[Pathogen Distribution,Imaging Characteristics,and Establishment and Verification of Risk Prediction Model of Pulmonary Infection with Multi-drug Resistant Organism in Patients with Severe Craniocerebral Injury].

Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury,and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively.According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients).The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model.The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection.The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multi-drug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively.The imaging characteristics included pleural effusion,lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%,respectively.Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P=0.003),history of diabetes (P=0.021),history of chronic obstructive pulmonary disease (P=0.038),mechanical ventilation ≥7 d (P=0.001),transfer from other hospitals (P=0.008),and coma (P=0.002).A risk scoring model was established with the ß value (rounded to the nearest integer) corresponding to each index in the regression equation.Specifically,the ß values of age ≥60 years,history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population).The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury.Pleural effusion,lung consolidation,and ground-glass shadow were the most common imaging characteristics.The established risk model has high discriminant validity in both the modeling group and the validation group.

[Clinic analysis of 16 patients of craniocerebral trauma with Labbé vein injury].

OBJECTIVES: To study the mechanism of Labbé vein injury, and its effect on traumatic cerebral infarction and prognosis in patients of craniocerebral trauma. METHODS: The clinic imageology and data of 16 patients of craniocerebral trauma with Labbé vein injury approved intraoperatively from June 2006 to February 2009 were analyzed. To compare the effect of the intraoperative finding of Labbé vein damage and blood vessel treatment on traumatic cerebral infarction, and to analyze the traumatic cerebral infarction size and prognosis. RESULTS: All the 16 patients had acute subdural hematoma and(or) intracerebral hematoma. And 15 of all the 16 patients with Labbé vein injury suffered from skull fractures. All patients accepted hematoma cleaning and intracranial decompression procedure by removing skull. The preoperative Glasgow coma scale (GCS) were as following: 5 patients being between 9 - 12, 7 patients being between 6 - 8 and 4 patients being between 3 - 5. Eight patients had cerebral hernia before operations on admission, and among them, 3 patients had corectasis of both sides and 5 patients had corectasis of only one side, the other 8 patients had no corectasis. Postoperatively, 14 patients suffered from traumatic cerebral infarction of different grades. After follow-ups of 24 months, 8 patients had relatively good prognosis, with 4 patients having good recoveries and 4 having middle disability; the other 8 had bad prognosis, including 3 patients being seriously disable and 5 kept vegetative state. CONCLUSIONS: Impact injury and counterblow are the main reasons to the injury of Labbé vein, which consequently leads to serious traumatic cerebral infarction and bad prognosis. Intraoperatively, it is quite important to protect Labbé vein during the surgery, which should not be easily cut or obstructed by electric coagulation, and this is an effective way to improve the prognosis of these patients.

The prospective study of the relationship between perimesencephalic cistern of CT scanning and the outcome of the patients with acute craniocerebral injury.

OBJECTIVE: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebral injury. METHODS: The CT scan features including the states of perimesencephalic cisterns, the deformations of the midbrain and the ratios of the occipitofrontal diameter and the transverse diameter of the midbrain of 132 cases were measured. The GOS of the patients 3 months after trauma were regarded as outcome. RESULTS: The rate of unfavorable outcome (dead, vegetative status, severe disability) was significantly correlated with perimesencephalic cistern narrower than 1 mm (P<0.05), especially narrower than 0.5 mm (P<0.005), deformed midbrain (P<0.005) or abnormal ratio (<0.9 or >1.1) of the occipitofrontal diameter and transverse diameter of the midbrain (P<0.01). But the patient's perimesencephalic cistern wider than 1mm and the patients without deformed midbrain got favorable outcome (moderate disability/good recovery). CONCLUSIONS: The state of the compressed perimesencephalic cistern (<1 mm) and the deformation of the midbrain may significantly indicate unfavorable outcome of the patients with acute craniocerebral injury.