Objective To observe the effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation.Methods A prospective randomized control study was conducted.56 patients with mechanical ventilation after craniocerebral operation were randomly divided into metoclopramide combined with early enteral nutritional group (observation group) and parenteral nutrition group (control group),28 in each group.The patients in the observation group received early enteral nutrition (24-48 h after operation),and intramuscular injection of metoclopramide (10mg Q8H) for 7 days.The patients in the control group received parenteral nutrition.The nutritional parameters,mechanical ventilation (MV) time,success rate of the ventilator weaning and the occurrence rate of pneumonia associated with ventilation (VAP) in one week,the incidence of adverse reaction were compared between the two groups.Results After 1 week therapy,the nutritioual parameters of the two groups showed no statistical significance(P ＞ 0.05);the observation group compared with the control group,3 、7days of blood glucose(P1 、P2) decreased significantly[(8.9 ± 1.6) mmol/L vs (11.4 ± 3.2) mmol/L,(8.2 ± 1.3) mmol/L vs (10.6 ± 2.1) mmol/L] (P1 =0.002,P2 =0.011),Mechanical ventilation (MV) time (P3) and the occurrence rate of VAP(P4) in one week also declined[(6.5 ±2.3)d vs (8.9 ±3.1)d,21.4％ vs 46.4％] (P3 =0.022,P4 =0.048),but within a week of success rate of the ventilator weaning improved (67.9％ vs 39.3％,P5 =0.032).Return rate (P6),gastrointestinal bleeding (P7) was significantly lower than those of the control group (17.9％ vs 42.9％,14.3％ vs 42.9％,P6 =0.042,P7 =0.038),but abdominal distention,diarrhea were no significant contrast (P ＞ 0.05).Conclusion Metoclopramide combined with early enteral nutritional may obviously improve the nutrition parameters,shorten the MV time,decrease the occurrence rate of VAP,not increase in side effects.

Objective To investigate the cryoprecipitate fracture hemorrhage clinical application value in the skull fracture hemorrhage,and provide reference for clinical treatment.Methods 80 patients with standard skull frac-ture hemorrhage were selected as the research subjects.The patients were randomly divided into observation group (40 cases)and the control group (40 cases).The control group was given hemostasis,dehydration,protecting stom-ach,antibacterial,nerve nutrition,reducing intracranial pressure,head up in bed and other symptomatic treatment.The observation group received the treatment besides in the control group and added the cryoprecipitate hemostasis,every time given 10U,every 6 -8h 1 time.According to the condition,they were given the cold sediment of 1 -3 times. Then,the cases that fit to give surgery we must cured them by the operation.After treatment 24h,the coagulation inde-xes were examined [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),two D -dimer],plasma fibrinogen (Fbg),International Glasgow (GOS).Finally,we observed clinical prognosis in two groups.Results PT,APTT,TT were significantly shorter than before treatment in the observation group and the con-trol group(t =6.654,5.746,6.193 and 3.342,3.552,3.646,P <0.01 or P <0.05).The PT,APTT and TT of the observation group were significantly shorter than those in the control group (t =3.322,3.406,3.315,all P <0.05). Plasma Fbg was significantly higher than before treatment in two groups(t =5.762,3.592,P <0.01 or P <0.05). Fbg in the observation group was significantly higher than the control group(t =3.407,P <0.05).The clinical prog-nosis in the observation group was significantly better than the control group(χ2 =8.747,P <0.05).Conclusion Cryoprecipitate is a safe and efficient drug.It can effectively improve the blood coagulation dysfunction of patients with fracture of skull base,active endogenous coagulation system,improve hemostatic effect,and reduce the occurrence of progressive cerebral hemorrhage.Therefore,it can improve the prognosis of patients.