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.

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.

Clinical Observation on Effect of Xuesaitong Injection (血塞通注射液) as Auxiliary Treatment of Severe Craniocerebral Injury

Objective To evaluate the effect of Xuesai-tong injection (XSTI, 血塞通注射液 , a preparation of Panax Notoginseng) as auxilliary treatment of severe craniocerebral injury. Methods Eighty-seven patients with severe craniocerebral injury were selected and randomly divided into the treated group (n=44) and the control group (n = 43), they were treated with conventional treatment, and XSTI was given additionally to the treated group. Intracranial pressure (ICP) and Glasgow coma score (GCS) of all patients were measuredafter 1 or 2-week treatment, and Glasgow outcome scale (GOS) of them was determined 3 months later. Then the therapeutic effect in the two groups were compared. Results After treatment, the ICP was lower, GCS higher and GOS better in the treated group than those in the control group significantly, all showing statistical significance (P<0.05). Conclusion XSTI has marked clinical therapeutic effect in treating patients with severe craniocerebral injury.Original article on CJITWM (Chin) 2004 ;23 (3): 213

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.

Effect of adjuvant ganglioside sodium therapy on nerve injury degree as well as cytokines and humoral immunity in patients with acute severe craniocerebral injury

Objective:To study the effect of adjuvant ganglioside sodium therapy on nerve injury degree as well as cytokines and humoral immunity in patients with acute severe craniocerebral injury. Methods:94 patients with severe craniocerebral injury treated in our hospital between March 2013 and March 2016 were selected and randomly divided into the ganglioside sodium group (GM1 group) and control group. Before treatment as well as after 4 weeks and 8 weeks of treatment, serum levels of nerve injury molecules, nerve injury cytokines, inflammatory cytokines and humoral immune molecules were determined respectively.Results: After 4 weeks and 8 weeks of treatment, serum neuron-specific enolase (NSE), S100β protein (S100β), ubiquitin carboxy-terminal hydrolase L1 (UCH L1), glial fibrillary acid protein (GFAP), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor α(TNF-α), and interleukin-6 (IL-6) content of both groups were significantly lower than those before treatment (P<0.05) while brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), IgG, IgM and IgA content were significantly higher than those before treatment (P<0.05), and serum NSE, S100β, UCH-L1, GFAP, hs-CRP, TNF-α and IL-6 content of GM1 group were significantly lower than those of control group (P<0.05) while BDNF, NGF, IgG, IgM and IgA content were significantly higher than those of control group (P<0.05).Conclusions: Adjuvant ganglioside sodium therapy can relieve the nerve injury, inhibit the inflammatory reaction and improve the humoral immune response in patients with acute severe craniocerebral injury.

Effect of recombinant human erythropoietin therapy on convalescent serological indicators in patients with severe craniocerebral injury

Objective:To study the effect of recombinant human erythropoietin (rHu-EPO) therapy on convalescent serological indicators in patients with severe craniocerebral injury.Methods:Patients with severe craniocerebral injury who were treated in Fifth Hospital in Wuhan between July 2014 and February 2017 were selected and randomly divided into the rHu-EPO group who accepted rHu-EPO combined with conventional therapy and the control group who accepted conventional therapy. Before and after treatment, serum levels of nerve injury indexes, inflammation indexes, oxidative stress indexes and apoptosis indexes were measured. Results:Serum Tau, S100B, GFAP, NSE, IL-1β, TNF-α, VCAM-1, ICAM-1, LPO, AOPP, 8-iso-PGF2 , sTRAIL, sFas and sFasL levels of both groups of patients 14 d after treatment were significantly lower than those before treatment, and serum Tau, S100B, GFAP, NSE, IL-1β, TNF-α, VCAM-1, ICAM-1, LPO, AOPP, 8-iso-PGF2 , sTRAIL, sFas and sFasL levels of rHu-EPO group were significantly lower than those of control group.Conclusion: rHu-EPO therapy can significantly improve the convalescent nerve injury, inflammation, oxidative stress and apoptosis in patients with severe craniocerebral injury.

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.

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.

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.

