Application of remifentanil in postoperative ICU sedation and analgesia in patients with severe craniocerebral trauma / 中国临床药理学与治疗学

AIM: To investigate the effect of remifentanil in the management of sedation and analgesia after severe traumatic brain injury and its influence on the incidence of inflammatory stress. METHODS: From January 2017 to April 2020, 92 patients with severe head trauma surgery in our hospital were selected as the research objects, randomly divided into groups, each with 46 cases. Both groups received postoperative sedation and analgesia management, the control group received dexmedetomidine + 0.9% sodium chloride injection, and the observation group received dexmedetomidine combined with remifentanil. The effects of sedation and analgesia, vital signs, and inflammatory stimuli C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10)related indicators, serum cortisol, β-endorphin, and the incidence of adverse reactions in the two groups were observed and counted. RESULTS: The scores of sedation and analgesia in the observation group were lower than control group at 2 h, 4 h, and 12 h after administration (P 0.05). CONCLUSION: Remifentanil is used in the management of sedation and analgesia after severe traumatic brain injury, which can effectively improve the effect of sedation and analgesia, reduce inflammatory stimulation, regulate the levels of cortisol, and β-endorphin It is worthy of clinical application.

Analysis of Risk Factors for Secondary Pulmonary Fungal Infection in Patients with Severe Craniocerebral Trauma after Tracheotomy / 中国药房

OBJECTIVE:To investigate the risk factors for secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy,and to provide reference for clinical prevention and treatment. METHODS:In retrospective study,87 severe craniocerebral trauma patients with secondary pulmonary fungal infection after tracheotomy were selected from Ezhou Municipal Central Hospital(called"our hospital"for short)during Jan. 2014-Jun. 2017 as observation group;87 severe craniocerebral trauma inpatients without secondary pulmonary fungal infection after tracheotomy were selected as control group. The distribution and drug resistance of infected fungal in observation group were analyzed. χ2 test and binary Logistic analysis were adopted to investigate risk factors of secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy. RESULTS:Totally 174 clinical specimens were detected in observation group of our hospital;7 kinds of fungus were detected and isolated from 87 strains,and the fungi with high detection rate were Candida albicans(41 strains,47.13%)and Candida glabrata(23 strains,26.44%). The resistance rates of C. albicans and Candida tropicalis to commonly used antifungal agents as fluconazole,itraconazole and fluoncytosine were lower than 20%;resistance rates of C. glabrata to fluconazole,itraconazole and fluoncytosine were more than 25%,to amphotericin B and nystatin were lower than 20%. χ 2test and binary Logistic analysis showed that independent risk factors of secondary pulmonary fungal infection included hypoproteinemia,Glasgow coma score(GCS,<8 points)at admission,serum creatinine clearance(<30 mL/min)at admission,tracheal incision ventilation time(≥7 days),the time of antibiotics use(≥14 days),combined use of antibiotics,the use of carbapenems and systemic glucocorticoid [odd ratios were 3.02,2.98,2.21, 2.05,2.48,2.35,4.74,5.97;95%CI were(1.59,5.74),(1.58,5.63),(1.18,4.41),(1.11,3.78),(1.34,4.59),(1.27,4.34), (2.49,8.35),(3.08,11.49),P<0.05]. CONCLUSIONS:The fungus of secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy in our hospital are mainly C. albicans and C. glabrata,which are sensitive to commonly used antifungal agents. Hypoproteinemia,GCS at admission,serum creatinine clearance rate at admission,tracheal incision ventilation time,the time of antibiotics use,combined use of antibiotics,the use of carbapenems and systemic glucocorticoid are independent risk factors of secondary fungal infection in patients with severe craniocerebral trauma after tracheotomy. It is necessary to pay attention to predictive value of above risk factors,improve sensitivity and specificity of diagnosis and treatment. Antifungal agent should be selected rationally according to the results of drug sensitivity test. At the same time,early prophylactic or empirical antifungal treatment should be given in time for high risk patients with above factors.

