Severe Craniocerebral Injury Patients Research Articles

Effect of combination invasive intracranial pressure (ICP) monitoring and transcranial Doppler in the treatment of severe craniocerebral injury patients with decompressive craniectomy

The aim of the present study was to explore the clinical effect and to predict the prognosis of severe craniocerebral injury patients with decompressive craniectomy by combining transcranial Doppler (TCD) and invasive intracranial pressure (ICP). A total of 60 severe craniocerebral injury patients with decompressive craniectomy, who were admitted to Shantou Central Hospital from June 2017 to March 2019, were enrolled in this retrospective study. Of these, 25 patients who had a Glasgow Coma Scale (GCS) score no greater 8 and no less than 6 underwent transcranial Doppler (TCD) before decompressive craniectomy, as well as ICP, after removing the skull and suturing the dura mater. The 60 patients were divided into 2 groups according to the following standards: (I) GCS score ≥8 on the 7th day postoperatively; (II) ICP continuously lower than 25 mmHg for the entire 7-day duration postoperatively; and (III) brain tissue consistently offset from the skull surface by 5 mm. The clinical outcome was determined based on the Glasgow Outcome Scale (GOS) 1, 3, and 6 months postoperatively. The TCD value, ICP, and prognosis were compared between the 2 groups. The average postoperative ICP <19 mmHg in the first 24 h, mean blood flow velocity >56.33 cm/s, end-diastolic blood flow velocity >40.28 cm/s, and resistance index <0.57 were statistically significant indicators to predict good prognosis . The use of TCD can predict the prognosis of severe craniocerebral injury patients.

Clinical effects of damage control surgery in treatment of severe craniocerebral injury combined with multiple extremity fractures

Objective To investigate the effects of damage control surgery (DCS) in the treatment of severe craniocerebral injury patients combined with multiple extremity fractures. Methods The clinical data of 128 patients with severe craniocerebral injury[Glasgow coma scale (GCS) scored 3-8] combined with multiple extremity fractures admitted from May 2011 to August 2015 were retrospectively analyzed by case-control study. There were 81 males and 47 females, with an average age of 37.3 years (range, 19-77 years). The patients were treated with intracranial pressure monitoring in addition to the common administration. The patients were subdivided into two groups: 87 patients treated with DCS concept as damage control group and 41 patients treated with non-DCS routine concept as control group. The DCS group received craniotomy and fracture fixation operation in stage I with selective operation of open reduction and internal fixation. The control group received craniotomy and open reduction and internal fixation in stage I. The postoperative intracranial pressure, operation duration, intraoperative blood loss, hospital stay and prognosis [Glasgow outcome scale (GOS)]were analyzed statistically. Results No intracranial infection was found in all patients during the treatment process. In damage control group, the postoperative intracranial pressure was normal in 44 cases (51%), which was significantly better than that in control group [8 cases (20%)](P<0.05). In damage control group, operation duration [(150.1±12.4)minutes], intraoperative blood loss[(270.6±15.3)ml], and hospital stay [(29.7±9.3)days] were significantly shortened compared with control group, whose operation duration, intraoperative blood loss and hospital stay were (270.6±9.8)minutes, (460.2±17.5)ml, and (34.4±6.2)days, respectively (P<0.05). The GOS rating of damage control group (70%) was notably higher than that in control group (42%) (P<0.05). Conclusion For severe craniocerebral injury patients combined with multiple extremity fractures, the application of DCS contri-butes to control of postoperative intracranial pressure, which can also shorten the duration of hospitalization and improve prognosis. Key words: Craniocerebral injury; Fractures, bone; Decompressive craniectomy; Damage control surgery

Effect of lowering the temperature of enteral nutrition on prevention of stress ulcer in patients with severe craniocerebral injury

