早期重型脑颅损伤的高压氧综合护理方法研究

目的:研究早期重型脑颅损伤的高压氧综合护理方法。方法:早期重型脑颅损伤的综合高压氧护理方法是通过呼吸道护理、入舱前护理、舱内护理观测、出舱后护理,确保患者安全的同时提升临床疗效。为验证高压氧综合护理方法对早期重型颅脑损伤患者护理的有效性,选取150例患者为临床对象,与常规高压氧护理方法进行对比。结果:3个疗程后,高压氧综合护理方法组患者的总有效率为91.6%,高于常规高压氧护理方法组。高压氧综合护理方法组患者的GCS评定值也显著高于常规高压氧护理方法组。结论:高压氧综合护理方法对早期重型脑颅损伤患者护理效果优于常规护理方法,可以推广。

标准大骨瓣减压术治疗重型颅脑损伤的临床疗效观察

目的对标准大骨瓣减压术治疗重型颅脑损伤的临床疗效进行探讨。方法回顾性分析65例重型颅脑损伤患者采用标准大骨瓣减压术治疗的临床资料。结果本组治愈28例,中度残疾23例,重度残疾7例,植物生存患者4例,死亡3例(4.62%)。结论标准大骨瓣减压术治疗重型颅脑损伤,能提高治愈率,降低病死率。

重型颅脑损伤患者术后发生呼吸机相关性肺炎的危险因素分析

目的研究重型颅脑损伤患者术后发生呼吸机相关性肺炎(VAP)的危险因素,并对其进行分析,提出针对性的干预措施。方法64例使用呼吸机时间>48 h的重型颅脑损伤患者,分析重型颅脑损伤患者术后发生VAP的影响因素,包括患者年龄、性别、术前格拉斯哥量表(GCS)评分、机械通气方式、术后机械通气时间、手术次数、吸烟史、误吸等。结果年龄≥60岁患者VAP发生率87.18%高于年龄<60岁的48.00%,术前GCS评分≥5分患者VAP发生率83.78%高于术前GCS评分<5分的55.56%,气管切开患者VAP发生率85.29%高于气管插管的56.67%,术后机械通气时间≥14 d患者VAP发生率89.47%高于术后机械通气时间<14 d的46.15%,手术次数>1次患者VAP发生率88.10%高于手术次数为1次的40.91%,有误吸患者VAP发生率83.33%高于无误吸的57.14%,差异均具有统计学意义(P<0.05);年龄、术前GCS评分、机械通气方式、术后机械通气时间、手术次数、误吸均为发生VAP的影响因素(P<0.05)。结论重型颅脑损伤患者术后VAP发生率较高,其影响因素包括年龄、术前GCS评分、机械通气方式、术后机械通气时间、手术次数、误吸等。

重型颅脑损伤去骨瓣减压术后脑膨出的临床特征

目的总结去骨瓣减压术治疗重型颅脑损伤并发脑膨出的临床特征。方法回顾性分析54例重型脑颅损伤经去骨瓣减压术治疗后并发脑膨出患者的临床资料。结果患者脑膨出程度随患者的预后评分增高而降低,且不同组之间差异具有统计学意义(P<0.05)。不同预后组患者随着术后恢复时间的延长,患者的脑膨出程度均呈现先增后减的趋势,在术后第14天达到最高。术后发生脑膨出患者的脑积水病发率最高,达53.70%,而发生颅内感染的几率最低为3.70%。结论重型颅脑损伤去骨瓣减压术后脑膨出的发生与患者预后具有一定的关系,故需有效的提高患者的预后,减少各类病发正的发生,是降低脑膨出程度,提高治疗效果的有效手段。

标准大骨瓣开颅减压治疗重型颅脑损伤43例体会

目的探讨标准大骨瓣开颅减压治疗重型颅脑损伤43例体会。方法选取2011年1月-2012年1月期间我院收治的81例重型颅脑损伤患者,按照治疗方式将其分组,43例患者选择大骨瓣开颅手术治疗,称之为观察组,38例患者选择常规开颅减压手术治疗,称之为对照组,比较两组患者治疗前后临床疗效。结果观察组患者手术后颅内压下降速度明显高于对照组患者,观察组术后预后由于对照组,在住院时间和住院费用上也明显低于对照组患者,两组患者具有统计学意义(P<0.05)。结论大骨瓣开颅减压治疗重型脑颅损伤具有减压速度快、预后良好、并发症少等优点,可明显提高患者的生活质量,即安全又有效的治疗方法 ,值得临床广泛推广及应用。

