Effect of Early Enteral Nutrition Combined with Probiotics on the Nutritional Status of Patients with Severe Craniocerebral Injury

Objective:To observe the effect of early enteral nutrition combined with probiotics on the nutritional status of patients with severe craniocerebral injury.Methods:Thirty-five patients with severe craniocerebral injury were divided into the study group(17 patients)and the control group(18 patients)according to the method of a randomized numerical table;both groups of patients started enteral nutrition via nasogastric tube within 24–48 hours after admission to the hospital,and probiotics were given in addition to the study group.Hemoglobin,total plasma protein,albumin,prealbumin,cholinesterase,fasting blood glucose,and other indexes were monitored before and early morning after enteral nutrition support,and upper arm circumference(AC),triceps skinfold thickness(TSF),and upper arm muscle circumference(AMC)were measured,and gastrointestinal response and time to first defecation of the patients were observed and compared with GCS score.Results:The hemoglobin,serum albumin,prealbumin,cholinesterase,and total plasma protein levels in the study group were significantly higher and fasting blood glucose levels were significantly lower than those in the control group after treatment(P<0.05).The incidence of reflux and constipation in the study group was lower than that in the control group,and the time to first defecation was shorter than that in the control group(P<0.05).After treatment,AC,TSF,and AMC were higher in the study group than in the control group(P<0.05).GCS scores were significantly higher in both groups after treatment,but the trend was more pronounced in the study group(P<0.05).Conclusion:Compared with simple enteral nutrition,enteral nutrition combined with probiotics can better correct metabolic disorders after heavy craniocerebral injury and improve the nutritional status of patients.

Changes in circulating inflammatory cells and the relationship to secondary brain injury in patients with craniocerebral injury

BACKGROUND：Recent studies have indicated that reactive encephalitis plays an important role in secondary tissue damage after craniocerebral injury. OBJECTIVE： To observe changes in white blood cells （WBC） and polymorphonuclear neutrophils （PMN） in peripheral blood, and to determine their role in secondary brain insult in patients with craniocerebral injury. DESIGN, TIME AND SETTING： A case-control study at the Department of Neurosurgery of the Affiliated Hospital North Sichuan University of Medical Sciences between August 2007 and May 2008. PARTICIPANTS： Sixty-three patients, admitted within 24 hours after craniocerebral injury and who received no surgery, were included in the study. The cohort consisted of 41 males and 22 females, aged 9–72 years, with an average age of 42 years. Ten healthy volunteers, selected from the Department of Neurosurgery, were designated as the control group. METHODS： WBC and PMN from the peripheral blood were measured 0, 24, 48, 72, and 168 hours after admission to hospital. The Glasgow coma scale, area of cerebral hemorrhage, and degree of brain edema were simultaneously determined. The Glasgow outcome scale was evaluated six months after injury. The relationship between changes in WBC and PMN were analyzed. Sixty-three patients were divided into 0, 24, 48, 72, and 168 hours groups, with admission time to hospital as the determining factor. As controls, WBC and PMN of peripheral blood were also detected in 10 healthy volunteers. MAIN OUTCOME MEASURES： The main outcome measures were WBC and PMN counts in the peripheral blood at 0, 24, 48, 72, and 168 hours after admission to hospital, the mutual relationship between GCS, WBC and PMN, and changes in brain hemorrhage volume and edema size. RESULTS： WBC peaked at 24 hours after injury, and PMN peaked at 48 hours after injury （P 〈 0.01）. These measures negatively correlated to the Glasgow coma scale （r = -0.657, -0.541, respectively, P 〈 0.05）. In patients with Glasgow coma sale 〈 8, WBC and PMN were significantly higher than in the patients with GCS ≥ 8 （P 〈 0.05）. Cerebral hemorrhage reached a peak at 24 hours after injury, and the degree of brain edema was maximal at 168 hours after injury. WBC and PMN counts were positively correlated to cerebral hemorrhage volume and brain edema size （P 〈 0.05）. CONCLUSION： WBC and PMN counts significantly increased after craniocerebral injury and exhibited a correlation with the GCS score, volume of hemorrhage and edema, and Glasgow outcome scale.

