不同分型脑外伤患者住院期间凝血功能指标比较

目的观察不同分型脑外伤患者住院期间凝血功能指标变化,总结其规律性。方法选择119例不同分型(格拉斯哥昏迷评分,GCS)近期住院的脑外伤患者,检测他们急性期(入院后6h内)各类凝血功能指标,包括PT、TT、FDP、DD和BPC计数。结果轻(GCS评分13～15分,58例)、中型(GCS评分9～12分,32例)颅脑损伤患者急性期的PT、APTT、FDP和DD等指标均明显低于重型脑外伤组(GCS评分≤8分,29例),而BPC计数明显高于重型脑外伤组(P均<0.05～0.01)。结论重型脑外伤患者各项凝血功能指标异常。

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.

Management of patients with severe traumatic brain injury guided by intraventricular intracranial pressure monitoring： a report of 136 cases

Objective： To evaluate the effect of the treatment modality guided by intraventricular intracranial pressure （ICP） monitoring on patients with severe traumatic brain injury （TBI）. Methods： The clinical data of a group of 136 severely brain-injured patients admitted to Shanghai Neurosurgical Emergency Center from December 2004 to February 2006 were studied. Results： The intraventricular ICP monitor was placed in all the 136 patients via Kocher＇s pathway, Paine＇s pathway or intraoperative opened ventricle. In this series, the probe was placed during the procedure of craniotomy in 98 patients; for other 38 patients, the probe was placed initially to measure or to monitor ICE A stepwise protocol targeting at ICP control （420 mm Hg） and optimal cerebral perfusion pressure （CPP） maintenance （60-90 mm Hg） was deployed.Among them, 76 patients survived with good recovery, 14 with moderate disability, 24 with severe disability, 10 with vegetative state, and 12 died. Complications associated with intraventricular ICP monitoring included hemorrhage and infection. Hemorrhage occurred in 1 patient and infection in 5 patients. There were no unacceptable complications related to ICP monitoring. Conclusions： Ventricular access for 1CP monitoring can be safely and accurately achieved. ICP monitoring via ventriculostomy may facilitate an early and accurate intervention for severely brain-injured patients. The intraventricular ICP monitoring is a low-risk procedure and can yield great benefits for management of patients with severe TBI.

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

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 1 week before and 2 weeks 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.