Diagnostic value of procalcitonin, erythrocyte sedimentation rate, and C-reactive protein in intracranial infection after craniocerebral surgery in patients in intensive care unit / 中国感染控制杂志

Objective To explore the diagnostic value and clinical significance of serum procalcitonin (PCT),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP) in intracranial infection after craniocerebral surgery in patients in intensive care unit(ICU).Methods 21 patients who were admitted to the ICU in a hospital between June 2011 and January 2016 were as infection group,42 patients without intracranial infection after craniocerebral surgery during the same period were as control group.Levels of PCT,ESR,and CRP in two groups were detected and analyzed statistically.Results Differences in age,gender,average body mass index,types of craniocerebral diseases,and postoperative indwelling drainage between infection group and control group were all not statistically significant (all P＞0.05).Patients with elevated serum PCT,ESR,and CRP in infection group accounted for 95.24％,80.95％ and 90.48％ respectively,in control group were 4.76％,14.29％,and 4.76％ respectively;the average concentrations of serum PCT,ESR,and CRP between two groups were compared respectively,differences were all significant(all P＜0.05).The sensitivity of PCT,ESR,CRP,and PCT + ESR + CRP in the diagnosis of intracranial infection after craniocerebral surgery in ICU patients were 95.24％,80.95％,90.47％,and 95.61 ％respectively;specificity were 95.23％,85.71％,95.23％,and 89.37％ respectively.Conclusion The combined detection of PCT,ESR,and CRP is helpful for the diagnosis of intracranial infection after craniocerebral surgery in ICU patients,it has important guiding significance for the rational use of antimicrobial agents in early stage.

Predictive value of cerebrospinal fluid lactate for the diagnosis of bacterial meningitis in patients post- neurosurgical operation with blood-contaminated cerebrospinal fluid / 中华危重病急救医学

Objective To evaluate the diagnostic value of cerebrospinal lactate for the diagnosis of bacterial meningitis in patients post-neurosurgical operation (PNBM) with blood-contaminated cerebrospinal fluid (CSF). Methods A prospective observational study was conducted. 101 patients underwent neurosurgical operation and clinically suspected PNBM admitted to neurosurgical intensive care unit (NSICU) of the First Affiliated Hospital of Sun Yat-sen University from October 2015 to December 2016 were enrolled. Based on red blood cell quantitative test in CSF, the patients were divided into blood-contaminated and non blood-contaminated CSF groups. According to the PNBM diagnostic criteria of 2008 Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN), all patients were divided into PNBM group and non-PNBM group. The biochemical indexes levels in CSF were compared among the groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CSF lactate for PNBM in blood-contaminated patients.Results A total of 101 suspected PNBM patients were enrolled. In 77 blood-contaminated CSF patients, 39 patients were diagnosed as PNBM (account for 50.6%); in 24 non-blood-contaminated patients, 12 patients were diagnosed as PNBM (account for 50.0%). ① In non-PNBM patients, the lactate level in blood-contaminated CSF was significantly higher than that of non-blood-contaminated CSF (mmol/L: 3.5±1.3 vs. 2.3±1.1,P 0.05). ② In both blood-contaminated and non blood-contaminated CSF, white blood cell (WBC), protein and lactate levels in PNBM group were significantly higher than those in non-PNBM group [WBC (×106/L): 660.0 (67.5, 1105.0) vs. 41.0 (15.0, 142.5) in blood-contaminated CSF,168.0 (86.5, 269.5) vs. 34.5 (7.0, 83.5) in non-blood-contaminated CSF; protein (mg/L): 4757.8 (2995.2, 10219.8) vs. 1292.8 (924.2, 1936.2) in blood-contaminated CSF, 39247.3 (14900.6, 62552.2) vs. 1441.6 (977.3, 2963.9) in non blood-contaminated CSF; lactate (mmol/L): 6.8±2.1 vs. 3.5±1.3 in blood-contaminated CSF, 6.9±2.5 vs. 2.3±1.1 in non blood-contaminated CSF, allP < 0.05], and glucose and CSF glucose/blood glucose ratio in PNBM group were significantly lower than those in non-PNBM group [glucose (mmol/L): 2.5±1.2 vs. 4.4±1.6 in blood-contaminated CSF, 1.9±1.4 vs. 3.4±0.9 in non blood-contaminated CSF; CSF glucose/blood glucose ratio: 0.28±0.15 vs. 0.46±0.16 in blood-contaminated CSF, 0.24±0.16 vs. 0.45±0.11 in non blood-contaminated CSF, allP < 0.01]. ③ It was shown by ROC curve analysis that CSF lactate level was a good diagnostic parameter for PNBM both in blood-contaminated and non blood-contaminated CSF, and the area under ROC curve (AUC) was 0.91 and 0.97, respectively. When the cutoff value of lactate in non blood-contaminated CSF was 3.35 mmol/L, the sensitivity was 100%, and the specificity was 91.7%. When the cutoff value of lactate in blood-contaminated CSF was 4.15 mmol/L, the sensitivity was 92.3%, and the specificity was 71.1%, and the combination of CSF lactate and glucose achieved better diagnostic specificity (AUC = 0.96, sensitivity was 97.4%, specificity was 84.2%).Conclusions Blood in CSF led to the elevation of CSF lactate as compared with that in non-blood-contaminated CSF of patients with PNBM. CSF lactate was still a good diagnostic parameter for PNBM both in blood-contaminated patients, and the combination of CSF lactate and glucose achieved better diagnostic specificity.