Clinical Evaluation of Enteral Nutrition+Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective:To evaluate the therapeutic effect of enteral nutrition+probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury.Methods:From September 2018 to February 2023,80 patients(20-82 years old)with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study.Their primary condition was severe craniocerebral injury,and all of them received conventional symptomatic treatment.Group A received enteral nutrition+probiotic therapy,whereas group B received enteral nutrition only.The differences in the following indicators were compared before and after treatment:nutritional and biochemical indicators,gastrointestinal function indicators,Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA),APACHE II score,serum procalcitonin(PCT),neutrophil(N)ratio,and C reactive protein(CRP).Result:The nutritional and biochemical indicators in group A were higher than those in group B,P<0.05;the time to first passage of flatus,time to first passage of stool,and bowel sound recovery time in group A were shorter than those in group B,P<0.05;the GCS of group A was higher than that of group B,P<0.05;the SOFA and APACHEⅡscores of group A were not different from those of group B,P>0.05;and the PCT,N ratio,and CRP levels of group A were lower than those of group B,P<0.05.Conclusion:In patients with gastrointestinal dysfunction after severe craniocerebral injury,enteral nutrition+probiotic therapy is highly effective and feasible,as it can optimize various nutritional indicators,shorten the gastrointestinal function recovery time,and reduce the body’s stress response.

Comparison of the Efficacy of Standard Decompressive Craniectomy Combined with Cerebrospinal Fluid Circulation Reconstruction in the Treatment of Severe Craniocerebral Injury

Objective:To observe and discuss the clinical effect of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury.Methods:Seventy patients who underwent surgery in our hospital were selected as subjects for this study.The time was from August 2016 to August 2018,and patients were divided into experimental group(35 cases)and control group(35 cases)according to the random number table method.The control group was treated with a single standard decompressive craniectomy according to clinical symptoms.The experimental group was treated with standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction.The surgical treatment effect,GCS(Glasgow Coma Scale)score and operation time were compared between the two groups.Results:After comparison,the surgical treatment effect of the experimental group was higher than that of the control group and there was a significant difference between the two groups(P<0.05).The GCS score and operation time of the experimental group were also better than of the control group and there was a significant difference the two groups(P<0.05).Conclusion:The use of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury is more effective and worthy of widespread promotion and application.

Parametric analysis of craniocerebral injury mechanism in pedestrian trafficaccidents based on finite element methods

Purpose:The toughest challenge in pedestrian traffic accident identification lies in ascertaining injurymanners.This study aimed to systematically simulate and parameterize 3 types of craniocerebral injuryincluding impact injury,fall injury,and run-over injury,to compare the injury response outcomes ofdifferent injury manners.Methods:Based on the total human model for safety(THUMS)and its enhanced human model THUMShollow structures,a total of 84 simulations with 3 injury manners,different loading directions,andloading velocities were conducted.Von Mises stress,intracranial pressure,maximum principal strain,cumulative strain damage measure,shear stress,and cranial strain were employed to analyze the injuryresponse of all areas of the brain.To examine the association between injury conditions and injuryconsequences,correlation analysis,principal component analysis,linear regression,and stepwise linearregression were utilized.Results:There is a significant correlation observed between each criterion of skull and brain injury(p<0.01 in all Pearson correlation analysis results).A 2-phase increase of cranio-cerebral stress andstrain as impact speed increases.In high-speed impact(>40 km/h),the Von Mises stress on the skull waswith a high possibility exceed the threshold for skull fracture(100 MPa).When falling and makingtemporal and occipital contact with the ground,the opposite side of the impacted area experienceshigher frequency stress concentration than contact at other conditions.Run-over injuries tend to have amore comprehensive craniocerebral injury,with greater overall deformation due to more adequate kinetic energy conduction.The mean value of maximum principal strain of brain and Von Mises stress ofcranium at run-over condition are 1.39 and 403.8 MPa,while they were 1.31,94.11 MPa and 0.64,120.5 MPa for the impact and fall conditions,respectively.The impact velocity also plays a significant rolein craniocerebral injury in impact and fall loading conditions(the p of all F-test<0.05).A regressionequation of the craniocerebral injury manners in pedestrian accidents was established.Conclusion:The study distinguished the craniocerebral injuries caused in different manners,elucidatedthe biomechanical mechanisms of craniocerebral injury,and provided a biomechanical foundation forthe identification of craniocerebral injury in legal contexts.

