Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury

Background

The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.

Methods

We performed a 2-year analysis of all patients on prehospital Ibuprofen with traumatic brain injury and intracranial hemorrhage. Patients on preinjury Ibuprofen were matched using propensity score matching to patients not on Ibuprofen in a 1:2 ratio for age, Glasgow Coma Scale, head-abbreviated injury scale, injury severity score, International Normalized Ratio, and neurologic examination. Outcome measures were progression on repeat head computed tomography (RHCT) and neurosurgical intervention.

Results

A total of 195 matched (Ibuprofen 65, no-Ibuprofen 130) patients were included. There was no difference in the progression on RHCT (Ibuprofen 18% vs no-Ibuprofen 24%; P = .50). The neurosurgical intervention rate was 18.9% (n = 37). There was no difference for need for neurosurgical intervention (26% vs 16%; P = .10) between the 2 groups.

Conclusions

In a matched cohort of trauma patients, preinjury Ibuprofen use was not associated with progression of initial intracranial hemorrhage and the need for neurosurgical intervention. Preinjury use of Ibuprofen as an independent variable should not warrant the need for a routine RHCT scan.     

The impact of intracranial pressure monitoring on mortality after severe traumatic brain injury

Background

The effect of intracranial pressure (ICP) monitoring on mortality after severe traumatic brain injury (sTBI) remains unclear. We hypothesized that ICP monitoring would not be associated with improved survival in patients with sTBI.

Methods

A retrospective analysis was performed on sTBI patients, defined as admission Glasgow Coma Scale score of 8 or less with intracranial hemorrhage. Patients who underwent ICP monitoring were compared with patients who did not. The primary outcome measure was inhospital mortality.

Results

Of 123 sTBI patients meeting inclusion criteria, 40 (32.5%) underwent ICP monitoring. On bivariate and multivariate regression analyses, ICP monitoring was associated with decreased mortality (odds ratio = .32, 95% confidence interval = .10 to .99, P = .049). This finding persisted on propensity-adjusted analysis.

Conclusions

ICP monitoring is associated with improved survival in adult patients with sTBI. In addition, significant variability exists in the use of ICP monitoring among patients with sTBI.     

电视胸腔镜与传统开胸手术治疗外伤性血气胸的效果比较

目的 比较电视胸腔镜(VATS)和传统开胸手术治疗外伤性血气胸的临床效果.方法 血气胸患者41例随机分为实验组和对照组,对照组26例,采用传统开胸手术方法;实验组15例,采用VATS治疗,对两组患者一般临床资料、术中出血量、手术时间、术后胸管放置时间、术后引流量等进行比较.结果 41例患者均无手术死亡、二次开胸止血,术后均未呼吸机辅助呼吸.实验组术中出血量[(176.5 ±78.5) ml]明显少于对照组[(401.3±90.7)ml],手术时间[实验组(64.7-±21.3) min,对照组(129.4±30.3) min]、术后胸管放置时间[实验组(2.3±0.9)d,对照组(4.5±1.0)d]、住院时间[实验组(9.1±2.1)d,对照组(12.7±2.2)d]及术后并发症发生率等方面均少于对照组,两组比较差异有统计学意义(P＜0.05).结论 VATS治疗外伤性血气胸与传统开胸手术比较,诊断快速准确,安全可靠,并发症少.     

部分脾栓塞术治疗外伤性脾破裂的临床应用

目的 探讨部分脾栓塞术(partial splenic embolization,PSE)治疗外伤性脾破裂的治疗效果.方法 回顾性分析2013年1月至2015年1月28例行开腹脾切除术治疗外伤性脾破裂病人的临床资料及同期开展的27例行PSE治疗外伤性脾破裂病人的临床资料并行对比分析.结果 行开腹脾切除术治疗组28例均痊愈.行PSE治疗组27例中,26例顺利完成选择性出血血管栓塞,其中1次栓塞成功25例,再次栓塞成功1例,无继发出血及开腹手术病例;1例栓塞过程中发现脾动脉主干受损,行脾动脉主干栓塞控制出血后立即中转开腹行手术处理;均痊愈出院.结论 PSE是治疗外伤性脾破裂的一种有效、微创的方法,且保留了脾脏功能.     

