Effect of pre-hospital mild hypothermia treatment on serum malondialdehyde level and its clinical efficacy in patients with severe craniocerebral injury
0
Citation
0
Reference
20
Related Paper
Abstract:
Objective To investigate the clinical efficacy of pre-hospital mild hypothermia in patients with severe craniocerebral injury,and to explore the possible mechanism by the changes of serum Malondialdehyde (MDA).Methods 120 cases of severe craniocerebral injury were divided into pre-hospital mild hypothermia group (group A,65 cases) and control group(group B,55 cases) by random number table.Patients in group A were gave pre-hospital mild hypothermia treatment,and patients in group B were gave mild hypothermia therapy only after hospitalization.Comparison of the change of serum MDA at admission,the 7th and 14th day between two groups,and the functional outcomes were evaluated by GOS score in 6 months after treatment.Results The MDA levels of two group at seventh days and 14 days were higher than that at admission [(10.4 ± 1.5)nmol/L and (8.2 ± 1.2)nmol/L in group A,(12.6 ± 1.9)nmol/L and (10.0 ± 1.4)nmol/L in group B,P ＜0.05],and it was the highest at 7th day,and its in group A was significantly lower than that in group B at 7th,14th day [(6.9 ± 1.1) nmol/L in group A,(6.6 ±1.0) nmol/L in group B,P ＜ 0.05].The good prognosis rate was 47.7％ (31 cases) in group A,higher than the 38.2％ (21 cases) in group B;The mortality rate was 12.1％ (8 cases) in group A,lower than the 21.4％ (12 cases)the group B,and the difference was statistically significant (Z =-2.132,P ＜ 0.05).Conclusion Pre-hospital mild hypothermia treatment can improve the prognosis of patients with severe craniocerebral injury and alleviate the damage of brain tissues.
Key words:
Brain injuries ; Hypothermia, induced ; Free radicals ; PrognosisKeywords:
Malondialdehyde
Group B
Group A
Objective To explore the protective effect of erythropoietin(EPO) on neonates with moderate or severe hypoxic-ischemic encephalopathy(HIE).Methods Forty-eight neonates of 72 hours after birth with HIE were selected from neonatal intensive care unit(NICU),who were randomized to treatment group(group A),in which,group A1 16 cases,and group A2,eight cases;and control group(group B),in which,group B1 16 cases,and group B2,eight cases.The neonates in group A were given EPO besides the same routine therapy as in the group B.ELISA was applied to detect the levels of NSE and S-100 protein.Results After seven and 14 days of therapy,the levels of NSE in each group of group A were much lower than that before treatment(F=3.36-10.39;q=3.34-6.78;P0.05).After seven days of treatment,the difference of NSE level between group A1 and group B1 was significant(F=8.26,4.39;q=5.23;P0.01);while after 14 days of treatment,the difference between the two groups was not significant.After seven and 14 days of treatment,the difference of NSE levels between group A2 and group B2 was significant(q=5.56,4.32;P0.01).After seven and 14 days of treatment,the levels of S-100 in each group declined greatly as compared with that before treatment(F=4.51,5.68;q=3.93-4.00;P0.05).In group A1,the levels of S-100 were significantly different as compared with group B2 after seven and 14 days of treatment(F=5.12,7.06;q=3.99,6.97;P0.05);in group A2,the levels of S-100 decreased much greater than that in group B2(q=3.93,P0.05).Conclusion EPO can obviously reduce the levels of NSE and S-100 in sick kids with HIE,and improve their prognosis.
Group B
Hypoxic-Ischemic Encephalopathy
Group A
Cite
Citations (0)
Objective: To investigate the clinical efficacy of early therapeutic with high dose ulinastatin in the treatment of acute pulmonary contusion. Methods: A total of 102 patients with pulmonary contusion were randomly divided into Group A(n=34, control group), Group B(n=34, regular dose group) and Group C(n=34, high dose group). The patients of Group A received routine treatment,while the patients of Group B were given Ulinastatin(100 kU intravenous drip once every 8 hours and continued 7 days) in addition, and the patients of Group C also were given Ulinastatin(400 kU intravenous drip once every 8 hours and continued 7 days) in addition.Artery oxygen pressure(PaO2), carbon dioxide pressure(PaCO2), oxygenation index(PaO2/FiO2), serum tumor necrnsis factor alpha(TNF-α) and interleukin 6(IL-6) levels were measured on the 1st, 4th and 7th day in these groups. The incidence rates of acute respiratory distress syndrome(ARDS) and pulmonary infection were compared among three groups during the treatment. Results: After treatment,PaO2 in group B was higher than that in group A on 7th day(P0.05), PaO2in group C was higher than that in group A on 1st, 4th and7th day(P0.05), PaO2in group C was higher than that in group B on 1st and 4th day(P0.05); PaCO2in group B and C were higher than that in group A on 4th day(P0.05); PaO2/FiO2in group B was higher than that in group A on 7th day(P0.05), PaO2/FiO2in group C were higher than those in group A and B on 4th and 7th day(P0.05); TNF-α in group B was lower than that in group A on 7th day(P0.05), TNF-α in group C was lower than that in group A on 4th and 7th day(P0.05), TNF-α in group C was also lower than that in group B on 4th day(P0.05); IL-6 in group B was lower than that in group A on 7th day(P0.05), IL-6 in group C was lower than those in group A and B on 4th and 7th day(P0.05). No significant difference was observed in the incidence rates of ARDS and pulmonary infection among three groups during the treatment. Conclusions: Early high-dose application of ulinastatin was obviously effective in the treatment of acute pulmonary contusion.