Objective To probe into the efficacy and safety of lowering the temperatures of enteral nutrition in severe craniocerebral injury patients to prevent stress ulcer, and provide reference for patients with severe craniocerebral injury to choose appropriate enteral nutrition temperature. Methods The clinical randomized controlled trial was adopted. Numbered the patients by the order of being hospitalized, then divided the 84 patients with severe craniocerebral injury who were receiving enteral nutrition into experimental group and control group with 42 cases each. The constant temperature in experimental group was 22 ℃, and that in control group was 38 ℃. Observed and compared regularly the pH levels, occult blood test of gastric juice and defecate of the two groups within 7 days. Results After different temperature enteral nutrition, pH value of gastric juice of patients at 1, 4, 7 days after enteral nutrition was 2.610.37, 4.550.35, 4.870.34 in experimental group, 2.210.44, 3.930.22, 4.180.30 in control group, there was significant difference between two groups (t=3.856, 8.185, 8.322, all P 0.05). There was no significant difference in the incidence of diarrhea and diarrhea start time between two groups (χ2=0.288, t=0.372, all P>0.05). Conclusions Lowering the temperature of enteral nutrition has a certain protective effect on the gastric mucosa of patients with severe craniocerebral injury, which is helpful to prevent the occurrence of stress ulcer, and does not increase the risk of diarrhea. Key words: Temperature; Craniocerebral trauma; Enteral nutrition; Stress ulcer

Influencing factors of eternal nutrition support at different time on postoperative result of severe craniocerebral patients

Objective To explore the eternal nutrition support impacted on postoperative result of severe craniocerebral injury patients. Methods A total of 258 patients with severe craniocerebral injury patients were collected and divided into early enteral nutrition (EEN) group (n=128) and delay enteral nutrition (DEN) group (n=130). The postoperative infection rate, length of hospitalization and expenditure were compared between the two groups. Results The infection rates were 43.75% (56/128), 43.85% (57/130) in EEN group and DEN group, while the length of hospitalization were (18.86±4.51), (19.21±5.91)d, total costs (54 914±2 493.1) and (55 107±3 443.9) Yuan in two groups without statistical significance (P>0.05). Conclusions Strengthening nutrition support does not impact on patients recovery within 48h or 72h severe craniocerebral injury, but early nutrition support has certain benefits for body metabolism, body resistance, infection rate and rehabilitation of prognosis. Key words: Eternal nutrition; Severe craniocerebral injury; Infection; Hospital expenditure; Length of hospitalization

The application of placing stomach tube into the jejunum blindly for severe craniocerebral injury patients

Objective To discuss the method of stomach tube instead of normal nasointestinal tube for severe craniocerebral injury patients. Methods Placing the stomach tube into the jejunum blindly according to the patient's gastrointestinal peristalsis for 99 severe craniocerebral injury patients and observing the success rate and plugging rate. Results Ninety-two tubes were successfully placed, the success rate was 92.9%(92/99). The placement time was (45.9±26.7) min. The time of successful insertion tube enteral nutrition was (46.0±34.2) d.No clogging occurred during this period. Conclusions The method of stomach tube instead of normal nasointestinal tube is safe and effective. Key words: Craniocerebral trauma; Enteral nutrition; Nasostomach tube; Nasointestinal tube

Clinical significance of percutaneous endoscopic gastrostomy for patients with severe craniocerebral injury

Objective:To investigate the application of percutaneous endoscopic gastrostomy (PEG) to patients with severe craniocerebral injury for the purpose of nutritional support therapy and pulmonary infection prevention,Methods:A total of 43 patients with severe craniocerebral injury admitted to our department from January 2008 to December 2012 received PEG followed by nutritional therapy. There were other 82 patients who were prescribed nasal-feeding nutrition. Nutrition status was evaluated by comparing serum albumin levels, and the incidence of pulmonary infection 1week before and 2weeks after operation was identified and compared,Results:Both PEG and nasal-feeding nutrition therapies have significantly elevated serum albumin levels (P<0.05). Serum albumin levels before and after nutritional therapies showed no significant difference between the two groups (P>0.05). The incidence of pulmonary infection in PEG group was significantly decreased compared with that in nasal-feeding nutrition group (P<0.05).Conclusion:PEG is an effective method for severe craniocerebral injury patients. It can not only provide enteral nutrition but also prevent pulmonary infection induced by esophageal reflux.

