Application of high perfusion therapy combined with fasudil and prostaglanddin E1 in patents with cerebral infarction after receiving surgery for severe traumatic brain injury / 中华神经医学杂志

Objective To investigate the traumatic cerebral infarction treatment in patients with severe craniocerebral trauma combined with cerebral hernia after performing large decompressive craniectomy.Methods Thirty-two patients with cerebral infarction after receiving decompressive craniectomy for severe traumatic brain injury combined with brain hernia,admitted to our hospital from January 2009 to April 2012,were chosen in our study; these patients were given saline (35 mL) +dopamine (100 mg)+Aramine (50 mg) micro-pump infusion for 2-3 mL/h,24 hours of high perfusion combined with fasudil and prostaglanddin E1 for antispasmodic therapy.The clinical data and treatment efficacy of these patients were retrospectively analyzed.Results Postoperative head CT confirmed the disappearance of infarction focuses and good recovery of brain tissues,including cure in 17 patients,good recovery in 12,mild disability and severe disability in 1; no persistent vegetative state or death were noted.Conclusion Under the premise of full blood volume,high perfusion combined with fasudil and prostaglanddin E1 for antispasmodic treatment enjoys good effect in patients with severe craniocerebral trauma combined with cerebral hernia after performing large decompressive craniectomy,which is economical,practical,and worthy to be popularized.

Clinical analysis of diffuse axonal injury:a report of 280 cases / 中华神经医学杂志

Objective To discuss the clinical features and pathological changes of diffuse axonal injury (DAI), and explore the treatment and prognosis of patients with DAI. Methods Two hundred and eighty patients with DAI, admitted to our hospital from January 1999 to December 2009,were enrolled in our study; bilateral decompressive craniotomy was performed in 76 patients and conservative treatment in 204 patients; the clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Good recovery was achieved in 122 patients (43.6%), mild disability in 86 (30.7%), severe disability in 37 (13.2%), persistent vegetative state in 2 (0.7%) and death in 33 (11.8%). Conclusion Decompressive craniotomy is needed as early as possible for patients with brain swelling, unilateral or bilateral mydriasis; early tracheotomy should be performed for patients in coma for a long time to maintain airway smooth; 20% mannitol plus furosemide plus albumin, together with methylprednisolone and mild hypothermia therapy, can be employed to treat patients with early dehydration.

Percutaneous endoscopic gastrostomy in nutritional supporting and pulmonary infection preventing of coma patients with severe brain injury / 中华神经医学杂志

Objective To study the effects of percutaneous endoscopic gastrostomy on coma patients with severe brain injury in preventing the pulmonary infection and supporting the nutritional therapy. Methods Forty coma patients with severe brain injury and 2 dysphgia patients with brain stem infarction, admitted to our hospital from January 2006 to December 2009 were chosen as experimental group and given nutritional therapy after percutaneous endoscopic gastrostomy. The other 42 coma patients with severe brain injury admitted to our hospital at the same period were chosen as control group and given nasal-feeding nutrition. The degree of lung infection and the contents of serum total protein, serum albumin and hemoglobin 1 w before, and 1 and 2 w after the surgery in the 2 groups were detected. Results All of the patients (40 in coma and 2 not being able to eat) benefited from percutaneous endoscopic gastrostomy: the pulmonary infection caused by esophageal back flow was prevented; the infection rate of G+ pathogenic bacteria and the G-pathogenic bacteria in the experimental group was 0significantly decreased as compared with that in the control group (P<0.05). No significant differences of the contents of serum total protein, serum albumin and hemoglobin at each time points between the 2 groups were noted (P>0.05). Conclusion Nutritional therapy after adopting the percutaneous endoscopic gastrostomy, preventing pulmonary infection caused by esophageal back flow, is a safe method and worth to be generalized.

Intracranial aneurysm treated by endovascular embolism:an clinical analysis of 38 cases / 中华神经医学杂志

Objective To explore the timing and technical points in treating intracranial aneurysms with endovascular embolization, and analyze its efficacy and the prevention of its complications. Methods Thirty-eight patients with intracranial aneurysm, admitted to our hospital from February 2006 to January 2009, were treated by endovascular embolism with the help of digital subtraction angiography (DSA). Twenty-six patients (27 aneurysms) were performed embolization with mechanical detachable coils (MDC) and 12 patients (12 aneurysms) were performed embolization with Guglielmi detachable coils (GDC). Their clinical data and efficacy were analyzed. Results Thirty-eight cases (39 aneurysms) were successfully embolized: 32 cases (84.2%) were fully embolized; 4 cases (10.5%) were 95% embolized and 2 cases (5.26%) were 90% embolized. Internal carotid artery thrombosis was found in 1 with wild-necked aneurysms after embolism and the patient was found hemiplegia and aphasia after 3 months. Bleeding caused by aneurysm rapture occurred in 2 and recovered after treatment Follow-up showed that 37 patients were successfully recovered except that 1 elderly patient died of lung infection and gastrointestinal bleeding. Conclusion Endovascular embolization, a minimally invasive, safe and effective technique, can effectively treat most patients with intracranial aneurysms.