Craniocerebral injury promotes the repair of peripheral nerve injury

The increase in neurotrophic factors after craniocerebral injury has been shown to promote fracture healing. Moreover, neurotrophic factors play a key role in the regeneration and repair of peripheral nerve. However, whether craniocerebral injury alters the repair of peripheral nerve injuries remains poorly understood. Rat injury models were established by transecting the left sciatic nerve and using a free-fall device to induce craniocerebral injury. Compared with sciat- ic nerve injury alone after 6-12 weeks, rats with combined sciatic and craniocerebral injuries showed decreased sciatic functional index, increased recovery of gastrocnemius muscle wet weight, recovery of sciatic nerve ganglia and corresponding spinal cord segment neuron mor- phologies, and increased numbers of horseradish peroxidase-labeled cells. These results indicate that craniocerebral injury promotes the repair of peripheral nerve injury.

Early hyperbaric oxygen therapy inhibits aquaporin 4 and adrenocorticotropic hormone expression in the pituitary gland of rabbits with blast-induced craniocerebral injury

In the present study, rabbits were treated with hyperbaric oxygen for 1 hour after detonator-blastinduced craniocerebral injury. Immunohistochemistry showed significantly reduced aquaporin 4 expression and adrenocorticotropic hormone expression in the pituitary gland of rabbits with craniocerebral injury. Aquaporin 4 expression was positively correlated with adrenocorticotropic hormone expression. These findings indicate that early hyperbaric oxygen therapy may suppress adrenocorticotropic hormone secretion by inhibiting aquaporin 4 expression.

Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

BACKGROUND Severe craniocerebral injury(STBI)is a critical physical trauma caused by a sudden external force acting on the head.The condition is complex and changeable,and disability and mortality rates are high.Although the life of STBI patients can be saved through treatment,the sequelae of consciousness,speech,cognitive impairment,stiffness,spasm,pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family.In the past,routine nursing was often used to treat/manage STBI;however,problems,such as improper cooperation and untimely communication,reduced therapeutic effectiveness.AIM To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.METHODS From January 2019 to December 2020,126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center.These patients were retrospectively selected as the research participants in the current study.The study participants were then divided into a control group(61 cases)and a study group(65 cases).The control group was treated with routine nursing.The study group adopted the proposed care bundle.The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale(GCS)were used to evaluate neurological function before and after emergency treatment.After 3 mo of rehabilitation,experimental outcomes were assessed.These included the GCS,Barthel Index,complication rate,muscle strength grade and satisfaction.RESULTS There was no significant difference in gender,age,cause of injury and GCS between the two groups.After emergency,the National Institutes of Health Stroke Scale/Score of the study group(10.23±3.26)was lower than that of the control group(14.79±3.14).The GCS score of the study group(12.48±2.38)was higher than that of the control group(9.32±2.01).The arrival time of consultation in the study group was 20.56±19.12,and the retention time in the emergency room was 45.12±10.21,which were significantly shorter than those in the control group.After 3 mo of rehabilitation management,the GCS and Barthel Index of the study group were 14.56±3.75 and 58.14±12.14,respectively,which were significantly higher than those of the control group.The incidence of complications in the study group(15.38%)was significantly lower than that in the control group(32.79%).The proportion of muscle strength≥grade III in the study group(89.23%)was significantly higher than that in the control group(50.82%).The satisfaction of patients in the study group was significantly higher than that in the control group.CONCLUSION Care bundles are used to optimize the nursing process.During first-aid,care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time.In early rehabilitation,they can effectively improve the consciousness of STBI patients,improve the activities of daily living,reduce the risk of complications,accelerate the recovery of muscle strength and improve their satisfaction.

Curative effect of ganglioside sodium for adjuvant therapy on acute severe craniocerebral injury

Objective: To study the effect of adjuvant therapy of ganglioside sodium on intracranial pressure (ICP), partial pressure of brain tissue oxygen (PbtO2), nerve injury molecules, nerve protection molecules and indexes of oxidative stress in patients with acute severe craniocerebral injury. <br> Methods: Forty-seven patients with severe craniocerebral injury treated in the emergency department of our hospital during the period time from December 2012 to October 2015 were selected for retrospective analyses. They were divided into the ganglioside group and the normal treatment group according to the usage of ganglioside sodium in the process of the emergency treatment. At days 1, 3, 5 and 7 before and after treatment, theICP and PbtO2 in patients of the two groups were measured. After 7 days of treatment, the nerve injury molecules, nerve protection molecules and the indexes of oxidative stress in serum of the patients of the two groups were determined. <br> Results: At days 1, 3, 5 and 7 before and after treatment, theICP in patients of the ganglioside group were all significantly lower than those of the normal treatment group, while the PbtO2 were all significantly higher than those of normal treatment group. After 7 days of treatment, the contents of serum methane dicarboxylic aldehyde, advanced oxidation protein products, 8-hydroxy-2'-deoxyguanosine urine, S100β, glial fibrillary acidic portein, neuron specific enolase, myelin basic protein, neuroglobin and ubiquitin carboxyl-terminal hydrolase L1 in patients of the ganglioside group were notably lower than those of the normal treatment group, while the contents of superoxidase dismutase, glutathione peroxidase, catalase, nerve growth factor and brain derived neurotrophic factor were significantly higher than those of the normal treatment group. <br> Conclusions: The adjuvant therapy of ganglioside sodium in patients with severe craniocerebral injury can effectively reduceICP, improve PbtO2 and alleviate the injuries of neurons and glial cells caused by oxidative stress.

The effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury

Objective:To study the effects of large doses of vitamin C and vitamin E on nerve injury,neurotrophic and oxidative stress in patients with acute craniocercbral injury.Methods:Patients with acute cranioccrebral trauma who were admitted to the Third People's Hospital of Zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups.The control group received conventional treatment,and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment.On the yh day and 7th day after treatment,peripheral blood was collected and serum was isolated,then the contents of nerve injury index NSE,S 100B,NGB,UCH-L1,Tf,Ft and neurotrophic indexes NTF-α,BDNE NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit,and the contents of SOD,GPx,CAT,OH-,O2,MDA and AOPP were measured by radioactive immunoprecipitation kit.Results:3th day and 7th day after treatment,the contents of NSE,S100B,NGB,UCH-L1,Tf,Ft,NTF-α,BDNF,NGF,IGF-Ⅰ,OH-,O2-,MDA and AOPP in the intervention group were all significantly lower than those in the control group.The content of SOD,GPx and CAT in serum in the intervention group was significantly higher than that in the control group.Conclusions:High-dose vitamin C and vitamin E treatment can alleviate nerve injury,oxidative stress response,and improve neurotrophic state in patients with acute craniocerebral injury.

Treatment of singultus following craniocerebral injury Intranasal cavity drip infusion versus intramuscular injection of aminazine

Craniocerebral injury always accompanies with singultus, while frequent singultus may cause increased intracranial pressure. Simultaneously, respiratory alkalosis and cerebral hypoxia induced by respiratory disorder may aggravate craniocerebral injury. OBJECTIVE： To observe the therapeutic effects of intranasal cavity drip infusion of aminazine and intramuscular injection on singultus following craniocerebral injury. DESIGN： Contrast observation. SETTING： Department ofNeurosurgery, Xi＇an Aerospace General Hospital. PARTICIPANTS： A total of 102 patients with singultus following craniocerebral injury were selected from the Department of Neurosurgery, Xi＇an Aerospace General Hospital from June 2001 to June 2006. Patients with craniocerebral injury were diagnosed with CT examination and randomly divided into nasal cavity medication group （n =62） and intramuscular injection group （n =40）. There were 44 males and 18 females in the nasal cavity medication group and their mean age was （33±4） years; while, there were 26 males and 14 females in the intramuscular injection group and their mean age was （29±4） years. All patients and their relatives provided the confirmed consent. METHODS： Patients in the nasal cavity medication group were slowly dripped aminazine solution into bilateral nasal cavity with the dosage of 12.5 mg （0.5 mL）. Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was stopped if symptoms were also observed after the fifth medication. In addition, patients in the intramuscular injection group received intramuscular injection of 50 mg aminazine. Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was changed if symptoms were also observed after the fifth medication. MAIN OUTCOME MEASURES： Therapeutic effects of different medications in the two groups. RESULTS： All 102 patients were involved in the final analysis. Effective rate in the nasal cavity medication group was higher than that in the intramuscular injection group, and there was significant difference （ x^2= 11.882, P 〈 0.01 ）. At 6 hours after onset of singultus, effective rate in the nasal cavity medication group was higher than that in the intramuscular injection group, and there was significant difference （ x^2 =8.188, P 〈 0.01）. CONCLUSION： Therapeutic effects of intranasal cavity drip infusion of aminazine on singultus following craniocerebral injury are superior to those of intramuscular injection.

Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment

BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.

