Objective To investigate the influencing factors of progressive hemorrhagic injury (PHI) after traumatic brain injury. Methods The medical records of 127 patients with traumatic brain injury (n=49 in PHI group and n=78 in non-PHI group) were reviewed. The relationship between PHI and influencing factors including sex, age, Glasgow coma scale, time from injury to first CT, traumatic subaraehnoid hemorrhage (tSAH), prothrombin time(PT),activated partial thromboplastin time(APTT) was analyzed. Results The time for first CT was(1.39± 1.27) h in PHI group and (2.91±1.85) h in non-PHI group (t=2.14, P<0.05). 35 cases of PHI group developed tSAH and 37 of non-PHI group developed tSAH (χ2=7.06, P<0.05). Multifactor Logistic regression analysis showed that the time for first brain CT after injury and the patients accompanied with tSAH were associated with PHI after traumatic brain injury (OR=0.558,95 % CI 0.329-0.946, OR=13.000,95 % CI 1.187-142.354, P<0.05 for each). Conclusions Time from injury to first CT and tSAH can be prognostic factors for PHI.

Objective To investigate the instructive role and clinical effect of invasive intracranial pressure monitoring in treating bilateral posttraumatic acute diffuse brain swelling(PADBS).Methods A total of 52 consecutive patients with bilateral PADBS managed under invasive intracranial pressure monitoring between October 2009 and December 2010 were enrolled as the study group.Another 53 patients with bilateral PADBS managed with non-intracranial pressure monitoring from February 2007 to September 2009 were set as the control group.The clinical outcomes of the two groups were compared.Results The ratios of good recovery[Glasgow Outcome Scale(GOS)=5 points]and severe disability(GOS=3 points)were 59.6％(31/52)and 11.5％(6/52)respectively in the study group,but 35.9％(19/53)and 28.3％(15/53)respectively in the control group(P＜0.05).The death rates of the study and control groups were 5.8％(3/52)and 9.4％(5/53)respectively(P＞0.05),and the average hospital stay was(34.35±17.50)days and(42.43±22.17)days respectively(P＜0.05).Conclusion Durative monitoring of invasive intracranial pressure in treatment of bilateral PADBS can improve prognosis,shorten hospital stay and therefore is worthy of clinical application.

Objective To provide theoretic support for preventing traumatic arterial and venous cerebral infarction after craniocerebral trauma by probing into the related risk factors.Methods The clinical data of 154 pateints with moderate or severe craniocerebral trauma treated by decompressive craniectomy were studied retrospectively.Univariate analysis was carried out on 13 related factors including gender,age,Glasgow Coma Score(GCS)on admission,pupil status,morphological changes of ambient cisterns,brain midline,associated injury,blood pressure,traumatic superficial cerebral veins injury,platelet count,plasma D-dimer value,dosage of dehydrating agent and perioperative fluid balance.Then,the logistic multiple regression analysis was made on significant indexes with SPSS 10.0.Results Univariate analysis showed that seven factors including pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline were significantly correlated with traumatic arterial cerebral infarction(P ＜ 0.05)and that three factors including traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury were significantly correlated with traumatic venous cerebral infarction(P ＜ 0.05).Logistic multi-factors regression analysis showed that mydriasis and hypotension might be the independent risk factor of traumatic arterial cerebral infarction and that traumatic superficial cerebral veins injury might be the independent risk factors of traumatic venous cerebral infarction.Conclusion The pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline are the risk factors of traumatic arterial cerebral infarction,with mydriasis and hypotension as independent risk factors.Traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury are the risk factors of raumatic venous cerebral infarction,with traumatic superficial cerebral veins injury as independent risk factor.