Effects of hyperbaric oxygen on serum inflammatory factors, oxidative stress, endothelin and intracranial pressure in patients with severe head injury

Objective:To investigate the effect of hyperbaric oxygen (HBO) on serum inflammatory factors, oxidative stress status, endothelial cell function and intracranial pressure in patients with severe craniocerebral injury (STBI), and to provide scientific basis for clinical treatment of patients with severe craniocerebral injury.Methods: 110 cases of STBI were selected and divided into control group and treatment group according to the random data table, 55 cases in each group. The control group received conventional combined therapy, the observation group were given HBO treatment on the base of the control group, the inflammatory factors [C reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10)] and oxidative stress [malondialdehyde (MDA) and superoxide dismutase-1 (SOD-1)], endothelin (ET) and intracranial pressure (ICP) level changes of the two groups were observed and compared before and after treatment for 10 d in patients. Results: The levels of CRP, TNF-α, IL-6, MDA, ET and ICP in the treatment group and the control group were significantly lower than those in the same group before treatment, the difference was statistically significant (P<0.05), the CRP, TNF-α, IL-6, MDA, ET and ICP levels of the observation group after treatment were significantly lower than the control group after treatment (P<0.05);After treatment, IL-10 and SOD-1 levels of the two groups of patients were significantly increased than the same group before treatment (P<0.05), and both levels in the observation group after treatment was significantly higher than the control group after treatment (P<0.05).Conclusions: HBO treatment of severe brain injury patients with significant effect, can effectively reduce oxidative stress damage and inflammation, improve patients' endothelial cell function, reduce intracranial pressure, and has a certain clinical value.

Effect of edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy on nerve function impairment in patients with severe craniocerebral injury

Objective:To study the effect of edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy on nerve function impairment in patients with severe craniocerebral injury.Methods: A total of 68 patients with severe craniocerebral injury who were treated in our hospital between January 2013 and May 2016 were collected and divided into control group and observation group according to the random number table, 34 cases in each group. Control group of patients received conventional + cattle encephalon glycoside and ignotin injection therapy, and observation group of patients received conventional +cattle encephalon glycoside and ignotin injection + edaravone therapy. The differences in serum levels of nerve injury indexes, oxidative stress indexes and inflammatory mediators were compared between the two groups of patients before and after treatment.Results: Before treatment, the differences in serum levels of nerve injury indexes, oxidative stress indexes and inflammatory mediators were not statistically significant between two groups of patients. After treatment, serum nerve injury index BNP level in observation group was higher than that in control group while S-100B, GFAP and NSE levels were lower than those in control group;serum oxidative stress indicators MDA and MPO levels were lower than those in control group while SOD and GSH-Px levels were higher than those in control group;serum inflammatory mediators IL-6, IL-8 and TNF-α levels were lower than those in control group.Conclusion:Edaravone combined with cattle encephalon glycoside and ignotin injection adjuvant therapy can effectively reduce the nerve function impairment in patients with severe craniocerebral injury, and the specific mechanisms are related to its effect on reducing the oxidative stress and inflammation.

Effect of adjuvant recombinant EPO therapy on neural functional recovery, inflammation and erythrocyte glucose metabolism in patients with severe craniocerebral injury

Objective:To study the effect of adjuvant recombinant EPO therapy on neural functional recovery, inflammation and erythrocyte glucose metabolism in patients with severe craniocerebral injury.Methods:A total of 78 patients with severe craniocerebral injury treated in our hospital between May 2013 and March 2016 were selected and randomly divided into the EPO group and control group who received recombinant human erythropoietin (rhEPO) combined with conventional therapy and conventional therapy respectively. Before treatment as well as 7 d and 14 d after treatment, the degree of brain tissue hypoxia, nerve injury and inflammation as well as erythrocyte glucose metabolism were evaluated respectively.Results:PbtO2 levels, serum NGB and HGB content as well as PFK activity of both groups 7 d and 14 d after treatment were significantly higher than those before treatment while serum NF-H, NF-L, NF-M, NSE, S100β, IL-2, P-selectin and sICAM-1 content as well as G-6PD and AR activity were significantly lower than those before treatment;PbtO2 levels, serum NGB and HGB content as well as PFK activity of EPO group 7 d and 14 d after treatment were significantly higher than those of control group while serum NF-H, NF-L, NF-M, NSE, S100β, IL-2, P-selectin and sICAM-1 content as well as G-6PD and AR activity were significantly lower than those of control group.Conclusion:Adjuvant recombinant EPO therapy can inhibit inflammation and improve erythrocyte glucose metabolism to reduce the nerve injury degree in patients with severe craniocerebral injury.