Clinical effect analysis of hemocoagulase topical spraying during the neurosurgical operation / 局解手术学杂志

Objective To explore the clinical effect and influence of hemocoagulase on bleeding control and coagulation function in neu -rosurgery .Methods A total of 300 patients with surgical treatment in our hospital from June 2013 to June 2014 were randomly divided into control group (n=150) and observation group (n=150).The patients in control group were treated with physiological saline 10 mL topical spraying,while the patients in observation group were treated with physiological saline 10 mL plus hemocoagulase 4U topical spraying.The clinical effect and coagulation index were compared between the two groups .Results The bleeding volume of the observation group was sig-nificantly lower than that of the control group (P0.05).Conclusion Hemocoagulase treatment during the operation can reduce the volume of bleeding and transfusion of blood ,and do not affect the coagulation function in the patients .

Clinical analysis of 54 cases of jugular foramen tumors with surgical treatment / 中华显微外科杂志

Objective To summarize the condition of surgical treatment and prognosis of 54 cases of jugular foramen tumors in the past 5 years.Methods All 54 cases were treated with operation by Fisch approach.Thirty-eight cases underwent total or near total resection of the tumor.Most resection of the tumor was underwent in 16 cases,in which,7 cases underwent postoperative radiotherapy or gamma knife therapy.The facial nerve monitoring was used in all cases.The facial nerve was anatomized and shifted in 35 cases,was just anatomized like a bridge in 10 cases,and was excised partly in 9 cases,in which,4 cases underwent facial-hypoglossal nerve anastomosis and 3 cases underwent transplantation of facial nerve and great auricular nerve.Results The external auditory canal was closed in 41 cases.The near pedicled temporalis muscle flap was obliterated in the operating cavity in 35 cases.Six cases underwent fat filling in the operating cavity.Eighteen patients showed facial palsy in varying degrees after operation.Among them,14 cases improved to different extents in 2 weeks to 9 months and 4 cases did not improve.One case showed recurrent laryngeal nerve paralysis in the same side before operation and improved in half a year after operation.Postoperative subcutaneous hematoma occurred in 2 cases,wound infection in 1 case.All the cases improved by debridement suture and anti-infective therapy.The cavity filling necrosis occurred in 2 cases,which recovered after debridement and dressing.For half a year after operation,except 9 cases of residual or recurrent,and the rest showed no recurrence.Conclusion The Fisch approach of surgical treatment of jugular foramen tumors can provid good exposure,clear vision,facilitate hemostasis.The skills of intraoperative facial nerve monitoring,facial nerve anatomy like a bridge or anatomy and shift when necessary are beneficial to the total or nearly total resection of tumor and reduce the injury of facial nerve.The operating cavity filling and selective external auditory canal closure can effectively reduce the surgical cavity effusion and the incidence of postoperative infection.

Clinical effect of Baquting on bleeding control in neurosurgery / 中国综合临床

Objective To investigate the hemostatic effect and influence on coagulation function of hemecongulase during neurosurgical operation.Methods Sixty patients with neurosurgical trauma at American statistical association(ASA) Ⅰ-Ⅱ were randomly divided into hemocoagnlase treatment group (n =30) and control group(n =30).Both two group were injected Baquting 2U at the day before the operation,30 min before the operation,every two day after the operation and end up 3 d.Treatment group were pedormed with Baqyting 4 U + physiological saline 10 ml topical spraying.The intelligibility of operating region,the volume of intraoperative,the volume of bleeding during the operation,transfusion of blood,postoperative drainage,and drainage tube exelcymosis time were recorded in all the patients.Prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen level(FIB),fibrinogen degradation product(FDP) and the two D-dimer and platelet count(PLT) before and after the surgery were also determined.All the patients were postoperatively followed up.Results The intelligibility of operating region was 70.0％ (21/30) in the hemocoagnlase treatment group,higher than that in control group (0％,P ＜0.05).The volume of bleeding during the operation in the hemecoagulase treatment group was (680.00 ± 95.22) ml,significantly fewer than that in the control group((790.00 ±47.00) ml,P =0.034).PLT significantly decreased after the surgery in both of the groups compare to that in preoperation (P ＜ 0.05 or P ＜ 0.01) and no significant difference was seen between two groups (P ＞ 0.05).No severe adverse events were found in both groups.Conclusion Hemocoagulase treatment during the operation can improve the intelligibility of operating region,reduce the volume of bleeding and transfusion of blood,and do not affect the coagulation function in the patients.Therefore,hemocoagulase is a safe and effective hemostatic and through local application during the operation it can improve curative effect.