Effect of indwelling nasointestinal tube for enteral nutrition support in patients with severe craniocerebral trauma undergoing mechanical ventilation / 中华危重病急救医学

Objective To evaluate the effect of indwelling nasointestinal tube for enteral nutrition (EN) support on patients with severe craniocerebral trauma undergoing mechanical ventilation (MV). Methods A total of 100 severe craniocerebral trauma patients undergoing MV admitted to intensive care unit (ICU) of the 117th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled, and they were divided into nasogastric tube group in which the EN was fed by nasogastric tube and nasal jejunal feeding tube group (nasointestinal tube group) by random digits table, with 50 patients in each group. Blood urea nitrogen (BUN), hemoglobin (Hb), serum albumin (Alb), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, Glasgow coma scale (GCS) score before and 10 days after treatment, duration of MV, hospitalization time, and the incidences of ventilator-associated pneumonia (VAP) and reflux wrong aspiration of the two groups were observed and compared. Results There was no statistically significant difference in BUN, Hb, Alb, APACHEⅡscore or GCS score before treatment between the two groups. Ten days after treatment, BUN and APACHEⅡ score in the nasointestinal tube group were significantly lower than those in the nasogastric tube group [BUN (mmol/L): 6.3±1.6 vs. 8.0±2.2, APACHEⅡscore: 17.9±3.2 vs. 20.8±6.3, both P < 0.05], Hb, Alb, GCS score were significantly higher than those in nasogastric tube group [Hb (g/L): 125.9±19.7 vs. 113.5±19.6, Alb (g/L): 35.9±6.2 vs. 31.9±6.2, GCS score: 9.7±1.9 vs. 8.2±5.7, all P < 0.05], duration of MV and hospitalization time were significantly less than those in the nasogastric tube group [duration of MV (days):14.7±3.4 vs. 17.5±2.9, hospitalization time (days): 15.4±5.6 vs. 19.2±7.3, both P < 0.05], and the complication rate in nasointestinal tube group was obviously lower than that in nasogastric tube group [10% (5/50) vs. 36% (18/50), P < 0.05]. Conclusion For patients with severe craniocerebral trauma treated with MV, the EN treatment by means of indwelling nasointestinal tube is helpful for the recovery of consciousness, improvement of nutritional indexes, reduction of incidences of complications such as reflux aspiration, etc. and shortening the course of disease, thus the method can obviously improve the patients quality of life.

Efficacy Observation of Xuebijing Injection in the Treatment of Severe Craniocerebral Trauma / 中国药房

OBJECTIVE:To evaluate therapeutic efficacy of Xuebijing injection in the treatment of severe craniocerebral trau-ma. METHODS:67 patients with severe craniocerebral trauma selected from neurosurgery department of our hospital were Treat-ment method divided into treatment group(33 cases)and control group(34 cases). Observation group was given conventional treat-ment,i.g. oxygen inhalation,dehydration,nourish cranial nerve,anti-infection. Treatment group On the basis of the control group was given Xuebijing injection 50 ml/time,tid,ivgtt. PT,TT,PLT,FIB,CK,LA, D-D,blood gas index (PaCO2,PaO2, HCO3-)of 2 groups were observed after 7 days of treatment,and prognosis of 2 groups were evaluated after 6 months as well as therapettin efficacy. RESULTS:After treatment,PT,TT,PLT,FIB,CK,LA, D-D,PaCO2,PaO2 and HCO3- of 2 groups were all better than before,and the treatment group was better than the control group,with statistical significance (P<0.05). The rate of good prognosis in treatment group (78.79%) was significantly better than in control group (55.88%) after 6 months of treat-ment,with statistical significance(P<0.05). CONCLUSIONS:Xuebijing injection in the treatment of severe craniocerebral trau-ma can improve coagulation function,blood gas levels and the inflammatory reaction,and is conducive to improve the patient's prognosis.

The effect of rinse with Chinese herbal preparation above intubation airbag for ventilator-associated pneumonia in patients with severe craniocerebral trauma / 中国中西医结合急救杂志

10.3969/j.issn.1008-9691.2013.03.012