Intentional Penetrating Craniocerebral Injury Caused by a Nail: Clinical Presentation and Management of Three Cases

The authors report on their experience in the medical and surgical management of three cases of penetrating craniocerebral injuries caused by a nail. In all three cases, it was an aggression. Two of the three patients were male. The cranial locations affected were respectively left parietal, right temporal and right frontal. The Glasgow coma score (GCS) was between 9 and 13. None of the patients had a motor deficit. A plain skull radiographs was performed for each patient. All patients underwent surgery and all received antibiotic therapy and tetanus vaccination. In two cases, post-operative outcome was simple. Recovery was complete without sequelae. The patient with a GCS of 9 died the day after surgery.

Effects of mild hypothermia on cerebral oxygen metabolism and brain injury in patients with severe craniocerebral injury

Objective: To investigate the effects of mild hypothermia on cerebral oxygen metabolism and brain injury in patients with severe craniocerebral injury. Methods: A total of 78 patients with severe craniocerebral injury who underwent emergency treatment in Huanggang Central Hospital between September 2015 and May 2017 were selected as the research subjects and divided into control group (n=39) and mild hypothermia group (n=39) by random number table. Control group received clinical standard large trauma craniotomy for severe craniocerebral injury, and mild hypothermia group received routine surgery and postoperative mild hypothermia therapy. The cerebral oxygen metabolism and brain injury in two groups of patients were detected immediately after admission (T0), 1 week after treatment (T1) and 4 weeks after treatment (T2). Results: At T0, there was no statistically significant difference in the levels of cerebral oxygen metabolism indexes, cerebral blood flow parameters and brain injury markers between the two groups. At T1 and T2, PO2 levels in mild hypothermia group were higher than those in control group while Da-jvO2 levels were lower than those in control group;cerebral blood flow parameters Vs and Wv levels were higher than those in control group while PI levels were lower than those in control group;brain injury markers MBP, AQP-4 and S-100B contents were lower than those in control group while BDNF contents were higher than those in control group. Conclusion: Adjuvant mild hypothermia therapy after routine surgery may further reduce the cerebral oxygen metabolism and relieve the brain injury in patients with severe craniocerebral injury.

Analysis of Enteral Nutritional Value in Severe Craniocerebral Injury

Objective.This study will analyze the clinical value of enteral nutrition treatment in patients with severe craniocerebral injury and discuss the safety of this treatment.Methods.This study selected patients who were treated in the hospital from January 2017 to December 2018.After the screening,all patients were diagnosed as severe craniocerebral injury.Fortyfour patients who have met the experimental criteria were undergone enteral nutrition treatment to improve the condition.The success rate of catheterization and the changes in patient’s vital signs were analyzed.Especially the effect on the disease after the insertion of nasogastric tubing for nutritional treatment.Results.From the treatment results,the success rate of catheterization was 95.45%(42/44).In term of the timeline,the average was(36.5±2.7)min,the shortest time was 30 minutes and the longest time was no more than 5 minutes.The vital signs were stable before and after treatment and no complications such as arrhythmia.For those 42 successful patients,the average time for jejunal nutrition therapy was(36.2±4.1)days,the shortest was 27 days while the longest was 53 days and no adverse cases occurred.Conclusion.Enteral nutrition has a clinical application on patients with severe craniocerebral injury and can meet the nutritional needs of patients.Moreover,it has a high degree of feasibility and safety which is conducive to the early recovery of patients and has been well received.

Effect of dexmedetomidine on the prevention of PSH in patients with severe craniocerebral injury by regulating TLR4/My D88/NF-kappa B signaling pathway

Objective:To investigate the clinical efficacy of dexmedetomidine in the regulation of TLR4/My D88/NF-κB in the prevention of paroxysmal sympathetic over-excitation (PSH) in patients with severe head injury. Methods:One hundred patients with severe head injury who were admitted to our hospital from September 2016 to May 2019 were enrolled. The randomized digital table method was divided into 50 cases in the study group and the control group. Patients in the study group were given dexmedetomidine at a dose of 1.0 μg/kg before anesthesia induction, followed by infusion at 0.4 μg / (kg·h), and the control group was injected with the same amount of normal saline. The incidence of PSH, clinical symptoms, imaging findings, mechanical ventilation time, tracheal intubation/incision duration, ICU hospitalization time, total length of hospital stay, and GCS scores three months after discharge were compared between the two groups. At the same time, the fluorescence intensity, TLR4, NF-κB expression level and tumor necrosis factor-α (TNF-α) expression levels in peripheral blood CD14+ monocytes of the two groups were detected. Results:The incidence of PSH was significantly lower in the study group than in the control group at 7 and 3 months (P<0.05). The total length of hospital stay, duration of ICU hospitalization, intraoperative tracheotomy, and mechanical ventilation time were significantly lower in the study group than in the control group. And the GCS score was higher than the control group, and the difference was statistically significant (P<0.05). In addition, the imaging results showed that there were some differences in the location of imaging lesions between the two groups. The proportion of lesions in the ventricular system and surrounding areas was higher in the control group than in the study group (P<0.05). And the T14-T3 CD14+ PBMC MyD88 fluorescence intensity, TLR4 and NK-κB positive expression rate were significantly higher than those of T0 (P<0.05), but the MyD88 fluorescence intensity, TLR4 and NK-κB positive expression rate in the study group were significantly lower than those in the control group at T1~T3 (P<0.05). The levels of serum TNF-α in T1~T3 groups were significantly higher than those in T0 (P<0.05), but the levels of serum TNF-α in T1~T3 in the study group were significantly lower than those in the control group (P< 0.05). Conclusions:Dexmedetomidine can reduce the oxidative stress response in patients with severe head injury by inhibiting TLR4/My D88/NF-κB signaling pathway, thus effectively reducing the risk of PSH and improving the prognosis of patients.