Risk Factors and Preventive Therapeutic Strategies on Intracranial Infection after Craniotomy / 中华医院感染学杂志

OBJECTIVE To study the risk factors and preventive therapeutic strategies of neurosurgical postoperative intracranial infection.METHODS Totally 1613 patients who had a neurosurgical operation from Jan 2005 to Jun 2008 in our department were chosen(64 cases with intracranial infection).The infection rate was 3.97%.The risk factors were studied retrospectively,?2 test was selected to analyze the factors which might cause infection.RESULTS The analysis of 1613 cases revealed that infection rate was closely related to ventricular drainage,long indwelling drainage,emergency subsequent surgery postcraniotomy,CSF leakage,the approach to the post fossa,surgical microscopy,operation time above 4 h and polluted operation;while had no significonce of sex,age,the season,application of antibiotics before the operation and emergency operation.CONCLUSIONS To decrease the infection rate,the suture should be complete to prevent CSF leakage,polluted region be cleaned effectively,strict asepticly technique be measured,the operation be finished as soon as possible,drainage be prevented from pollution carefully and the duration of the drainage be controlled strictly,especially to the ventricular drainage.

Early re-operation on patients with intracranial tamors for intraeranial hypertension following initial operation: analysis of 16 cases / 中国基层医药

Objective To summarize the causes and re-surgical methods of early intracranial hypertension in- duced by operation in meningeal neoplasms. Methods Analysize the re-surgical materials about the early intracranial hypertension induced by operation in meningeal neoplasms of 16 cases. Results The formation of hematoma or the appearance of tension injury after the surgery of meningeal neoplasms was related to the location and quality of the tumor. The reasons for these were as follows. The tension injury often happens in 48 ～ 72h after surgery. The time needed by the operation of hernatoma is changeable. The decreasing level of consciousness was the major expression of intracranial hypertension after surgery. Conclusion Watch the conditions of meningeal neoplasms after operation. Do the image examination if needed. So it is easy the final and deal with the hematoma or the cerebral edema.

Postoperative Infections of CNS : A Retrospective Study / 中华医院感染学杂志

OBJECTIVE To study the risk factors of neurosurgical postoperative intracranial infection.METHODS Totally 5405 patients who had a neurosurgical operation from 1996 to 2003 in our department were chosen(172(cases) with intracranial infection).Many risk factors were studied retrospectively,A data-base was set up with EXCEL,and Logistic regression was selected to analyze the factors which might cause infection.RESULTS The(analysis) of 5405 cases revealed that infection rate was closely related to the operation durations,CSF fistulae,(ventricle) drainage,the insertion of tubes,the approach to the post fossa,the complication from diabetes mellitus(DM),and open(craniocerebral) injuries.While had little effect of sex,age,the season,longer application of hormones before the operation,preoperative diseases,and longer application of antibiotics before or after the operation.(CONCLUSIONS) To decrease the infection rate,according the clinical experience,the operation should be finished as soon as possible,the suture should be done completely to prevent CSF fistulae,and the duration of the ventricle drainage should be controlled strictly.

Clinical study on total intravenous anesthesia with sufentanil-profofol given by target-controlled infusion in neurosurgical operations / 中国临床药理学与治疗学

0.05).At the T1,T3,T4,T7 time point,changes of the MAP and HR were more stable in TCI group than those in control group.The awakening time and extubation time in TCI group was obviously shorter in than that in control group.The OAAS scores after extubation were higher and the VRS scores 30 min after extubation were lower in TCI group than those in control group(P

Retrospective survey of the application of medical aural and encephalic glue to 1024 neurosurgical operation / 重庆医科大学学报

Objective: To summarize the experience in the use of medical aural and encephalic glue in neurosurgical operation.Methods: The effects of medical aural and encephalic glue used in 1024 neurosurgical operation were retrospected and analyzed and discussed in relationed to the pertinent literature.Results: The effect of medical aural and encephalic glue in all kinds of neurosurgical intervention we operated in our department was reliable and there was no side effect.Conclusions: The effect of medical aural and encephalic glue in neurosurgical operation is notable,especially in preventing and treating the cerebrospinal fluid fistulae and stopping bleeding during the operation.The glue is safe and trustworthy.

A Case of Subdural Tension Pneumocephalus after Operation

Tension pneumocephalus is rare complication is neurosurgical operation. But it should be treated promptly because of sudden neurological deterioration. Computed tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. A case of subdural tension pneumocephalus after cranial operation under the impression of bifrontal subdural hygroma is presented.