重型颅脑损伤患者早期肠内营养护理的应用与效果

目的探讨ICU重型颅脑损伤患者早期肠内营养护理的应用与效果。方法选取2017年1月至2019年6月马鞍山十七冶医院重症医学科收治的80例重型颅脑损伤手术治疗后患者作为研究对象,回顾性分析不同营养方式对营养指标和近期并发症的影响。行肠外营养支持和护理的40例为对照组,行早期肠内营养支持和护理的40例为观察组。比较两组实施7 d后营养指标水平(包括血浆白蛋白、血浆前白蛋白、血红蛋白)及早期并发症的发生率。两种营养支持方式实施前,均评估患者状况,测算营养需求。实施肠内营养支持前,排除既往有消化道溃疡和消化道出血病史,和疑似消化道出血者,抬高床头30°~45°滴注营养素(能全力),由低浓度、慢速开始,观察不良反应,根据肠道耐受性逐步增加滴速和浓度,冬季需加热器升温。结果对重型颅脑损伤患者施行不同营养支持方式7 d后,观察组各项营养指标(血浆白蛋白、血浆前白蛋白、血红蛋白)水平显著高于对照组,差异有统计学意义(P<0.05,P<0.01);收治10 d内评价,观察组早期并发症(电解质紊乱、消化道出血、肺炎)发生率较对照组有所降低,但差异无统计学意义(7.5%vs 20.0%,P>0.05)。结论ICU重型颅脑损伤患者实施早期肠内营养支持符合生理需求,可显著提高患者营养指标水平,可能有助于降低早期并发症的发生,能否获得有统计学意义的收益,尚待扩大样本量进一步观察。

55例重型颅脑损伤患者高压氧治疗中的护理观察

目的：对重型颅脑损伤患者在高压氧治疗中的护理效果进行观察，并进行研究和分析。方法：选取2011年1月~2014年1月，我院收治的重型颅脑损伤患者105例，回顾性分析临床资料，随机分成2组，给予高压氧治疗和患者进舱、舱内、出舱后的护理的55例患者，为观察组；给予抗感染、补液、改善脑供血等常规治疗和常规护理的50例患者，为比对组。观察2组患者格拉斯哥昏迷评分值（GCS评分值），并进行比较分析。结果：治疗护理前，2组患者的GCS评分值之间差异不明显，且P〉0．05，无统计学意义；经治疗和护理后，观察组的GCS评分值明显高于比对组，患者意识情况改善显著，且P〈0．05，差异具有统计学意义。结论：对于接受高压氧治疗的重型颅脑损伤患者，给予相应的优质护理，能够有效改善患者的意识情况，临床疗效显著，值得在临床中推广和应用。

Early enteral nutrition supplemented with probiotics improved the clinical outcomesin patients with severe head injury： protocol for a meta-analysis of randomizedcontrolled trials

Objective： The aim of this systematic review of randomized controlled trials （RCTs） is to determine the effects of earlyenteral nutrition supplemented with probiotics on clinical outcomes in patients with SHI.Methods and analysis： A systematic search will be carried out in PubMed, Cochrane Central Register of ControlledTrials （CENTRAL）, China National Knowledge Infrastructure （CNKI）, WanFang database, and Chinese BiomedicalLiterature （CBM） in order to identify the randomized controlled trials （RCTs） investigated the potential of early enteralnutrition supplemented with probiotics on patients with severe head injury, as well as we will also manually check thebibliographies of eligible studies and topic-related reviews. We will assign two investigators to independently search allpotential citations, extracted data, and appraised risk of bias accordingly, and then STATA software version 12.0 will beused to statistically analyze all data.Ethics and dissemination： The ethics approval and patient written informed consent will not be required because allanalyses in the present study will be performed based on data from published studies. We will submit our systematicreview to a peer-reviewed scientific journal for publication.

Posttraumatic hydrocephalus associated with decompressive cranial defect in severe brain-injured patients

Objective： To investigate the occurrence of posttraumatic hydrocephalus （PTH） in severe braininjured patients who underwent decompressive craniectomy （DC） and to discuss the management. Methods： A total of 389 patients suffering from severe head trauma between January 2004 and May 2010 were enrolled in this study. Clinical data were analyzed retrospectively. Of them, 149 patients who underwent DC were divided into two groups according to the presence of PTH： hydrocephalus group and nonhydrocephalus group. Clinical factors including preoperative Glasgow Coma Score （GCS）, bilateral or unilateral decompression, and duraplasty in DC were assessed by single factor analysis to determine its relationship with the occurrence of PTH. Results： Of the 149 patients undergoing DC, 25 （16.8%） developed PTH; while 23 developed PTH （9.6%） among the rest 240 patients without DC. Preoperative GCS, bilateral or unilateral decompression, duraplasty in DC were significantly associated with the development of PTH. Ventriculoperitoneal shunt was performed on 23 of 25 patients with PTH after DC. Frontal horn was preferred for the placement of the catheter. Sixteen of them were operated upon via frontal approach and 7 via occipital approach. After shunt surgery, both radiological and clinical improvemerits were confirmed in 19 patients. Radiological improvement was found in 2 patients. One patient died eventually of severe pneumonia. Shunt-related infection occurred in 1 patient, which led to the removal of the catheter. Conclusions： It is demonstrated that the occurrence of PTH is high in patients with large decompressive skull defect. Patients with low GCS and bilateral decompression tend to develop PTH after DC. Duraplasty in DC might facilitate reducing the occurrence of PTH. Patients with PTH concomitant skull defect should be managed deliberately to restore the anatomical and physiological integrity so as to facilitate the neurological resuscitation.