Ulinastatin
Oxygenation index
Group B
Group A
Pulmonary Contusion
Cite
Citations (0)
To investigate the protective effect of mild hypothermia at different starting times on the physiological functions of the viscera of exertional heat stroke (EHS).A prospective randomized controlled trial was conducted. EHS patients admitted to intensive care unit of the 159th Hospital of People's Liberation Army and the First Affiliated Hospital of Zhengzhou University from June 2015 to June 2017 were enrolled. The patients were divided into 2, 4, 6 hours start hypothermia treatment groups according to the random number table method, the mild hypothermia was initiated at 2, 4 and 6 hours after the disease onset respectively, and the methods were the same in each group. After treatment of 2, 12, 24 hours, the venous blood in the three groups was collected to detect serum cardiac troponin I (cTnI) with chemiluminescence method, MB isoenzyme of creatine kinase (CK-MB) with immunosuppressive method, creatinine (Cr) with creatine oxidase method, β2-microglobulin (β2-MG) with turbidimetry, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with enzyme method. Multiple organ dysfunction syndrome (MODS) within 24 hours after treatment was recorded. Linear regression analysis of the correlation between mild hypothermia start-up time and MODS was done.Ninety-three cases of EHS were included, with 32, 31 and 30 patients in 2, 4, 6 hours start treatment groups respectively. There were no significant differences in gender, age, core temperature, onset time to admission, Glasgow coma scale (GCS), acute physiology and chronic health evaluation system II (APACHE II) score at admission among the three groups. There were no significant differences in the levels of serum cTnI, CK-MB, Cr, β2-MG, ALT and AST at 2 hours after treatment. But with the prolongation of the treatment time, all indicators gradually increased. And the earlier start of the mild hypothermia, the less significant of the above indexes. All indexes in 2 hours start treatment group were significantly lower than those of 2 hours and 6 hours start treatment groups at 24 hours after treatment [cTnI (ng/L): 49.53±9.25 vs. 56.52±10.05, 64.57±11.21; CK-MB (U/L): 51.47±11.83 vs. 57.87±7.43, 64.40±7.93; Cr (μmol/L): 140.97±11.33 vs. 148.16±10.39,155.57±8.65; β2-MG (mg/L): 10.28±1.46 vs. 11.58±2.13, 12.93±1.98; ALT (U/L): 248.53±75.47 vs. 341.42±129.58, 425.77±101.23; AST (U/L): 197.25±42.59 vs. 292.81±58.49, 351.20±60.41, all P < 0.05]. There was significant difference in the incidence of MODS in 2, 4, 6 hours start treatment groups [43.75% (14/32), 64.52% (20/31), 80.08% (24/30), χ2 = 8.761, P = 0.013]. Linear regression analysis showed that the earlier onset time of mild hypothermia, the lower incidence of MODS (R2 = 0.915, P = 0.013).The application of mild hypothermia in 2 hours can effectively protect the physiological function of EHS organs and reduce the incidence of MODS.
Creatine kinase
Blood urea nitrogen
Cite
Citations (2)
Objective: To explore the neuroprotective effect of ulinastatin on the patients with severe craniocerebral injury. Methods: Ninety cases with severe craniocerebral injury were randomly divided into ulinastatin treatment group( group U) and control group( group C). On the basis of routine therapy,patients in group U and group C received ulinastatin and piracetam respectively. The effect was assessed with GCS score and MMSE score at the 12 thday and GOS score at 6 months after treatment. The changes of serum urea nitrogen( BUN),creatinine( CR),alanine aminotransferase( ALT) and total bilirubin( TBIL) levels after treatment were detected. Results: After treatment,GCS scores,MMSE scores and GOS scores were increased in the two groups,and the scores in group U were higher than those in group C( P 0. 05). There was no significant difference in BUN,CR,ALT and TBIL levels between the two groups before treatment( P 0. 05),after treatment,the levels of these indexes were increased,but those of group U were lower than those of group C( P 0. 05). Conclusions: Ulinastatin has good effect in protecting nerve,improving memory and intelligence disorder in patients with severe craniocerebral injury.