循证护理在重型颅脑外伤气管切开护理中的应用

Objective: This paper will give a clinical study on patients with severe craniocerebral injury, so as to explore the clinical effect of evidence-based nursing in the trachea incision in patients with severe craniocerebral trauma, in order to improve the effect of nursing patients with severe craniocerebral injury, and provide a reliable basis and ultimately improve the quality of life and life safety. Methods: The study group of severe craniocerebral injury patients with tracheotomy to evidence-based nursing measures; control group of severe craniocerebral injury patients with tracheotomy to routine clinical nursing measures. Observe and record the time of hospitalization, mortality and respiratory tract infection occurred in two patients, give statistical analysis, draw the conclusion. Results: The study group of severe craniocerebral trauma by clinical nursing of trachea evidence-based nursing measures for patients after incision, the incidence rate was 43.75%, the mortality rate was 12.50%, the average hospitalization time was 23.44± 7.83 days the respiratory tract infection, the incidence rate was 81.25%, the mortality rate was 37.50%, the average hospitalization time was 31.50± 9.25 days, and the P <0.05 patients with respiratory tract infection severe craniocerebral injury of trachea was significantly better than the control group only received routine nursing care measures for incision, the results of between two groups have statistical significance. Conclusion: Severe brain trauma after tracheotomy patient to prevent gas of evidence-based nursing, avoid infection of incision of evidence-based nursing, ensure unimpeded respiratory tract of evidence-based nursing, airway humidification of evidence-based nursing care, environment and equipment of evidence-based nursing in clinical nursing measures and subcutaneous bleeding, can effectively improve the clinical nursing effect, reduce the occurrence of rate and mortality in patients with respiratory tract infection, shorten hospitalized time, improve patient safety and quality of life, worthy of clinical application.

Effect of early tracheotomy on the prognosis of patients with serious brain lesions in intensive medicine

Objective To investigate the effects of early tracheotomy on the prognosis of patients with severe brain lesions .Methods The clinical data of 68 patients with severe brain lesions were retrospectively analyzed . According to the time of tracheotomy ,we assigned 68 patients to receive either early tracheotomy or late tracheotomy . 34 patients who were given tracheotomy within 72 hours in Intensive Care Unit were selected as the early tracheotomy group （ET group）.34 patients who were given tracheotomy after 14 days in Intensive Care Unit were selected as the late tracheotomy group（LT group）.The time of mechanical ventilation,length of hospital stay,and the incidence of ventilator associated pneumonia （ VAP ） , sedative drug use time , antibiotic use time , in-hospital mortality were compared between the two groups.Results In ET group,the hospitalization time,mechanical ventilation time, incidence of VAP,sedative drug use time,antibiotic use time were （4.2 ±2.4）d,（3.5 ±0.6）d,（14.5 ±3.2）%, （1.5 ±0.5）d,（3.3 ±0.3）d,those in LT group were （12.5 ±4.8）d,（8.5 ±5.6）d,（28.6 ±8.6）%,（6.3 ±1.2）d, （13.2 ±1.1） d respectively,the differences between the two groups were statistically significant （ t =3.14,2.96, 3.28,3.46,2.57,all P〈0.05）.The hospitalization mortality rates of ET group ,LT group were （23.8 ±4.38）%, （24.5 ±4.16）%,respectively no significant difference between the two groups （ t=1.49,P〈0.05）.Conclusion The use of early tracheotomy can reduce the hospitalization time ,shorten the time of mechanical ventilation ,reduce the incidence of ventilator associated pneumonia ,and reduce the time of using sedative drugs and antibiotics ,but the mor-tality has no significant effect in the severe craniocerebral injury patients . Key words: Tracheotomy ; Craniocerebral trauma; Stroke ; Prognosis

Effects of early enteral nutrition support on prognosis in patients with severe craniocerebral injury

