Clinical Analysis Of Patients With Severe Craniocerebral Injury

Background:Craniocerebral injury both in peacetime and in war,belong to neurosurgery is the most common diseases,based on the analysis of statistical data in different periods of different countries,found that the incidence of traumatic brain injury,the second in the whole body fracture with after limb fractures,but compared with limbs fracture,traumatic brain injury has higher morbidity and mortality.With the continuous improvement of science and technology as well as the economic level,the transportation develops rapidly.With the pace of economic development,the construction industry develops rapidly one after another.Besides,there are various extreme challenge projects,such as skydiving and bungee jumping.At the annual meeting of the craniocerebral injury project in Beijing in 1965 on the classification of acute closed craniocerebral injury to carry on the revision,the revision will coma patients with craniocerebral injury patients according to time,if there are positive signs and the patient vital signs in the divided into medium and light craniocerebral injury traumatic brain injury and severe head injury.At the Chinese academy of psychiatry conference held in nanjing in 1978,severe brain injury was classified as severe brain injury.Currently,the recognized classification standard of craniocerebral injury in China is the classification method mentioned above.Among them,the definition of severe craniocerebral injury is as follows :(1)the patient is in a deepcoma,and the duration of coma is > for 12 hours,and the patient's level of consciousness gradually decreases or coma occurs again after waking up.(2)the patient showed obvious positive neurological symptoms after injury.(3)the patient's vital signs are very unstable,the respiratory rate appears too fast or too slow or even disappears,the patient's body temperature appears too high or too low,and even the temperature will be affected by the ambient temperature,pulse and blood pressure are also very unstable,too high or too low.Definition of patients with severe craniocerebral injury :(1)patients with severe primary brain injury,who continue to be in coma after craniocerebral injury,who have cerebral rigidity,or who are accompanied by organ damage in other parts,or who have shock.(2)the patient presented positive alignment of advanced cerebral hernia,bilateral pupil dilation,loss of light emission,severe disorder of vital signs,respiratory arrest or life support,and continuous mechanical ventilation was required.As China's economic developing after reform and opening up,and the rapid development of transportation,the number of car accidents is growing fast,those result in the highest proportion of the total number of craniocerebral injury,so generates the number of traffic accidents is closely associated with craniocerebral injury death rate,according to incomplete statistics,in Beijing,Shanghai and other cities in China,traumatic brain injury has the very high population proportion,the mortality rate was 6.3/100,000 people.Objective:The Glasgow coma score(GCS)was proposed by Teasdale and Jennett,because there was a positive correlation between the degree of coma and the degree of craniocerebral injury.For patients with severe craniocerebral injury(6-8 points),the duration of coma is longer than 6 hours after craniocerebral injury,or the consciousness of patients with craniocerebral injury deteriorates seriously within 24 hours,or the duration of re-coma is longer than 6 hours.Patients with Glasgow index score of 3-5 are classified as patients with severe craniocerebral injury,and the patients remain in coma after craniocerebral injury.Only when the body's respiratory,circulatory and nervous systems are functioning properly can a person keep alive.In patients with severe craniocerebral injury,neurological integrity is the prerequisite for inventory.The nervous system is the premise of maintaining the normal internal environment,respiration and circulatory function of patients.Craniocerebral injury is divided into the brain damage,diencephalon injury and brain stem injury,etc.,in patients with craniocerebral injury with more than a few parts of the injury after injury situation is serious,general patients for more severe head injury patients,patients after the injury,will occur secondary brain edema,if patients after onset of treatment is not timely,it is easy to cause cerebral hernia,lead to respiratory failure patients,apnea,that led to the deaths of patients eventually.An important factor for the treatment plan,resource allocation,patient classification and communication with patients' families is the early prognosis evaluation of patients with craniocerebral injury.Especially for patients with GCS score of 6-8,whether the patients can survive and how the quality of survival is the most concerned issue for the patients' families and neurosurgeons at present.At present,in order to analyze the prognostic factors of patients with severe craniocerebral injury,many experts and scholars have conducted a large number of animal experiments.(2)patient gender;(3)patients after the onset of GCS score;(4)CT image score analysis of patients;(5)after the onset of the patient whether to cause brain hernia;6.Intracranial blood loss;7)scope of cerebral contusion;8)the position of hematoma after intracranial injury.However,most of thecurrent clinical studies are based on univariate analysis.In this study,we conducted correlation analysis on factors that may affect the prognosis of patients,not only considering the individual effects of each factor,but also analyzing the interaction effects of each factor.Patients with severe brain injury have a high mortality rate,and the current medical level does not have a good treatment plan for the treatment of such patients to improve the prognosis,so our study did not include patients with severe brain injury,this study mainly analyzed patients with severe brain injury of 6-8points.We the research data processing,on the basis of medical statistics,with factors may affect the prognosis of patients with chi-square test,regression model for statistically significant factors for further analysis,it is concluded that affect the prognosis of patients with recovery factors,through multiple factor analysis of influencing factors,is more scientific than single factor results.To analyze the prognosis of patients with severe craniocerebral injury and the main factors leading to poor prognosis.Methods:Data of the patients were collected.After the patients were admitted to the hospital,physical examination was conducted for the patients,the past medical history of the patients was asked,the age,gender,whether the patients had cerebral hernia,the types of injuries of the patients were recorded,the amount of hematoma and the location of the hematoma were recorded,and the patients were assessed by GCS score.Patient treatment,need to undertake choosing according to patients condition,to meet the operation against surgery patients,the clinical main current operation method for the removal of hematoma,craniotomy surgery for patients with nerve nutrition,after the meeting,dehydration processing,hemostasia for possible complications after surgery in patients with prevention,for mechanical ventilation to spontaneous breathing patients,for patients with eating can still be given enteral nutrition,can according to patients condition for parenteral nutrition.After the patient's condition is stabilized,neuronutrition,activating blood circulation and resolving blood stasis can be carried out according to the patient's actual recovery.Inorder to improve the patient's recovery,acupuncture,hyperbaric oxygen and other rehabilitation treatments can be given to the patient.Major patient data were collected through outpatient review or telephone follow-up.For the patients who died during treatment,the survival days ranged from the onset of the disease to the death of the patient,and the survival time for the surviving patients ranged from the onset of the disease to the last follow-up.Results:We followed up 168 patients for 3 months,except those who died within 3months.During the follow-up period,a total of 35 patients died,with a mortality rate of 20.8%,and severe craniocerebral injury was the main cause of death.During the1-10 days of follow-up,25 patients died,with a mortality rate of 71.4%.During the11-20 days of follow-up,8 patients died,with a mortality rate of 22.9%.During the20-30 days of follow-up,2 patients died,with a mortality rate of 5.7%.All the patients died of severe craniocerebral injury.The chi-square test was used to analyze the factors that might affect the prognosis of patients with severe craniocerebral injury,and the single factor analysis showed that the factors with statistical significance included whether the patient had dilated pupils,age,m GCS score,hematoma volume,hematoma location,CT image score and the range of cerebral contusion and laceration,etc.Through multi-factor analysis,it was found that the factors influencing the prognosis of the patients were mainly age,m GCS score,whether there was brain hernia,and CT image score.Conclusion:The most important factors affecting the prognosis of patients are CT image score,cerebral hernia score and m GCS score.