Objective: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine vasopressin (AVP) in patients with acute moderate or severe cerebral injury. Methods: The...Objective: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine vasopressin (AVP) in patients with acute moderate or severe cerebral injury. Methods: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS≤8 in 27cases ) or severe (GCS>8 in 21 cases) cerebral injury (Group A), in 42 cases of non cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. Results: The early plasma concentrations of ET ( 109.73 ng/L±12.61 ng/L ), NO ( 92.82 μmol/L± 18.21 μmol/L ) and AVP ( 49.78 ng/L±14.29 ng/L ) in Group A were higher than those in Group B ( 67.90 ng/L ±11.33 ng/L , 52.66 μmol/L±12.82 μmol/L and 29.93 ng/L±12.11 ng/L , respectively, P<0.01 ) and Group C ( 50.65 ng/L±17.12 ng/L , 36.12 μmol/L ±12.16 μmol/L and 5.18 ng/L ± 4.18 ng/L , respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L± 18.12 ng/L , 108.19 μmol/L±13.28 μmol/L and 58.13 ng/L±16.78 ng/L , respectively, which were significantly higher than that of the patients with moderate cerebral injury ( 92.33 ng/L±16.32 ng/L , 76.38 μmol/L ±12.71 μmol/L and 36.18 ng/L±12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L± 15.23 ng/L , 118.18 μmol/L±10.12 μmol/L and 63.49 ng/L±14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma ( 81.13 ng/L ±12.37 ng/L , 68.02 μmol/L±13.18 μmol/L and 45.63 ng/L±12.41 ng/L respectively, P<0.01 ). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. Conclusions: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.展开更多
Objective: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT II) in patients with acute moderate and severe cerebral injury. Methods: The early plasma concentration wa...Objective: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT II) in patients with acute moderate and severe cerebral injury. Methods: The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non cerebral injury and 30 healthy volunteers. Results: The early plasma concentrations of AVP ( 50.23 ng/L± 15.31 ng/L) and AT II ( 248.18 ng/L± 82.47 ng/L) in cerebral injury group were higher than those in non cerebral injury group (AVP for 30.91 ng/L± 11.48 ng/L and AT II for 120.67 ng/L± 42.49 ng/L, P< 0.01 ). The early plasma concentrations of AVP and AT II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L± 4.23 ng/L and AT II for 43.11 ng/L± 16.39 ng/L, P< 0.001 ). At the same time, the early plasma level of AVP ( 58.90 ng/L± 18.12 ng/L) and AT II ( 292.13 ng/L± 101.17 ng/L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L± 12.16 ng/L and AT II for 201.42 ng/L± 66.10 ng/L, P< 0.01 ). The early level of AVP and AT II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP ( 45.98 ng/L± 13.48 ng/L) and AT II ( 263.28 ng/L± 80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L± 15.56 ng/L and AT II for 319.82 ng/L± 108.11 ng/L, P< 0.01 ). Conclusions: AVP and AT II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT II will be. The early plasma level of AVP and AT II may be one of the severity indexes of cerebral injury.展开更多
Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP b...Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1β and interleukin-6). Results: There were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences. Conclusions: Mild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.展开更多
Objective: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebra...Objective: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebral injury.Methods: The CT scan features including the states of perimesencephalic cisterns, the deformations of the midbrain and the ratios of the occipitofrontal diameter and the transverse diameter of the midbrain of 132 cases were measured. The GOS of the patients 3 months after trauma were regarded as outcome.Results: The rate of unfavorable outcome ( dead, vegetative status, severe disability ) was significantly correlated with perimesencephalic cistern narrower than 1mm (P < 0.05), especially narrower than 0.5 mm (P < 0.005), deformed midbrain (P< 0.005) or abnormal ratio ( < 0.9 or >.1) of the occipitofrontal diameter and transverse diameter of the midbrain (P < 0.01). But the patient's perimesencephalic cistern wider than 1mm and the patients without deformed midbrain got favorable outcome (moderate disability/good recovery).Conclusions: The state of the compressedperimesencephalic cistern ( < 1 mm) and the deformation of the midbrain may significantly indicate unfavorable outcome of the patients with acute craniocerebral injury.展开更多
Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Re...Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews（CDSR）.Methods：An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted.We retrieved such databases as CDSR and Cochrane Injury Group,excluded the duplications,and eventually obtained 20 results,which stand for critical appraisal for as many as 20 different measures for TBI patients.The important data of each systematic review,including total population,intervention,outcome,etc,were collected and presented in a designed table.Besides,we also tried to find out the possible weakness of these clinical trials included in each review.Results：Analysis of these reviews yielded meanfuling observations：（1）The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful,and tranexamic acid,nimodipine and progesterone show a promising effect in bleeding trauma,traumatic subarachnoid hemorrhage,TBI or severe TBI.（2）A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients,largely due to the uncertainty of the effectiveness.（3）The quality of most trials reported in the systematic reviews is more or less questionable.（4）In addition,lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.Conclusions：For clinical physicians,to translate these conclusions into practice with caution is essential.Basic medication and nursing care deserve additional attention as well and can be beneficial.For researchers,high quality trials with perfect design and comprehensive consideration of various factors are urgently required.展开更多