Objective To investigate the impact of early enteral nutrition on the prognosis of severe head injury patients.Methods According to the different nutritional therapy,160 cases of severe craniocerebral injury patients were randomly divided into two groups using random digit.Two groups of patients were all given similarly conventional methods,the observation group were given early enteral nutrition therapy,the control group were given routine nutrition.CD3+,CD4+,IgE,IgG immune factors were observed after treatment for 10d.Results 10d later,the serum IgG,IgM,IgA in the observation group were significantly higher than those in the conventional nutrition group(t =2.18,3.42,11.23,all P ＜ 0.05),IgE was significantly lower than that in the conventional nutrition group (t =4.76,P ＜ 0.05) ;The serum T-lymphocyte subsets CD3+,CD4+ level in the observation group were higher than those in the conventional nutrition group(t =21.41,5.38,all P ＜ 0.05),the incidence of complications of the observation group was 23.75%,which was significantly lower than 55.00% in the conventional nutrition group(x2 =4.73,P ＜ 0.05).Conclusion Early enteral nutrition therapy can significantly improve the immunity of severe head injury patients,reduce complications,thereby improve the prognosis and the patient's quality of life. Key words: Craniocerebral trauma; Enteral nutrition; Immune factors

Analysis of the causes of Aspergillus infection secondary to severe traumatic brain injury and nursing measures

Objective To discusses the reason and effective prevention and control nursing measures in severe craniocerebral injured patients complicated with secondary pulmonary aspergillosis.Methods The reason of 21 severe craniocerebral injury patients infected by pulmonary aspergillosis were analyzed,and comprehensive nursing care was given to these patients,including strict disinfection and isolation,strengthening management of hospital environment,early close observation of disease,applying effective antifungal drugs in time,strengthening the medication nursing and nutrition support,standard antibiotic application,attention to the respiratory tract management,basic and college nursing.Results 13 cases were recovered,4 cases were better,4 cases died,the mortality rate was 19％.Conclusions Reasonable treatment and nursing care to the severe craniocerebral injury patients complicated with secondary pulmonary aspergillosis can effectively prevent and control the spread of pulmonary aspergillosis in the hospital,improve the cure rate,reduce the complications and the mortality rate,and ensure the safety of patients. Key words: Svere craniocerebral injury; Pulmonary aspergillosis infection; Reason analysis; Nursing measures

The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury

To observe the impact of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in mechanically ventilated patients with severe craniocerebral injury. A prospective, interventional, self-control study was conducted. Thirty severe craniocerebral injury patients with central respiratory failure were enrolled. The changes in CVP, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation [SpO2] were monitored at different PEEP levels [0, 3, 6, 9, 12, 15 cm H2O; 1 cm H2O=0.098 kPa] during mechanical ventilation and after weaning of mechanical ventilation. The influences of PEEP and its discontinuance on haemodynamics and oxygenation were analyzed. The values of CVP [cm H2O] were increased when PEEP increased (from 7.9±3.1 to 13.1±3.7), a linear correlation was found (R=0.509, P=0.000), and linear regression equation was CVP [cm H2O]=7.774+0.368×PEEP [cm H2O]; CVP was elevated about 0.368 cm H2O when PEEP increased 1 cm H2O. CVP values significantly decreased during discontinuance of mechanical ventilation, as compared to those measured at different PEEP levels during mechanical ventilation (F=24.429, P=0.000). The values of MAP, HR and SpO2 showed no significant change with increase of PEEP levels [MAP (mm Hg, 1 mm Hg=0.133 kPa): from 81.6±10.4 to 85.6±10.6; HR (beats per minute): from 79.9±13.5 to 88.1±15.4; SpO2: from 0.968±0.036 to 0.975±0.033, all P>0.05] in mechanically ventilated patients, but discontinuance of mechanical ventilation could significantly increase the levels of MAP and HR (95.3±8.4 and 94.9±10.3, respectively) and lower SpO2 levels (0.928±0.036, all P=0.000). CVP values were overestimated during an increase in PEEP in mechanically ventilated patients with severe craniocerebral injury. CVP was increased about 0.368 cm H2O following an increase of PEEP of 1 cm H2O, whereas the values of MAP, HR and SpO2 showed no significant change with increase in PEEP levels. This study could offer a theoretical base in the correct assessment of CVP values at different PEEP levels without discontinuation of mechanical ventilation.