Effect of hyperbaric oxygen therapy on BI index, GCS, SAS and SDS in patients with craniocerebral injury

Objective: To research and analyze the effect of psychological nursing intervention on self-rating depression (SDS), self-rating anxiety scale (SAS), Glasgow Score (GCS), Barthel index (Barthel, index, BI) of patients. Methods: From September 2015 to September 2016, 84 patients with craniocerebral injury admitted to our hospital were divided into observation group (n = 42) and control group (n = 42) according to randomized single blindness method. All patients were treated with hyperbaric oxygen therapy. The control group was given routine nursing care, while the observation group was treated by psychological nursing intervention. Results: The scores of GCS in the observation group after 2 weeks and 8 weeks of treatment were respectively (7.79±1.42), (11.86±2.56) which were higher than those in the control group (6.23±1.01), (8.21±1.65) the data show significant difference. After treatment, the scores of SDS and SAS in the observation group were respectively (39.14±1.21), (41.67±1.12) which were lower than those in the control group (45.56±2.50), (56.89±2.47) the data show significant difference. The BI index of the observation group was (43.29±4.63), which was higher than that of the control group (36.83±3.10), the scores of NFD was (23.12±1.01) in the observation group, which was lower than that in the control group (28.45±1.67), the data were statistically significant. Conclusion: Psychological care intervention in patients with craniocerebral injury treated by hyperbaric oxygen therapy is helpful to improve the adverse psychological state and consciousness state, improve the ability of daily living activities and promote the recovery of neurological function. It can be actively promoted and applied in clinical practice.

An Experimental Study of Craniocerebral Injury Caused by 7. 62 mm Bullets in Dogs

The experimental models of craniocercbral wounds caused by 7. 62 mm bullets, i. e. thepenetrating craniocerebral injury, the tangential brain injury and the tangential skull injury, were es-tablished in dogs. The craniocerebral ballistics, craniocerebral pathology, serum and cerebrospinal flu-id total lactate dehydrogenase, blood-brain barrier permcabalities, and the pathophysiology ofcardiovascular and respiratory systems were studied. These results suggest that: 1. These injuries ofhigh-velocity missile can all cause general brain damage and intracranio-hematomas ; 2. The severityof the wound depends on the site of the injury, the kinetic energy of the missile force and the effectof the temporary cavity ; 3. The brain injury can seriously damage the blood brain barrier, leadingto brain edema ; 4. The dysfunction of respiratory and cardiovascular system is the fatal complicationendangering the life of the subjects ; 5. Estimating serum and cerebrospinal fluid total lactatedehydrogenase is a simple and valuable way to judge the severity and prognosis of this injury.

COMPARATIVE OBSERVATION ON CURATIVE EFFECT OF POSTOPERATIVE SYMPTOMS OF THE CLOSED CRANIOCEREBRAL INJURY TREATED BY ACUPUNCTURE

The results of treating the closed injury of brain with two methods are reported, one is Western medicine treatment (control group), and the other is acupuncture combined with Western medicine treatment (acupuncture group). The total curative rate of the latter is 86 %, and that of the former is 56 %. The therapeutic effect of acupuncture group is better than that of control group. Coordinating acupuncture therapy in early stage is thus certainly necessary. At the same time, pathogenesis of the disease and the mechanism of acupuncture treatment are also discussed.

Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .