Study On The Clinical Treatment Of Missile Craniocerebral Injury (56 Cases)

Objectives:1. Fingding out the general situations of all patients who suffer from Missile Craniocerebral Injury and are hospitalized for treatment such as their wound causes, factors and composition, the classification firearms caused wound, the type and degree of wound, whether they have gone through operation, how about the operation effect, key clinical features, complications, treatment methods, prognosis and so on.2. Summing up treatment experience so as to further promote the curative effect of Missile Craniocerebral Injury.Methods:1. Data source:Examing and collecting detailed MCI data from the thousands of cases filed in the Neurosurgery Division since its establishment (1966-2009) of both Fuzhou General Hospital and Fuzhou Air Force Hospital and to get relevant imaging documents from the Imaging Dept.2. Investigating index:Making data tables to sort out the collected MCI data in a systematic way:(1) General data: sex, age, job, native place, education degree.(2) clinical expression: factors caused wound, treatment process, prognosis, conscious state, vital signs, biological changes in blood pressure, blood sugar, etc., complications, treatment and results..3. Experience of treatment:key treatment principles and methods, comparison of different treatment methods for different types of wounds, comparison of key treatment methods in different time, close observation and monitoring, life support, general treatment, diagnosis and treatment of primary wound and associated wound, diagnosis of complications, nutritional support, rehabilitation treatment.4. The result of treatment:status at discharge, prognosis, analysis on cause of death.Results:1. The age of onset of Missile Craniocerebral Injury is between 11～40 mostly, especially between 21～30. Therefore, education and monitoring on the people at such ages shall be enhanced.1980s and 1990s are the years with high incidence, so it can be seen that the incidence of Missile Craniocerebral Injury has greatly reduced along with the great economic development and perfection of various policies and regulations in China. 2. The education degrees of the Missile Craniocerebral Injury patients were mostly middle and primary school, so it is a necessary measure to promote the cultural qualities of the whole nation.3. Most Missile Craniocerebral Injury patients were workers, peasants, police and soldiers, so the preventive education for such people shall be enhanced to promote the self-protection awareness of them.4. The Missile Craniocerebral Injury were mostly caused by air guns, grenades and shotguns (guns made by indigenous methods), so the control over guns should be strictly enhanced.5. The types of Missile Craniocerebral Injury were basically open wounds and mainly blindgut wounds. The wound degree was mostly severe (GCS6-8). The wounded parts were mainly in frontal and temporal parts. Therefore, for clinical treatment, the treatment for severe open Missile Craniocerebral Injury shall be improved.6. The complications of Missile Craniocerebral Injury mainly include intracerebral hematoma, epidural hematoma and wide contusion and laceration of brain. The extracranial complications mainly include injury in chest and abdomen, pulmonary infection and upper gastrointestinal bleeding. Therefore, paying close attention to and treatment of these diseases can improve treatment effect.7. (1966-2009)For the 56 Missile Craniocerebral Injury patients,54 survived (accounting for 96.4%), wherein,36 patients recovered well (accounting for 64.3%),15 were moderately disabled (accounting for 26.8%), one was severely disabled (accounting for 1.8%), one vegetative patient (accounting for 1.8%) and 2 deaths (accounting for 3.6%).8. The prognosis effect will be better if debridement is carried out to the Craniocerebral Firearm Wound patients earlier. First aid at scene such as wrapping, hemostasis and initial debridement shall be carried out to the patient quickly and correctly by emergency treatment team, injury condition shall be evaluated correctly, and then the patient shall be transited from the scene actively. Second-line treatment shall make injury condition evaluation again, prepare well for operation and decide operation way according to the injury condition evaluated, clinical manifestation and the position of metallic foreign body. Generally, direct craniotomy debridement + removal of metallic foreign body will be taken, while stereospecific or navigation technique will be taken for complex injury condition and if the position of the metallic foreign body is deep. It is better to transited wounded persons at primary hospitals to higher-level hospitals by air.Conclusions:Key measures for promoting MCI cure rate and reducing complications, disability rate and fatal rate are as follows:1. Carrying out on-spot first aid to the patient quickly, make wound assessment correctly and carry out emergency operation.2. Keeping close observation of consciousness at early stage, provide lift and nutritional support actively and keep stable internal environment of the patient.3. Carrying out debridement of craniocerebral wound to clear out intracranial hematoma, metal foreign body, skull fracture fragments and other foreign bodies as early as possible. 4. Preventing complications and combined injuries actively and provide active rehabilitation treatment after the patient is in stable condition.5. Taking all factors which may influence the prognosis of Missile Craniocerebral Injury in to consideration and carry out comprehensive treatment so as to improve the curative effect.