Relationship between using proton pump inhibitors to prevent stress ulceration and the hospital-acquired pneumonia in severe craniocerebral injury patients

Objective To investigate whether using proton pump inhibitors (PPI) to prevent stress ulceration increase the incidence of hospital acquired pneumonia (HAP) in severe craniocerebral injury patients.Methods 120 case with severe craniocerebral injury for more than 7 days in our hospital in recent one year were analyzed and compared the incidence of HAP between using PPI and not.Results There were 83 cases using PPI in 120 cases of severe craniocerebral injury and 29 occurring HAP.The infection rate was 34.94％,especially with continued use ≥ 7days it was 47.05％.There were 34 cases without using PPI,4 found occurring HAP.The infection rate was 10.81％.Conclusions The incidence rate of HAP in patients with severe craniocerebral injury using PPI is significantly higher than that of those without using PPI.And incidence rate of HAP in the long-term use of PPI is obviously higher than the short-term one.The clinical doctors should choose drug and control drug using time according to the specific situation of patients,to reduce the incidence of HAP,and relieve pain of patients and reduce waste of resources. Key words: Proton pump inhibitors; Severe craniocerebral injury; Hospital-acquired pneumonia

Gradually controlled decompression in treatment of severe craniocerebral injury

Objective To investigate the effects of gradually controlled decompression and standard large craniotomy for treatment of severe craniocerebral injury.Method Among 285 severe craniocerebral injury cases,160( A group) underwent gradually controlled decompression and 125 (B group) underwent decompression of routine standard large craniotomy.Results The incidences of acute intraoperative encephalocele,delayed intracranial hematoma,brain tissue embedded,brain shift,brain stem distorted,large - area cerebral infarction and GOS score of two groups were significantly different ( P ＜ 0.05 ).Conclusions The gradually controlled decompression could decrease intraoperative and postoperative complications,disability rate and mortality of severe craniocerebral injury patients. Key words: Craniocerebral trauma; Neurosurgical procedures; Encephalocele; Delayed hematoma

Rescue and Nursing of severe craniocerebral injury patients with shock

Objective To explore the rescue and nursing point of severe craniocerebral injury patients with shock.Methods Review and analyse 88 cases of severe craniocerebral injury patients with shock.Through observeing consciousness,pupil,life sign,cardiogram,SPO,central venous pressure changes ect.,supply blood-volume and electrolyte in time.Rescue and nursing separate with different dgrees of severe craniocerebral injury and associated injury of differnet parts,and early Intervention of rehabilitation nursing.Results Total 88 cases,there are 74 cased with surgical therapy,14 cases with non-surgical therapy,cure 68 cases,Mutilation 14 cases,deadth 6 cases.Conclusion To be observed of severe craniocerebral injury patients,not only need to be observed the craniocerebral but also the other injury in other parts of the body,hemostasia in time in order to avoid shock is the most importance in increasing the cure rate.Do well in rehabilitation and nursing during every periods,and reduce complication,expedite patients' getting well,these are very important in increasing the quality of life for patients. Key words: Severe craniocerebral injury; Shock; Nursing

The nursing for the incision of trachea on the severe craniocerebral injury patients

Objective To investigate the nursing point for the incision of trachea on the severe craniocerebral injury patients.Methods 52 patients with incision of trachea were given the strict, utility, careful nuring, keeping the respiratory tract easy and smooth, keeping the ward cleaning,limiting visiting. Results The windpipe bushing stayed for 7 ～ 30 days,and there were 10 patients with the lung infection, 6 patients with the tube blocking,2 patients with the windpipe narrow, 1 patient with the windpipe emerging. Conclusions If the severe craniocerebral injury patients were given the incision of trachea early, it could be better and important for improving the life quality. Key words: Incision of trachea; Severe eraniocerebral injury; Coma patient

TOR-mediated autophagy regulates cell death inDrosophilaneurodegenerative disease

Objective To study the changes of intramucosal pH(pHi) and serum protein levels after early enteral nutrition in patients with severe craniocerebral injury.Methods According to the vital signs and intestinal sounds,enteral nutrition(EN) and parenteral nutrition(PN) were respectively given to the patients 12 to 72 h after operation.The value of pHi was monitored continuously in the following 5 days.Results The value of pHi and serum protein levels increased in both groups on the 5th day after operation(P0.05).Moreover,the value of pHi and serum protein levels of EN group increased more than that of PN group(P0.05).The restoration of anal exhaust time of EN group shortened significantly than that of PN group(P0.05).Conclusion The use of early enteral nutrition can improve the blood perfusion and oxygenation of gastrointestinal mucosae as well as the nutritional status in severe craniocerebral injury patients.

