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Effects of nimodipine on changes of endothelin after head injury in rabbits

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Chinese Journal of Traumatology 2001年第3期4卷 172-174页

作者：沈光建邹咏文许民辉刘保松徐有奇 Department of Neurosurgery Daping Hospital Third Military Medical University Chongqing 400042 China.

Objective: To investigate the effects of nimodipine on changes of endothelin after head injury. Methods: Sixty five adult rabbits were randomized into an injury group (IG, n=30), a nimodipine treatment group (NTG, n=30) and a control group (CG, n=5). With their heads unfixed, the animals in IG and NTG were injured in the frontal parietal zone with BIM II bioimpact. Blood samples and brain tissue were collected before and after injury. The endothelin level was measured with RIA. Results: The endothelin level in plasma and brain tissue was significantly increased 24 hours after injury. At the 8th or/and 24th hours postinjury, the endothelin level was significantly lower in NTG than that in IG. Conclusions: Nimodipine can prevent endothelin from elevation and act as a practical endothelin antagonist after head injury clinically.

关键词： head injuries Endothelins Rabbits Nimodipine

Traumatic subdural hydroma developing into chronic subdural hematoma

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Chinese Journal of Traumatology 2004年第3期7卷 188-190页

作者：刘玉光徐长军朱树干江玉泉李刚李新钢苏万东吴承远 Department of Neurosurgery

Objective: To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH). Methods: We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature. Results: 16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage. Conclusions: TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.

关键词： Subdural effusion Hematoma, subdural head injuries Chronic disease

Clinical analysis on 149 old patients with craniocerebral injury

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Chinese Journal of Traumatology 2001年第1期4卷 28-30页

作者：费力季耀东 Department of Neurosurgery Jinshan HospitalMedical Center of Fudan University

To study the clinical features of craniocerebral injury (CI) in the aged. Methods: The data of 149 old patients with CI hospitalized in the department from July 1991 to May 2000 were studied retrospectively in this study. The causes of injury, traumatic pathology, clinical manifestation and causes of death were analyzed, too. Results: Automobiles were the main victim makers, and falls were the second. And there was no significant difference between the first two kinds of victim makers. The patients suffered mainly from cerebral contusion, intracerebral hematomas and subdural hematomas, and relatively fewer from epidural hematomas. The scores of Glasgow Coma Scale (GCS) were related closely to the prognosis when hospitalized or before surgical treatment. The total mortality rate was 37.5 % in this study. The main cause of death was brain injury. Conclusions: The old patients with CI have a high mortality rate. And the causes of injury, traumatic pathology and clinical manifestation are peculiar in the aged.

关键词： Aged head injuries Mortality

Treatment of very severe brain injuries

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Chinese Journal of Traumatology 2004年第1期7卷 49-51页

作者：杨振九杨佳勇冯承宣宋伟健孙强 Department of Neurosurgery

Objective: To sum up the experience in treating very severe traumatic brain injuries. Methods: Retrospective analysis of 68 patients with very severe traumatic brain injuries treated in our hospital from 1997 to 2002 was done. Results: Forty one (60%) patients died. In the 50 patients treated surgically 27 (40%) survived, 8 recovered well, 9 had moderate disability and 10 had sever deficits. The 18 patients treated non operatively all died. Conclusions: Much attention should be given to the observation of the changes of severe brain injuries with cranial base injury. Timely operative decompression, basic life support, keeping effective brain blood perfusion and effective oxygen supply, improving cerebral microcirculation and preventing or controlling complications are the main methods to raise the successful rate of treating very severe brain injuries and the life quality of the patients.

关键词： head injuries Therapy

Moderate hypothermia therapy for patients with severe head injury

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Chinese Journal of Traumatology 2001年第3期4卷 164-167页

作者：陈礼刚朴永旭曾凡俊卢敏匡永勤李讯 Department of Neurosurgery Chengdu General Hospital of Chengdu Military Command Chengdu 610083 China.

Objective: To evaluate the effect and safety of early moderate hypothermia therapy (MHT) on patients with head injury by using parallel control test. Methods: Thirty patients with severe head injury within 6 hours after accidents were treated by MHT generally for 4 10 days. The other 30 patients with similar head injury treated routinely were enrolled for a parallel control test. The mortality, morbidity and changes of some neuro functional indexes as Glasgow Coma Scores, and Glasgow Outcome Scale, levels of endothelin and some other factors of neurobiochemistry in blood plasma were observed. Meanwhile, the dynamic monitoring by transcranial Doppler ultrasonography was conducted in these patients. Results: The mortality in MHT group was significantly lower than that in control group. MHT not only reduced endothelin but also increased the brain biochemical factors, which were helpful to the protection of neurons in the early brain ischemia after head injury. Conclusions: Early MHT can help reduce mortality and morbidity in patients with acute head injury.

