Objective
To evaluate the effects on nutritional intakes and clinical outcomes of severe brain injury patients receiving percutaneous gastrojejunostomy (PEG-J) feedings.
Methods
The severe brain injury patients treated in ICU of Changshu No.1 Hospital from Jan 2013 to Dec 2016 were enrolled in the study. Patients were randomized into: control group, patients received nasoduodenal feedings and treatment group, patients received PEG-J feedings. The feeding speed was adjusted according to the amount of gastric residual or reflux vomiting. The daily dose of enteral nutrition in the first week, endocrine function, immune function, nutritional states and clinical outcomes were recorded.
Results
Totally 87 patients were enrolled in this study, 45 patients in the control group and 42 patients in the treatment group. The daily dose of enteral nutrition of the treatment group were significantly more than the control group from the fourth to the seventh days (P= 0.001, <0.01, 0.024), the CD4+T-lymphocyte percentage and CD4+/CD8+ ratio were significantly higher in the treatment group on day 7 (P=0.03, 0.01), levels of thyroidstimulating hormone, free triiodothyronine and free thyroxine of the treatment group were higher (P=0.036, 0.013, 0.025), and the level of hormonal was lower in the treatment group (P=0.004). The levels of albumin, prealbumin and insulin dosage were not significantly different between the two groups, neither did mortality, rates of organ failures. But the treatment group has a higher Barthel index scores (P=0.049), shorter length of mechanical ventilation and stay ICU (P=0.044, 0.048), and the lower incidence of vomiting and ventilator associated pneumonia (P=0.013, 0.037).
Conclusions
PEG-J could increase energy intake, improve immunity and endocrine function, promote the recovery of life ability, reduce the incidence of VAP, shorten mechanical ventilation time and ICU stay in severe brain injury patients.
Key words:
Percutaneous gastrostomy-jejunostomy; Severe brain injury; Enteral nutrition; Clinical outcomes
Objective
To investigate the validity and feasibility of optic nerve sheath area (ONSA) determined by ultrasound in evaluating intracranial pressure (ICP) of craniocerebral trauma patients.
Methods
This was a prospective clinical trial. Thirty-six patients with craniocerebral trauma who were hospitalized in intensive care unit (ICU) of Changshu No.1 People’s Hospital from June 2015 to June 2018 were selected as research objects. On 1, 3 and 5 days postoperatively, bedside ultrasound was used to measure diameter of the optic nerve sheath 3 mm behind the eyeball. The optic nerve sheath long diameter (ONSLD) and optic nerve sheath vertical diameter (ONSVD) were measured in the horizontal axis and the sagittal position, respectively. The ONSA was calculated according to ONSLD and ONSVD. At the same time, ICP values were monitored.
Results
ONSLD, ONSVD and ONSA determined by ultrasound were significantly correlated with ICP (r=0.493, 0.507, 0.551; P=0.000, 0.000, 0.000). The correlation between ONSA and ICP was higher than ONSLD and ONSVD. Optimal cut-off values of ONSLD, ONSVD and ONSA for detection of elevated ICP(>20 mmHg, 1 mmHg=0.133 kPa)were 5.6 mm, 5.75 mm, 26.52 mm2, with sensitivity of 73.7%, 73.7%, 73.7%, specificity of 86.5%, 91.1%, 92.1%.
Conclusions
ONSLD, ONSVD and ONSA have good correlations with ICP and higher predictive value for increased intracranial. But ONSA has a closer correlation with ICP and has clinical application value.
Key words:
Ultrasound; Optic nerve sheath; Area; Intracranial pressure
BACKGROUND To probe into diagnoses and operation methods of adult congenital megacolon.?CASE REPORT?7 of 14 cases were diagnosed before operation and another 7 cases were diagnosed in operation. Primary radical operations were performed in 7 cases, secondary operations in 4 cases, and 3 cases were dead.?DISCUSSION?Long term history of constipation and examination with barium enema are the main basis of diagnosing the adult congenital megacolon before operation and to selecting different operations according to the patient's conditions is the key to increase curative effect, reduce complications and death rate.
A comparative study has been conducted on the anti-free-radical damage by the vital energy-reinforcing and blood-tonifying methods. The results shows that Sijunzi decoction and Siwu decoction can increase the vitality of SOD, accelerate the elimination of free-radical and inhibit the growth of LPO and MAO-B. This means that both these two methods help to delay senility and the vital energy-reinforcing one is more effective.
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