Influence of efficient communication on severe craniocerebral injury patients with persistent coma

Objective To explore the influence of efficient communicational humanistic nursing care on severe craniocerebral injury patients with persistent coma.Methods A total of 66 severe craniocerebral injury patients with persistent coma were divided into the two groups,both were received the same treatment and same nursing routine care,in addition,treatment group(34casos)were received an efficient communicational humanistic nursing care additional. GCS score in different stages,coma recovery and hospitalized days of patients were observed.Results The scores of GCS and coma recovery in treatment group showed better than that in control group after i month hospitalization,the sober time were also higher after 2 month hospitalization,and consciousness recovery showed better when the patients were discharged the hospital, while the hospitalization days were shorter than control group(P ＜ 0.05).Conclusions Communicational humanistic nursing care can obviously improve the prognosis of severe craniocerebral injury patients with persistent coma. Key words: Craniocerebral trauma; Coma; Summon nursing

Psychological analysis of acute severe craniocerebral injury patients'families and countermeasures

Objective To study the psychological conditions of acute severe craniocerebral injury patients'families and provide scientific basement for health education and psychological nuring care.Methods SCL-90 and self-designed questionnaire on general condition were used to investigate the psychological conditions of 80 acute severe craniocerebral injury patients'families.The scores of SCL-90 were analyzed.Results The acute severe craniocerebral injury patients'families had psychological symptoms.Most people showed abnormity in sleeping,diets and somatization symptoms.There were significant correlation between many items of general conditions and several factors of the abnormal psychological condition.Conclusions When acute severe craniocerebral injury patients be treated,the life difficulties of patients'families should be paid attention.Help patients'families improve the capability of coping,enhance the doctor-patient cooperation,exert their function in patients'rehabilitation. Key words: Craniocerebral injury ; Severe ; Patients'families ; Psychoanalysis ; Countermeasures ;

Role of the Visual Afferent Stream in Recovery of the Postural Control in Different Periods after Craniocerebral Injury

A comprehensive posturographic (PG), electroencephalographic, and clinical examination was performed during rehabilitation in 17 patients (mean age 27.5 ± 7.4 years) who had suffered a severe craniocerebral injury (SCCI). Of these, nine were examined soon after the SCCI and eight, in the period of remote consequences of the SCCI. The patients were compared to a control group of 18 healthy subjects (mean age 27.8 ± 12.2). The PG studies showed that, in the healthy subjects, the amplitude of sway of the common center of pressure (ACCP) in the absence of the visual control was higher than with the eyes open. The ACCP was higher in the sagittal than in the frontal plane and decreased during optokinetic stimulation. In the control group, rhythmic photostimulation produced a local increase in interhemispheric EEG coherence in symmetrical occipital and parietal cortical areas. In the patients examined early after the SCCI with the eyes open, the ACCP was higher than in the healthy subjects, especially in the frontal plane. The ACCP did not decrease in the Romberg posture and increased during optokinetic stimulation. In these patients, rhythmic photostimulation was accompanied by a generalized increase in mean interhemispheric EEG coherence as compared to the resting level. In the remote period after the SCCI, the PG and EEG responses to a decrease or an increase in the visual afferent stream proved to be inverted: the patients stood better with the eyes closed than with them open and photostimulation produced a decrease in EEG coherence in the occipitoparietal areas of the cortex. The results confirmed a greater efficiency of rehabilitation in the early period after the SCCI. Thus, specific PG and EEG reactions were observed in the SCCI patients at different stages of recovery. The generalized reactivity and “infantile” features of the EEG and PG rearrangements characteristic of the early period after the SCCI were considered to be a favorable prognostic sign for the recovery of the integrative brain activity and postural control of a patient. The inversion of the reactions in the remote period after the SCCI testified to limited possibilities of the recovery of the impaired functions and was indicative of a pathological type of compensatory rearrangements.