基金ThisstudywassupportedbytheFundFoundationofHealthDepartmentofZhejiangProvince (No .96 174 )
文摘Objective: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine vasopressin (AVP) in patients with acute moderate or severe cerebral injury. Methods: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS≤8 in 27cases ) or severe (GCS>8 in 21 cases) cerebral injury (Group A), in 42 cases of non cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. Results: The early plasma concentrations of ET ( 109.73 ng/L±12.61 ng/L ), NO ( 92.82 μmol/L± 18.21 μmol/L ) and AVP ( 49.78 ng/L±14.29 ng/L ) in Group A were higher than those in Group B ( 67.90 ng/L ±11.33 ng/L , 52.66 μmol/L±12.82 μmol/L and 29.93 ng/L±12.11 ng/L , respectively, P<0.01 ) and Group C ( 50.65 ng/L±17.12 ng/L , 36.12 μmol/L ±12.16 μmol/L and 5.18 ng/L ± 4.18 ng/L , respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L± 18.12 ng/L , 108.19 μmol/L±13.28 μmol/L and 58.13 ng/L±16.78 ng/L , respectively, which were significantly higher than that of the patients with moderate cerebral injury ( 92.33 ng/L±16.32 ng/L , 76.38 μmol/L ±12.71 μmol/L and 36.18 ng/L±12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L± 15.23 ng/L , 118.18 μmol/L±10.12 μmol/L and 63.49 ng/L±14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma ( 81.13 ng/L ±12.37 ng/L , 68.02 μmol/L±13.18 μmol/L and 45.63 ng/L±12.41 ng/L respectively, P<0.01 ). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. Conclusions: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.
文摘Objective: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT II) in patients with acute moderate and severe cerebral injury. Methods: The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non cerebral injury and 30 healthy volunteers. Results: The early plasma concentrations of AVP ( 50.23 ng/L± 15.31 ng/L) and AT II ( 248.18 ng/L± 82.47 ng/L) in cerebral injury group were higher than those in non cerebral injury group (AVP for 30.91 ng/L± 11.48 ng/L and AT II for 120.67 ng/L± 42.49 ng/L, P< 0.01 ). The early plasma concentrations of AVP and AT II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L± 4.23 ng/L and AT II for 43.11 ng/L± 16.39 ng/L, P< 0.001 ). At the same time, the early plasma level of AVP ( 58.90 ng/L± 18.12 ng/L) and AT II ( 292.13 ng/L± 101.17 ng/L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L± 12.16 ng/L and AT II for 201.42 ng/L± 66.10 ng/L, P< 0.01 ). The early level of AVP and AT II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP ( 45.98 ng/L± 13.48 ng/L) and AT II ( 263.28 ng/L± 80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L± 15.56 ng/L and AT II for 319.82 ng/L± 108.11 ng/L, P< 0.01 ). Conclusions: AVP and AT II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT II will be. The early plasma level of AVP and AT II may be one of the severity indexes of cerebral injury.
文摘Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1β and interleukin-6). Results: There were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences. Conclusions: Mild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.
文摘Objective: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebral injury.Methods: The CT scan features including the states of perimesencephalic cisterns, the deformations of the midbrain and the ratios of the occipitofrontal diameter and the transverse diameter of the midbrain of 132 cases were measured. The GOS of the patients 3 months after trauma were regarded as outcome.Results: The rate of unfavorable outcome ( dead, vegetative status, severe disability ) was significantly correlated with perimesencephalic cistern narrower than 1mm (P < 0.05), especially narrower than 0.5 mm (P < 0.005), deformed midbrain (P< 0.005) or abnormal ratio ( < 0.9 or >.1) of the occipitofrontal diameter and transverse diameter of the midbrain (P < 0.01). But the patient's perimesencephalic cistern wider than 1mm and the patients without deformed midbrain got favorable outcome (moderate disability/good recovery).Conclusions: The state of the compressedperimesencephalic cistern ( < 1 mm) and the deformation of the midbrain may significantly indicate unfavorable outcome of the patients with acute craniocerebral injury.
文摘Objective：To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury（TBI）mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews（CDSR）.Methods：An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted.We retrieved such databases as CDSR and Cochrane Injury Group,excluded the duplications,and eventually obtained 20 results,which stand for critical appraisal for as many as 20 different measures for TBI patients.The important data of each systematic review,including total population,intervention,outcome,etc,were collected and presented in a designed table.Besides,we also tried to find out the possible weakness of these clinical trials included in each review.Results：Analysis of these reviews yielded meanfuling observations：（1）The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful,and tranexamic acid,nimodipine and progesterone show a promising effect in bleeding trauma,traumatic subarachnoid hemorrhage,TBI or severe TBI.（2）A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients,largely due to the uncertainty of the effectiveness.（3）The quality of most trials reported in the systematic reviews is more or less questionable.（4）In addition,lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.Conclusions：For clinical physicians,to translate these conclusions into practice with caution is essential.Basic medication and nursing care deserve additional attention as well and can be beneficial.For researchers,high quality trials with perfect design and comprehensive consideration of various factors are urgently required.