Effects of thyrotropin-releasing hormone on severe head injury:A preliminary clinical trial

Objective: To evaluate the effects of thyorotropin-releasing hormone (TRH ) on severe head injury.Methods: Eighty--seven severely head injured patients with a Glasgow Coma Scale (GCS ) score of & or less wererandomized into TRH--treated and saline control groups. In TRH treated group. the treatment was started with abolus injection of 0. 2 mg/kg followed by continuous infusion for 2 hours at 0. 2 mg/kg/h. Such treatment wasgiven once a day for 4 times. The patients in control group were given the equivalent normal saline with the samemethod. Results: TRH, administered intravenously after head injury. promoted the recovery of consciousness andGCS score, alleviated the traumatic brain edema, controlled and lowered the intracranial pressure. decreased thelevel of lipid superoxides, decreased the mortality rate. and improved the life quality of the survivals. Nocomplications or adverse and toxic effects were noted during the course of TRH treatment. Conclusion: TRH hasbeneficial effects on patients with severe head injury.

Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

Introduction. Penetrating craniocerebral wounds (PCCWs) are a particular lesion in the category of traumatic brain injury (TBI). The objective of this study was to describe the management of these lesions, and to identify signifiant risk factors associated with mortality in patients with a PCCW. Methods. It was a transversal, descriptive and analytical study performed in Departmental Teaching Hospital of Borgou and Alibori in Benin. From January 1, 2015 to June 30, 2020, patients with a PCCW were retained. Risk factors of mortality and morbidity associated to etiological, clinical and surgical parameters were assessed using the chi-square test. p value < 0.05 was considered to be statistically significant. Results. During the study period, 1267 cases of traumatic brain injuries (TBI) were admitted. Of these patients, 77 (6.1%) cases of PCCW were retained. These patients were divided into 66 (85.7%) male and 11 (14.3%) female. The mean age of the patients was 22.6 ± 14.8 years (range from 2 years to 70 years). The circumstances of occurrence were a traffic accident in 42 (54.5%) cases, an assault in 33 cases (42.9%) and a fall 2 (2.6%). The PCCW was unilateral in 71 cases (92.2%). A brain CT-scan was performed in 60 (77.9%) patients. Surgery was performed in 69 (89.6%) patients. Post-operative outcomes were simple in 59 (85.5%) cases. GCS, pupillary abnormalities, motor deficit were a statistically significant risk factor associated with death or sequels (p < 0.0001). Conclusion. The identification of risk factors of mortality or sequels is a major step for an efficient management of PCCWs and a reduction of morbidity and mortality. Whatever strategies are adopted, prevention must remain a priority.

高压氧联合肠内营养对重症颅脑损伤患者术后炎性因子、肠道菌群及神经功能的影响

目的探讨高压氧联合肠内营养对重症颅脑损伤患者术后炎性因子、肠道菌群及神经功能的影响。方法选取2021年9月至2022年8月收治的重症颅脑损伤患者98例,根据治疗方式不同分为对照组和观察组,每组49例。对照组给予高压氧联合肠外营养治疗,观察组给予高压氧联合肠内营养治疗。比较2组治疗前后血清炎性因子水平、免疫功能、肠胃黏膜功能、肠道菌群及神经功能变化情况。结果2组血清TNF-α、IL-6、IL-8水平下降,且观察组较对照组明显(P<0.05)。2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)升高,CD8^(+)降低,且观察组更明显(P<0.05)。与治疗前相比,2组血清D-乳酸、二胺氧化酶、内毒素水平下降,且观察组更明显(P<0.05)。观察组肠道内的乳酸杆菌、双歧杆菌含量高于对照组,大肠杆菌、肠球菌含量低于对照组(P<0.05)。2组FMA、GCS评分升高、NIHSS评分下降,且观察组更明显(P<0.05)。结论重症颅脑损伤患者术后给予高压氧联合肠内营养治疗,可减轻炎性反应,改善肠胃黏膜屏障功能,调节肠道菌群失调,增强免疫功能,促进神经功能恢复,具有重要的临床应用价值。

优化型流程式护理干预对老年颅脑损伤患者的康复效果的观察

目的观察优化型流程式护理干预对老年颅脑损伤患者康复效果的影响,为治疗该病症提供方法。方法选取2022年1月—2023年7月启东市中医院神经外科收治的83例老年中重型颅脑损伤患者作为研究对象,按随机信封法将患者分为流程式干预组(n=41)和常规组(n=42)。2组患者均给予相同的基础治疗,流程式干预组患者接受优化型流程式护理干预,常规组患者接受常规护理,2组均连续干预3个月。比较2组患者生活能力评分、肢体活动评分、康复进程指标和并发症发生情况。结果干预后,流程式干预组患者的Barthel指数和Fugl-Meyer运动功能量表评分均高于常规组,首次下床活动时间、机械通气时间、昏迷时间、住院天数、住院费用均少于常规组,并发症总发生率低于常规组,差异均有统计学意义(P<0.05)。结论优化型流程式护理干预在老年颅脑损伤患者的康复过程中可促进患者日常生活能力恢复,促进康复进程,减少并发症发生,具有一定的临床应用价值。