关键词： head injuries Hypothermia Therapeutics

Prospective survey on neurosurgical intensive care for patients with severe head injury

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Chinese Journal of Traumatology 2001年第2期4卷 93-96页

作者：杨学军杨树源王明璐高永中 Department of Neurosurgery General Hospital of Tianjin Medical University Tianjin 300052 China

Objective:: To prospectively compare the clinical outcome of intensive care therapy (ICT) with that of conventional care therapy (CCT) in severe head injured patients. Methods: Patients with severe head injury were assigned randomly into Group ICT and Group CCT, 100 patients in each group. Patients in Group ICT accepted intensive care therapy in neurosurgical intensive care (NIC) unit for the first 2 weeks after admission, while patients in Group CCT accepted conventional care therapy in ordinary ward. The outcomes were evaluated 3 months after injury. Results: There was a significant increase in good recovery (54%) (χ 2= 4.43 , P< 0.05 ) and significant decrease of death (25%) (χ 2= 4.50 , P< 0.05 ) in Group ICT compared to 39% and 39% in Group CCT respectively. The differences were also confirmed statistically in the following aspects: the patients under 50 years with good recovery pronounced a number increase (χ 2= 7.54 , P< 0.01 ), while the mortality in the same range of age was decreased in Group ICT (χ 2= 5.28 , P< 0.05 ). The mortality was reduced significantly in patients with GCS for 6-8 on admission (χ 2= 8.47 , P< 0.01 ) and in patients with the level of brain stem injured bellow mesencephalon (χ 2= 4.15 , P< 0.05 ). ICT would improve the outcome in patients undergoing conservative therapy only (χ 2= 13.13 , P< 0.01 ). Conclusions: NIC plays an important role in assessing the neurological state, guiding management, evaluating curative effect and estimating the outcome.

关键词： head injuries Intensive care, surgical Outcome

Peri-operative treatment of most severely head-injured patients

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Chinese Journal of Traumatology 2001年第2期4卷 67-69页

作者：徐伟顾士欣庞力季耀东周良辅高亮曹晓运胡德志 Department of Neurosurgery Huashan Hospital Shanghai Medical University Shanghai 200040 China

Objective:: To summarize the peri-operative experience from 53 patients with traumatic head injuries with GCS score 3-5. Methods: Fifty-three most severely head-injured patients with GCS score 3-5 were admitted to our department and treated operatively from Oct. 1994 to Jun. 1998 and the data were analyzed retrospectively. Results: Thirty-seven cases ( 69.8 %) survived, among them 28 ( 52.8 %) had a good recovery or moderate disability, and 9 (17%) had severe deficits. The other 16 ( 30.2 %) died after therapy. Conclusions: The prognosis of most severely head-injured patients could be improved by peri-operative treatment including premedical care, early evacuation of intracranial hematoma with large decompressive craniectomies, intracranial hypertension monitoring, moderate hypothermia therapy, effective prevention and treatment of cerebral vasospasm and complications.

关键词： head injuries Surgery, operative Prognosis

The influence of traumatic subarachnoid hemorrhage on prognosis of head injury

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Chinese Journal of Traumatology 2002年第3期5卷 169-171页

作者：陈广鑫邹咏文杨东红 Department of Neurosurgery Daping Hospital the Third Military Medical University. Chongqing 400042 China

Objective: To study the influence of traumatic subarachnoid hemorrhage on secondary intracranial damage in GCS 13 15 head injuries and prognosis. Methods: One hundred and twenty eight patients with mild head injury, including 64 with subarachnoid hemorrhage and 64 without subarachnoid hemorrhage, were selected and analyzed according to the changes of their conditions after injury. Results: Intracranial abnormality was found in 14 patients ( 21.87 %) with subarachnoid hemorrhage and only in 4 patients ( 6.25 %) without subarachnoid hemorrhage (Phead injury should be given much attention. Early drainage of bloody cerebrospinal fluid by lumbar puncture is an effective method for prevention and treatment of complications in mild head injury.

关键词： head injuries Subarachnoid hemorrhage Therapeutics

Effect of mild hypothermia on partial pressure of oxygen in brain tissue and brain temperature in patients with severe head injury

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Chinese Journal of Traumatology 2002年第1期5卷 43-45页

作者：张赛只达石林欣尚彦国牛玉德 Department of Neurosurgery Huanhu Hospital Tianjin 300060 China

Objective: To study the changes of partial pressure of oxygen in brain tissue ( P btO 2) and brain temperature (BT) in patients in acute phase of severe head injury, and to study the effect of mild hypothermia on P btO 2 and BT. Methods: The P btO 2 and the BT of 18 patients with severe head injury were monitored, and the patients were treated with mild hypothermia within 20 hours after injury. The rectal temperature (RT) of the patients was kept on 31.5- 34.9℃ for 1-7 days ( 57.7 hours± 28.4 hours averagely), simultaneously, the indexes of P btO 2 and BT were monitored for 1-5 days (with an average of 54.8 hours± 27.0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated at 6 months after injury. Results: Within 24 hours after severe head injury, the P btO 2 was significantly lower ( 9.6 mm Hg± 6.8 mm Hg, 1 mm Hg= 0.133 kPa) than the normal value (16-40 mm Hg). After treatment of mild hypothermia, the mean P btO 2 increased to 28.7 mm Hg± 8.8 mm Hg during the first 24 hours, and the P btO 2 was still maintained within the range of normal value at 3 days after injury. The BT was higher than the RT in the patients in acute phase of severe head injury, and the difference between the BT and the RT significantly increased after treatment of mild hypothermia. Hyperventilation (the partial pressure of carbon dioxide in artery (P aCO 2)≈25 mm Hg) decreased the high intracranial pressure (ICP) and significantly decreased the P btO 2. Conclusions: This study demonstrates that P ptO 2 and BT monitoring is a safe, reliable and sensitive diagnostic method to follow cerebral oxygenation. It might become an important tool in our treatment regime for patients in the acute phase of severe head injury requiring hypothermia and hyperventilation.

关键词： head injuries Hypothermia Temperature Blood gas monitoring, transcutaneous