Comparison of fondaparinux sodium and low molecular weight heparin in the treatment of hypercoagulability secondary to traumatic infection

Purpose: To compare the effects and side-effects of fondaparinux sodium and low molecular weight heparin in patients with hypercoagulability accompanied with traumatic infection. Methods: Thirty-six patients with post-traumatic infections in our hospital intensive care center were diagnosed with hypercoagulability from February 2012 to February 2013. These patients were randomly divided into 2 groups. In group F (18 patients), the patients were treated with fondaparinux sodium, 2.5 mg, 1/d for 11 d. In group L (18 patients), the patients were treated with low molecular weight heparin, 4100 U, 1/12 h for 11 d. The incidence of deep vein thrombosis, bleeding events and multiple organ dysfunction syndrome (MODS) and mortality of two groups after anticoagulation therapy were analyzed. Fibrinogen, D-dimer level and activity of antithrombin III were measured by the coagulation analyzer. Results: The incidence of deep vein thrombosis, MODS incidence and mortality were not significantly different between the two groups. The rate of bleeding evens in group F was lower than group L (p < 0.05). Antithrombin III got an upward trend after anticoagulant therapy, in which it was higher in group F than in group L on the 5th d and 11th d (p<0.05). Fibrinogen levels were gradually increased, and there was no significant difference between two groups (p>0.05). D-dimer was significantly decreased after anticoagulant therapy for 5 d (p<0.01), and there were significant differences between two groups on the 5th d and 7th d (p < 0.05). It showed no significant difference on the 11th d (p>0.05). Conclusion: Fondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection. Compared with low molecular weight heparin, fondaparinux sodium may reduce the risk of bleeding events in patients with hypercoagulability accompanied by traumatic infection.     

外伤性脾破裂腹腔镜与开腹脾切除临床研究

【摘要】〓目的〓对比腹腔镜脾切除术(LS)与开腹脾切除术(OS)在外伤性脾破裂治疗的临床疗效,探讨LS的可行性、安全性。方法〓将45例外伤性脾破裂患者根据手术方式分为腹腔镜组(LS组)和开腹组(OS组)。LS组18例,OS组27例,比较2种术式的手术时间、手术出血量、术后肛门排气时间、术后住院时间以及并发症发生率。结果〓LS组的平均手术时间与OS组差异无统计学意义(P>0.05),手术出血量、术后肛门排气时间、术后住院时间以及并发症发生率均优于OS组。差异有统计学意义(P<0.05)。结论〓腹腔镜脾切除术治疗外伤性脾破裂的临床疗效优于传统开腹手术,在临床上是可行、安全有效的。     

经颅多普勒超声在儿童颅内压增高性疾病中的应用

经颅多普勒超声(transcranial doppler ultrasonography,TCD)是一种非侵入性评价颅内动脉的检测手段,自上世纪80年代问世以来,已被广泛性应用于临床工作的各个领域.由于其操作简便、重复性好,可以对患者进行床旁连续、动态观察,尤其适用于监测危重症患者.颅内压增高是儿童致病致死的再要原因之一,它可使脑血流灌注下降,造成脑功能障碍等严重后果,因此颅内压监测有重要临床意义.TCD作为一种无创性监测工具,可根据其血流速度、相关参数及血流频谱的变化对颅内压增高患者脑血流动力学进行动态监测与评估,从而达到监测颅内压改变的目的.本文着重阐述TCD在几种常见的儿童颅内高压性疾病中的应用进展.     

Auto‐inflammatory syndromes and oral health

Auto‐inflammatory diseases (periodic syndromes) are rare childhood‐onset disorders which are characterized by fluctuating or recurrent episodes of fever and inflammation affecting serosal surfaces, joints, eyes and/or skin without significant autoantibody production or an identifiable underlying infection. They are disorders of innate immunity and the underlying genetic defect has been identified in most of the syndromes. Diagnosis relies on clinical symptoms and evidence of an elevated acute phase response during attacks, supported by finding mutations in the relevant genes. Several syndromes can lead to systemic AA amyloidosis. Aphthous‐like oral ulceration has been reported as one manifestation in several of the syndromes, including periodic fever, aphthous‐stomatitis, pharyngitis, adenitis (PFAPA) familial Mediterranean fever (FMF), hyperimmunoglobulinaemia D and periodic fever syndrome, tumour necrosis factor receptor associated periodic syndrome and pyogenic sterile arthritis, pyoderma gangrenosum, acne (PAPA). Chronic jaw recurrent osteomyelitis has been recorded in chronic recurrent multifocal osteomyelitis. Advances in the molecular pathogenesis of these syndromes and the regulation of innate immunity have enhanced diagnosis, and rationalized therapies. This article reviews the periodic fever syndromes relevant to oral health and the suggested association of FMF with Behçet’s disease.     

■创伤性牙髓炎和根尖周炎的临床研究

为进一步探讨创伤引起牙髓和根尖周炎的病因、病理及临床诊治情况，作者通过对８９例患者的１００颗此类患牙的病例观察，总结出这类疾病的发病特点和临床表现；提出了创伤性牙髓炎或根尖周炎的诊断名词与诊断指标，并对这些病例进行了２年的追踪观察及疗效分析，提出了综合治疗方案。为这类疾病的临床诊治提供了依据。