Ulinastatin
Blood urea nitrogen
Alanine aminotransferase
Piracetam
Urea nitrogen
Cite
Citations (0)
Objective To analyze the correlation between changes of blood glucose level in patients with traumatic brain injury and prognosis.Methods A total of 112 cases with traumatic brain injury were selected from our hospital as the research object,they were divided into groups with its admission Glasgow coma score(GCS): the mild group(n = 42),the moderate group(n = 40),severe group(n = 30),fasting blood glucose were detected on first day after admis sion,third day,fifth day and seventh day.They were grouped according to the blood glucose level of first day: the fasting blood glucose 10 mmol/L group(n = 85),≥10 mmol/L group(n = 27),the outcomes were compared of two groups.Results Three groups of patients after admission glucose level was obvious negatively related to GCS score(P 0.05);Compared with moderate group and mild group,fasting blood glucose levels of severe group on the first day was significantly higher,there was significant difference(P 0.05);Each group of patients with fasting blood glucose level with the extension of treatment time decreased.The proportion of GCS 5 score in 10 mmol/L was significantly higher than that in ≥10 mmol/L group,the proportion of 1 score was significantly lower than that in ≥ 10 mmol/L group,two groups were significantly different(P 0.05).Conclusion Patients with traumatic brain injury by regular inspection of fasting blood glucose,can better understand the prognosis of the patients,which has guiding significance to the clinical treatment.
Clinical Significance
Coma (optics)
Cite
Citations (0)
Postoperative cognitive dysfunction
Venous blood
Rectal temperature
Plasma levels
Normal group
Cite
Citations (0)
Objective
To investigate the effects of perioperative hypothermia therapy on immune function and nerve function recovery in elderly patients with acute intestinal obstruction.
Methods
From January 2010 to December 2015, 80 elderly patients with acute intestinal obstruction in the Traditional Chinese Medicine Hospital of Beilun District were selected and randomly divided into two groups, with 40 cases in each group.The control group was given conventional symptomatic treatment during operation, the observation group was given intraoperative hypothermia therapy on the basis of the control group.The CD4+ , CD8+ , CD4+ /CD8+ changes of immunoglobulin were observed in the two groups, the ESS(NIHSS) and Barthel index(daily life ability score) were compared between the two groups.
Results
After intervention, the CD4+ , CD8+ , CD4+ /CD8+ levels in the observation group were (35.1±2.0)%, (30.6±1.3)% and (1.9±0.3), respectively, which were higher than those in the control group[(26.0±0.9)%, (24.4±1.0)% and (1.6±0.2)], the differences between the two groups were statistically significant(t=26.242, 23.908, 5.262, all P<0.05). The IgM, IgG, IgA levels in the observation group were (1.60±0.03)g/L, (9.50±0.12)g/L, (3.90±0.20)g/L, respectively, which were higher than those in the control group[(1.30±0.02)g/L, (8.80±0.10)g/L, (1.80±0.15)g/L], there were statistically significant differences between the two groups(t=52.623, 28.342, 53.126, all P<0.05). The ESS, Barthel index in the observation group were (78.6±8.5), (77.3±6.6), respectively, which were higher than those in the control group[(59.6±6.1), (62.6±5.4)], there were statistically significant differences between two groups(t=11.486, 10.902, all P<0.05).
Conclusion
Hypothermia treatment can effectively reduce the effect of surgery on immune function in elderly patients with acute intestinal obstruction, promote the recovery of the nervous system, and improve the quality of life of the patients.