Objective To investigate the combined effects of invasive intracranial pressure and transcranial Doppler (TCD) monitoring in the treatment for posttraumatic acute diffuse brain swelling (PADBS).Methods The clinical data of 120 patients with PADBS admitted from January 2014 to January 2016 were retrospectively analyzed by case-control study.There were 88 males and 32 females,aged 19-70 years (mean,43.6 years).Patients were divided into three groups based on whether they had accepted invasive intracranial pressure and TCD:Group A (37 cases) with neither invasive intracranial pressure nor TCD,Group B (40 cases) with invasive intracranial pressure only,and Group C (43 cases) with both intracranial pressure and TCD.The hospitalization time in ICU,better prognosis [Glasgow outcome scale (GOS) scored 4-5] at 12 months after injury,Barthel index (BI),and mini-mental status examination (MMSE),mydriasis rate,and decreased values of Glasgow coma scale (GCS) were compared among three groups.Results (1) The ICU length of stay in the Groups of A,B and C was respective (9.6 ± 6.8) days,(9.2 ± 5.4) days and (8.9 ± 5.7) days (P ＞ 0.05).The ratio of better prognosis in the Groups of A,B and C was respective 46％ (17/37),65％ (26/40) and 72％ (31/43),showing a better result in Groups B and C than Group A (P ＜ 0.05).However,there was no significant difference in ratio of better prognosis between Groups B and C (P ＞ 0.05).The BI in the Groups of A,B and C was respective (51.0 ± 36.7) points,(58.0 ± 35.7) points and (70.2 ± 34.6) points,while the MMSE was respective (17.3 ± 12.5) points,(18.8 ± 12.0) points and (21.2 ± 11.4) points.Both BI and MMSE in Groups B and C were higher than those in Group A (P ＜ 0.05),moreover,those in Group B were also statistically lower than those in Group C (P ＜ 0.05).(2) The ratio of mydriasis from admission to initiation of operation in Groups A,B and C was respective 33％ (9/27),13％ (4/30) and 7％ (2/28),showing a higher ratio in Group A than Groups B and C (P ＜ 0.05).But there were no statistical difference in the ratio of mydriasis between Groups B and C (P ＞ 0.05).The decreased value of GCS from admission to initiation of operation in Groups A,B and C was (1.4 ± 1.3) points,(0.7 ± 0.5) points and (0.6 ± 0.4) points respectively,showing a larger decrease in Group A than Groups B and C (P ＜ 0.05).But there was no statistical difference in the decreased value of GCS between Groups B and C (P ＞ 0.05).Conclusion Application of invasive intracranial pressure and TCD monitoring can present a timely and precise condition changes,improve the better prognosis rate,daily activity abilities and cognitive function,indicating that it has protective effects on the brain function.

Objective To investigate the related factors of intracranial infection and intracranial hemorrhage from invasive intracranial pressure monitoring so as to provide a reference for reducing the incidence rate of complications from invasive intracranial pressure monitoring.Methods The clinical data of 349 patients dealt with invasive intracranial pressure monitoring and admitted from October 2009 to June 2016 were retrospectively analyzed by case series study.The possible factors leading to intracranial infection included gender,age,disease classification,type of intracranial pressure probe,implantation method of the intracranial pressure probe,intracranial pressure probe retention time,implementation of craniotomy or not,surgery time,and combination with skull base fracture or not.The possible factors related to complicated intracranial hemorrhage included gender,age,hypertension,international standardized ratio (INR) before intracranial pressure probe implantation,platelet count,serum fibrinogen level,type of intracranial pressure probe,implantation method of the intracranial pressure probe,and the combination with brain contusion or bleeding around intracranial pressure probe implantation site or not.The related factors and independent risk factors of intracranial infection and intracranial hemorrhage were evaluated by univariate analysis and multivariate Logistic regression analysis.Results The univariate analysis showed disease classification (ruptured intracranial aneurysms vs other diseases (P ＜ 0.05),intracranial pressure probe implantation method (P ＜ 0.05),retention time of intracranial pressure probe (P ＜ 0.05),and combination of basal skull fracture (P ＜ 0.05) were the related factors of intracranial infection.Multivariate Logistic regression analysis showed that the disease classification (P ＜ 0.05) and implantation method of intracranial pressure probe (P ＜ 0.05) were independent risk factors for intracranial infection.In addition,probe type (P ＜ 0.05) and implantation method of intracranial pressure probe P ＜0.05) were independent risk factors for intracranial hemorrhage.Conclusions Ruptured intracranial aneurysms and implantation method for intracranial pressure probe (craniotomy or skull drilling) are independent risk factors for intracranial infection from invasive intracranial pressure monitoring.Type of probe (ventricular intracranial pressure probe) and implantation method for intracranial pressure probe (skull cone) are independent risk factors for intracranial hemorrhage from invasive intracranial pressure monitoring.In clinical practice,the indications of invasive intracranial pressure monitoring should be strictly supervised and the relevant risk factors should be prevented to reduce the complications of invasive intracranial pressure monitoring.