Effects of early hyperbaric oxygen therapy on clinical outcome in postoperative patients with intracranial aneurysm.

OBJECTIVE: To investigate the effects of hyperbaric oxygen (HBO2) in postoperative patients with intracranial aneurysm. METHODS: A total of 120 patients who underwent clipping of intracranial aneurysm of the anterior circulation were randomized into the HBO2 group (n = 60) or the Control group (n = 60). Compared with the Control group, patients in the HBO2 group received additional HBO2 therapy, which was initiated within one to three days as soon as they were deemed clinically stable, for at least 20 sessions (one session per day). Mean flow velocities of the middle cerebral artery (MCA) on the operative approach side were measured on Days 1, 3, 7, 14 and 21 after operation. CT scans were performed on Days 1, 7, 14 and 21 after surgery to determine the abnormal density volume in the operative area. Cases associated with symptomatic cerebral vasospasm (CVS) were assessed on Days 3, 7 as well as 14, and the functional state determined by Karnofsky Performance Scale (KPS) score was evaluated on Days 3 and 21 after operation. Finally, Glasgow Outcome Scale (GOS) scores were obtained at six months after surgery. RESULTS: There were no differences between groups in terms of the mean flow velocities of MCA on the operative approach side, the cases with symptomatic CVS, and the KPS scores within three days after surgery (P > 0.05). Compared with those of the Control group, the mean flow velocities of MCA on the operative approach side were significantly lower in the HBO2 group on Days 7 and 14 (P < 0.05 or P < 0.01). On Days 7, 14 and 21, patients in the HBO2 group had smaller HBO2 density volume in the operative region than those in the Control group (P < 0.05). The HBO2 group developed less cases of symptomatic CVS than the Control group did on Days 7 (chi2 = 4.04, P < 0.05) and 14 (chi2 = 4.18, P < 0.05). The KPS scores were higher on Day 21 after surgery in the HBO2 group (P < 0.05). More patients in the HBO2 group achieved GOS scores of 4 and 5 at six months after surgery (chi2 = 6.032, P < 0.05). CONCLUSIONS: Early HBO2 appears to be beneficial asan adjunctive treatment of postoperative intracranial aneurysm. Attenuating postoperative CVS, brain edema, and cerebral ischemia contributes to the effectiveness of HBO2.

[Effects of probiotics on blood glucose levels and clinical outcomes in patients with severe craniocerebral trauma].

OBJECTIVE: To investigate the effects of probiotics on blood glucose levels and clinical outcomes in patients suffering from severe craniocerebral trauma. METHODS: A prospective randomized control study was conducted. Fifty-two severe craniocerebral trauma patients admitted to intensive care unit (ICU) were randomized into experimental or control group (each n=26). All patients received conventional treatment according to Guidelines for the Clinical Management of Traumatic Brain Injury and enteral nutrition within 24-48 hours after admission through nasogastric tube. In addition, the experimental group received 1×10(9) bacteria of viable probiotics (Golden Bifid, 3.5 g for 3 times per day) per day for 21 days. The fasting blood glucose levels were determined in the morning before intervention and on day 4, 8, 15, 21 after intervention. Amount of insulin used during hospitalization, Glasgow coma scale (GCS) scores, length of ICU stay, and 28-day mortality rate were studied. RESULTS: There was no difference in term of the blood glucose levels between two groups before intervention. On day 8 and 15 after intervention, significantly lower levels of fasting blood glucose were observed in the experimental group compared with those of the control group (8 days: 6.6±1.2 mmol/L vs. 8.0±2.7 mmol/L, t=-2.500, P=0.017; 15 days: 6.1±1.4 mmol/L vs. 7.2±2.2 mmol/L, t=-2.269, P=0.028). There were significantly less patients treated with insulin or shorter days of insulin therapy in experimental group than in control group [19.2% (5/26) vs. 46.2% (12/26), χ(2)=4.282, P=0.039; 1.6±0.9 vs. 4.3±3.1, t=-2.698, P=0.017]. The length of ICU stay was significantly shorter in the experimental group than that of control group (6.8±3.8 days vs. 10.7±7.3 days, t=-2.123, P=0.034). No significant differences were found about the GCS scores (before intervention: 6.3±1.0 vs. 6.4±1.0, t=-0.408, P=0.685; 21 days after intervention: 10.1±4.0 vs. 9.6±4.3, t=0.435, P=0.665) and 28-day mortality rate [11.5% (3/26) vs. 19.2% (5/26), χ(2)=0.148, P=0.701] between experimental group and control group. CONCLUSIONS: Probiotics could facilitate blood glucose control in patients with severe craniocerebral injury. The underlying mechanisms and its long-term efficacy in this category of patients, however, need to be further investigated.