases) and a midazolam group (62 cases) according to the random number table method.Both groups were given conventional western medicine treatment,and in cases with surgical indications,operations were performed;in midazolam group,additionally intravenous injection of midazolam 2-3 mg was given firstly,and then continuous intravenous infusion of the drug 0.05-0.10 mg· kg-1· h-1 was applied by a pump,and in operative patients,the above management was given 3 hours after operation.The mean arterial pressure (MAP),heart rate (HR),Riker sedation agitation score (SAS) and electroencephalogram bispectral index (BIS) were measured before and after treatment for 24,48 and 72 hours,respectively.The levels of interleukin-6 (IL-6) and soluble nerve chemotactic protein (sFkn) in plasm and cerebrospinal fluid (CSF) were measured by double antibody sandwich enzyme linked immunosorbent assay (ELISA) at each time point;the incidence of epilepsy and 28-day mortality were recorded.Results Before and after treatment,the MAP and HR in the two groups of patients were stable,the difference being not statistically significant (both P ＞ 0.05).Compared with those before treatment,after treatment the SAS score and BIS in two groups of patients were gradually decreased,and at 72 hours reached the lowest levels (SAS score:conventional treatment group was 3.8 ± 1.0 vs.5.7 ± 2.0,midazolam group was 3.6 ± 0.9 vs.5.8 ± 1.7;BIS:conventional treatment group was 69± 12 vs.82± 12,midazolam group was 72± 15 vs.82± 12,all P ＜ 0.05),but there were no significant differences between the two groups (all P ＞ 0.05),suggesting that the two groups had achieved the desired goal of sedation.ELISA results showed:compared with those before treatment,after treatment for 24 hours,the CSF IL-6,sFkn and plasm sFkn levels were temporarily increased in short term,and then showed a tendency of gradually decreasing,and the plasm IL-6 presented persistently descending in the conventional treatment group,while in the midazolam group,since 24 hours after treatment,each index showed a trend of decrease and continued to 72 hours.After treatment at each time point,the CSF and plasm levels of IL-6 and sFkn were significantly lower in midazolam group than those of the conventional treatment group,and reached to the minimal levels at 72 hours [CSF:IL-6 (ng/L) was 251.6 ± 145.7 vs.347.3 ± 146.4,sFkn (ng/L):289.7 ± 79.3 vs.423.6 ± 132.8;plasm:IL-6 (ng/L) was 54.4± 27.3 vs.85.6 ± 41.8,SFkn (ng/L):919.9±426.3 vs.1 199.4 ± 414.8,all P ＜ 0.05].The incidence of epilepsy in the midazolam group was obviously lower than that in the conventional treatment group [1.61％ (1/62) vs.10.34％ (6/58),P ＜ 0.05],but there was no significant difference between midazolam group and the conventional treatment group in the 28-day mortality [11.29％ (7/62) vs.10.34％ (6/58),P ＞ 0.05].Conclusion Midazolam can reduce the incidence of epilepsy in patients with moderate and severe traumatic brain injury,and its brain protective effect may be related to the decrease of CSF and plasm IL-6 and sFkn levels.
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Objective To study and observe the change of nerve function and erythrocyte immune indexes of patients with severe craniocerebral injury during the perioperative period.Methods Forty patients with severe craniocerebral injury treated with surgery in our hospital from July 2013 to August 2015 were selected as the observation group and 40 healthy persons with the same ages in the same period were selected as the control group.The nerve function related indexes and erythrocyte immune indexes of observation group before and at first,third,fifth,seventh,tenth and fourteenth day after the surgery and those of control group were compared.Results The serum nerve function related indexes of observation group before and at first,third,fifth,seventh,tenth and fourteenth day after the surgery were higher than those of control group.The erythrocyte immune indexes of observation group before and at first,third,fifth,seventh and tenth day after the surgery were worse than those of control group.The erythrocyte immune indexes at fifth and seventh day after the surgery were worse than those before and at first,third,third,tenth and fourteenth day after the surgery.The differences of comparison indexes were all significant (P＜0.05).Conclusion The change of nerve function and erythrocyte immune indexes of patients with severe craniocerebral injury during the perioperative period are obvious.Those indexes should be paid with enough monitoring and intervention.