Key words:
Hypothermia, induced; Intestinal obstruction; Immunoglobulins; Aged
Cite
Citations (0)
The value of early base excess monitoring on predicting prognosis in traumatic brain injury patients
Objective To dynamically monitor the base excess(BE) in traumatic brain injury(TBI) patients within 3 d after admission,and to assess the impact of the early BE on prognosis.Methods Blood BE was monitored for 3 d in 56 TBI patients.Patients were classified into mild group(15 patients),moderate group (22 patients) and severe group (19 patients) according to the scores of Glasgow coma scale(GCS).Patients were classified into survival group(42 patients) and dead group(14 patients) according to prognosis.Patients were classified into high BE group (35 patients,BE≥-8 mmol/L) and low BE group (21 patients,BE ＜-8 mmol/L).The relations among BE,degree of injury and prognosis were analyzed.Results The level of BE in mild group,moderate group and severe group was increased after treatment for 1,2,3 d than that before treatment.The level of BE was consistent with the degree of injury [mild group:(-3.02 ± 0.21)mmol/L; moderate group:(-8.49 ± 1.44) mmol/L;severe group:(-9.64 ± 1.19) mmol/L].The level of BE in mild group and severe group had significant difference than that in moderate group (P＜ 0.01).The level of BE in dead group before treatment and after treatment for 1,2,3 d was significantly lower than that in survival group [(-11.97 ±2.13) mmol/L vs.(-6.29 ± 1.16) mmol/L,(-9.84 ± 1.33) mmol/L vs.(-4.89 ± 1.78)mmol/L,(-8.78 ± 2.01) mmol/L vs.(-3.61 ± 1.43) mmol/L,(-7.84 ± 1.42) mmol/L vs.(-3.10 ±0.98)mmol/L] (P ＜0.01).The scores of APACHE Ⅱ before treatment and fatality rate in low BE group were significantly higher than those in high BE group [(24.84 ± 3.68) scores vs.(16.27 ± 2.21) scores,52.4％ (11/21) vs.8.6％(3/35)] (P ＜ 0.01).The scores of GCS before treatment in low BE group was significantly higher than that in high BE group [(7.56 ± 3.09) scores vs.(10.51 ± 2.43) scores](P ＜ 0.01).Conclusion The level of early BE is a good factor on evaluating the condition and prognosis in TBI patients.
Key words:
Craniocerebral trauma; Prognosis; Base excess
Cite
Citations (0)
Objective TO investigate the effects of intensive insulin therapy in severe acute pancreatitis patients(SAP).Methods 31 patients with ASP were divided into treatment group (T group,n=18) and control group(N group,n=13).Both groups were treated by the conventional mode of therapy.Treatment group received intensive insulin therapy in which the blood glucose levels were controlled within 4.4-6.1 mmol/L,while the control group received routine insulin therapy in which the blood glucose levels were controlled within 10.0-11.7 mmol/L.The following tests of two groups of patients were made:amylase levels in urine and blood ,blood routine analysis,biochemical indicators and the APACHE II scores.The incidence of complications and hospital days were evaluated.Results (1)The declining time for APACHE II scores of T group was 1 day,which was much shorter than that of N group (3 day).The APACHE II scores of T group were lower than that of N group after 3 days(P0.05).(2)Patients in T group had decreased rate of complications and hospital mortality than patients in N group.(3)The hospital days of T group were significantly shorter than that of N group.(4) Hypoglycemia was found in 4 patients out of 18 patients in T group,which was not found in N group.Conclusion Intensive insulin therapy can advance the restoration,improve disease proceeding and reduce hospital days of severe acute pancreatitis.
Group B
Cite
Citations (0)
Objective To investigate the relationship between MgSO4 therapy and serum Methylene dianiline (MDA) , outcome in the patients with severe traumatic brain injury (sTBI) . Methods A prospective randomized single-blind clinical trial of MgSO4 therapy was performed in 54 cases of the patients with sTBI who were enrolled within 12 hours after injury, and given intravenous MgSO4 in the treatment group, which was initiated with a bolus of 2.5g in a 100ml solution of 0.9% NaCl over 15 minutes, followed by continuous infusion at 0.4g/hour (10g in a 500ml solution of 0.9% NaCl at 22.5 ml/hour) for 3 days. In control group, clinical management principles were the same as treatment group except MgSO4. the Two group were subdivided into sTBI group (GCS 6-8) and special severe traumatic brain injury (ssTBI) group (GCS 3~5). Daily serum Mg2+ and MDA were monitored, and clinical outcomes were valued using the Glasgow Outcome Scale score (GOSs) at 3 months after injury. Results Decreased serum MDA were observed in the patients with treatment group compared to control group and sTBI group compared to ssTBI group (P 0.05). In ssTBI group, serum Mg2 is lower than sTBI group (P 0.05). There was a slight but not significantly better GOS score in treatment group compared to control group. Conclusion The severer TBI is, the lower serum Mg2+ and the higher serum MDA are. Intravenous MgSO4 can significantly reduce their serum MDA. Mg2+ may act as a neuroprotective agent, and there is a trend of improving these patients' outcome.
Glasgow Outcome Scale
Bolus (digestion)
Cite
Citations (2)