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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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Objective@#To investigate the application value of hs-CRP and BNP detection in COPD patients with pulmonary heart disease.@*Methods@#From January 2016 to January 2018, 80 patients with COPD in the Fifth People's Hospital of Datong were selected.Forty-two COPD patients complicated with pulmonary heart disease were selected as COPD and cor pulmonale group, 38 COPD patients without pulmonary heart disease were selected as COPD group, and 30 healthy volunteers were selected as control group.The differences of hs-CRP and BNP levels were compared, and the diagnostic value of hs-CRP and BNP for COPD combined with pulmonary heart disease was analyzed.@*Results@#There were statistically significant differences in hs-CRP[(72.5±20.4) mg/L vs.(37.5±9.8) mg/L vs.(3.7±1.2)mg/L], BNP[(362.8±86.9) ng/L vs.(125.9±34.8) ng/L vs.(28.5±9.9)ng/L] among the COPD and cor pulmonale group, COPD group and control group (F=9.245, 14.668, all P<0.05). The hs-CRP and BNP levels in the COPD and cor pulmonale group were significantly higher than those in the other two groups(t=19.294, 11.576, 21.385, 9.258, 9.258, all P<0.05), which of the COPD group were significantly higher than those of the control group (t=8.912, 12.567, all P<0.05). The best boundary value of BNP in diagnosis of COPD with cor pulmonale was 261.8ng/L, and its diagnostic sensitivity and specificity were 96.2% and 85.4%, respectively, the area under the line was 0.834, which were all higher than those of hs-CRP.With the increase of cardiac function, the levels of hs-CRP[(38.5±10.3) mg/L vs.(51.4±14.8) mg/L vs.(75.1±21.5) mg/L vs.(93.7±31.8)mg/L], BNP[(142.8±56.5) ng/L vs.(285.9±94.8) ng/L vs.(352.5±118.2) ng/L vs.(478.5±130.3)ng/L] increased, the differences were statistically significant (F=13.577, 16.776, all P<0.05). There were significant correlation between hs-CRP, BNP levels and COPD patients complicated with cor pulmonale (r=0.675, 0.766, all P<0.05).@*Conclusion@#hs-CRP and BNP have high diagnostic potency for COPD patients combined with cor pulmonale, and are positively correlated with cardiac function classification.
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Objective To investigate the application value of hs-CRP and BNP detection in COPD patients with pulmonary heart disease.Methods From January 2016 to January 2018,80 patients with COPD in the Fifth People＇s Hospital of Datong were selected.Forty-two COPD patients complicated with pulmonary heart disease were selected as COPD and cor pulmonale group,38 COPD patients without pulmonary heart disease were selected as COPD group,and 30 healthy volunteers were selected as control group.The differences of hs-CRP and BNP levels were compared,and the diagnostic value of hs-CRP and BNP for COPD combined with pulmonary heart disease was analyzed.Results There were statistically significant differences in hs-CRP[(72.5 ± 20.4) mg/L vs.(37.5 ± 9.8) mg/L vs.(3.7 ± 1.2)mg/L],BNP[(362.8 ± 86.9) ng/L vs.(125.9 ± 34.8) ng/L vs.(28.5 ± 9.9)ng/L] among the COPD and cor pulmonale group,COPD group and control group (F=9.245,14.668,all P<0.05).The hs-CRP and BNP levels in the COPD and cor pulmonale group were significantly higher than those in the other two groups(t=19.294,11.576,21.385,9.258,9.258,all P<0.05),which of the COPD group were significantly higher than those of the control group (t=8.912,12.567,all P<0.05).The best boundary value of BNP in diagnosis of COPD with cor pulmonale was 261.8ng/L,and its diagnostic sensitivity and specificity were 96.2% and 85.4% , respectively,the area under the line was 0.834,which were all higher than those of hs-CRP.With the increase of cardiac function,the levels of hs-CRP[(38.5 ± 10.3) mg/L vs.(51.4 ± 14.8) mg/L vs.(75.1 ± 21.5) mg/L vs.(93.7 ± 31.8) mg/L],BNP[(142.8 ± 56.5) ng/L vs.(285.9 ± 94.8) ng/L vs.(352.5 ± 118.2) ng/L vs. (478.5 ± 130.3)ng/L] increased,the differences were statistically significant (F=13.577,16.776,all P<0.05). There were significant correlation between hs-CRP,BNP levels and COPD patients complicated with cor pulmonale (r=0.675,0.766,all P<0.05).Conclusion hs-CRP and BNP have high diagnostic potency for COPD patients combined with cor pulmonale,and are positively correlated with cardiac function classification.
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Objective To investigate the effects of damage control surgery (DCS) in the treatment of severe craniocerebral injury patients combined with multiple extremity fractures.Methods The clinical data of 128 patients with severe craniocerebral injury[Glasgow coma scale (GCS) scored 3-8] combined with multiple extremity fractures admitted from May 2011 to August 2015 were retrospectively analyzed by case-control study.There were 81 males and 47 females,with an average age of 37.3 years (range,19-77 years).The patients were treated with intracranial pressure monitoring in addition to the common administration.The patients were subdivided into two groups:87 patients treated with DCS concept as damage control group and 41 patients treated with non-DCS routine concept as control group.The DCS group received craniotomy and fracture fixation operation in stage Ⅰ with selective operation of open reduction and internal fixation.The control group received craniotomy and open reduction and internal fixation in stage Ⅰ.The postoperative intracranial pressure,operation duration,intraoperative blood loss,hospital stay and prognosis [Glasgow outcome scale (GOS)] were analyzed statistically.Results No intracranial infection was found in all patients during the treatment process.In damage control group,the postoperative intracranial pressure was normal in 44 cases (51％),which was significantly better than that in control group [8 cases (20％)] (P ＜ 0.05).In damage control group,operation duration [(150.1 ± 12.4)minutes],intraoperative blood loss [(270.6 ± 15.3)ml],and hospital stay [(29.7 ± 9.3) days] were significantly shortened compared with control group,whose operation duration,intraoperative blood loss and hospital stay were (270.6 ± 9.8) minutes,(460.2 ± 17.5) ml,and (34.4 ± 6.2) days,respectively (P ＜ 0.05).The GOS rating of damage control group (70％) was notably higher than that in control group (42％) (P ＜ 0.05).Conclusion For severe craniocerebral injury patients combined with multiple extremity fractures,the application of DCS contributes to control of postoperative intracranial pressure,which can also shorten the duration of hospitalization and improve prognosis.
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Objective To investigate the clinical value of ventricular intracranial pressure monitoring in treatment of severe craniocerebral trauma with high intracranial pressure.Methods A retrospective analysis was conducted on forty cases of severe craniocerebral trauma with GCS score of 3-5 undergone bilateral decompressive craniectomy from October 2010 to January 2012.The patients were divided into three groups:Group A (12 cases received craniotomy after the placement of ventricular intracranial pressure probe) ; Group B (15 cases had craniotomy ahead of the probe placement) ; control group (13 cases had probe placement alone).Intracranial pressure control,dose and duration of administration of dehydrator and prognosis were compared among groups.Results Groups A and B showed a better result in aspects of controlling intracranial pressure within 15 mm Hg,dose and duration of mannitol treatment,and prognosis,as compared with control group (P ＜ 0.05).Furthermore,Group A had seven cases of severe disability or in vegetable state,but only three cases in Group B (P ＜ 0.05).Conclusion Ventricular intracranial pressure monitoring can effectively reduce intracranial pressure,raise treatment success rate and decline the use of mannitol in management of severe craniocerebral trauma.