基于随机森林算法的重型颅脑损伤患者并发急性胃肠损伤的现状及风险模型构建

目的探讨重型颅脑损伤患者并发急性胃肠损伤的危险因素,为预防急性胃肠损伤提供借鉴。方法2021年1月至2023年1月,便利抽样法选取某院收治的重型颅脑损伤患者150例为研究对象,建立基于重型颅脑损伤并发急性胃肠损伤的危险因素的随机森林算法的预测模型。结果150例重症颅脑损伤患者中,并发急性胃肠损伤患者94例,占62.67%。是否并发急性胃肠道损伤的患者在糖尿病、白蛋白、APACHE-Ⅱ评分、休克指数、液体负平衡、酸中毒、深度镇静、呼吸衰竭方面的差异均有统计学意义(均P<0.05)。构建重型颅脑损伤并发急性胃肠损伤的随机森林模型,树的数量为103时出现的错误率最低;影响重型颅脑损伤并发急性胃肠损伤的因素重要性排序为糖尿病、液体负平衡、急性生理与慢性健康评分、白蛋白、深度镇静及酸中毒;随机森林模型预测重型颅脑损伤并发急性胃肠损伤的受试者工作特征曲线(receiver operating characteristic,ROC)下面积(area under curve,AUC)为0.798,Logistic回归模型的AUC为0.773。结论构建的重型颅脑损伤并发急性胃肠损伤的风险预测模型预测效能较高,临床值得推广应用。

重型颅脑损伤患者营养状况及住院时间与相位角的关系

目的探讨重型颅脑损伤患者营养状况及住院时间(LOS)与相位角(PA)的关系。方法选取神经外科收治的患者100例[格拉斯哥昏迷量表(GCS)评分≤8分]作为研究对象。通过人体成分分析检测以及采血化验,获得患者细胞内外水分、骨骼肌、PA、预后营养指数(PNI)以及LOS指标。根据PA值将患者分为低PA组(n=42)和正常PA组(n=58)。比较2组人体成分相关指标、PNI和LOS,分析PA与各指标的相关性,分析患者发生营养不良的影响因素。结果低PA组患者细胞内水分、身体总水分、身体细胞含量、PNI低于正常PA组,LOS长于正常PA组,差异有统计学意义(P<0.05)。PA与细胞内水分、细胞外水分、身体总水分、骨骼肌、身体细胞含量、骨矿物质含量、基础代谢率、PNI呈正相关(P<0.05),PA与LOS呈负相关(P<0.05)。PA(OR=5.441,P=0.001,95%CI:2.011~14.719)和LOS(OR=8.373,P<0.001,95%CI:3.079~22.765)是患者发生营养不良的影响因素。结论PA与重型颅脑损伤患者营养状况以及LOS显著相关。

有创颅内压监测下控制性阶梯式减压在重型颅脑损伤中的应用

目的:探讨有创颅内压监测下控制性阶梯式减压法治疗重型颅脑损伤者的应用价值。方法:选取2022年7月—2023年7月肇庆市第一人民医院收治的82例重型颅脑外伤者作为研究对象,将其分为对照组和试验组,每组各41例。患者均未行手术治疗,且处于急性期。对照组常规监测生命体征变化情况,试验组行脑室型有创颅内压监测探头植入术。比较两组颅内压、并发症发生率(迟发血肿、术后脑梗塞)、死亡率、格拉斯哥昏迷评分法(Glasgow Coma Scale,GCS)评分及预后情况。结果:术后6 h、12 h、24 h,对照组颅内压指标高于试验组,差异有统计学意义(P<0.05)。对照组术后并发症发生率高于试验组,差异有统计学意义(P<0.05)。术后24 h、72 h、7 d,两组GCS评分比较,差异无统计学意义(P>0.05)。术后3个月,对照组恢复良好率低于试验组,差异有统计学意义(P<0.05)。结论:有创颅内压监测下控制性阶梯式减压疗法应用于重型颅脑损伤患者中效果理想,可改善患者颅内压指标,降低术后并发症发生率及死亡率,患者可更快恢复意识,改善预后。