Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Effects of decompressive craniectomy combined with edaravone on postoperative neurological functions and hemodynamics of patients with severe traumatic brain injury

OBJECTIVES

To assess the effects of decompressive craniectomy combined with edaravone on the postoperative neurological functions and hemodynamics of patients with severe traumatic brain injury (STBI).

METHODS

The subjects included totally 186 STBI patients admitted during January 2018 and January 2021. The random number table method was adopted to set an operation group (n=82) and a combined medication group (n=104) for the subjects. The changes of the clinical indicators were observed.

RESULTS

Compared with the operation group, the combined medication group had higher Neurobehavioral Cognitive Status Examination score, Barthel index score, total response rate and heart rate (p<0.05). Besides, by contrast to those of the operation group, the mean arterial pressure, myocardial zymogram indicators, postoperative neurological function indicators and total incidence rate of complications of the combined medication group were reduced (p<0.05). In comparison with the operation group, the combined medication group exhibited raised ipsilateral contralateral blood velocities (p<0.05). Furthermore, the combined medication group had a better postoperative 1-year prognosis than the operation group (p<0.05).

CONCLUSION

Edaravone in combination with decompressive craniectomy benefits the postoperative improvement of neurological functions of STBI patients, effectively stabilizes the hemodynamics, induces few complications and improves the prognosis.

Efficacy of Antithrombotic Therapy and Risk of Hemorrhagic Complication in Blunt Cerebrovascular Injury Patients with Concomitant Injury: A Systematic Review

BACKGROUND

The risk-benefit balance of antithrombotic therapy administration for blunt cerebrovascular injuries (BCVI) patients with concomitant injuries at high risk for bleeding is an ongoing therapeutic conundrum for trauma clinicians. We performed a systematic review to assess the reported efficacy and safety of treatment in this population with respect to prevention of ischemic stroke and risk of hemorrhagic complications.

STUDY DESIGN

A systematic electronic literature search of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases was performed from January 1, 1996 to December 31, 2021. Studies were included if they reported treatment-stratified clinical outcomes after antithrombotic therapy in BCVI patients with concomitant injuries at high risk of bleeding into a critical site. Data were extracted from selected studies by two independent reviewers, including the main outcomes of interest were BCVI-related ischemic stroke rates and rates of hemorrhagic complications.

RESULTS

Of the 5,999 studies reviewed, 10 reported on the effects of treating BCVI patients with concurrent traumatic injuries and were included for review. In the pooled data, among patients with BCVI and concomitant injury who received any form of antithrombotic therapy, the BCVI-related stroke rate was 7.6%. The subgroup of patients who did not receive therapy had an overall BCVI-related stroke rate of 34%. The total rate of hemorrhagic complications in the treated population was 3.4%.

CONCLUSIONS

In BCVI patients with concomitant injuries at high risk for bleeding, antithrombotic use reduces the risk of ischemic strokes with a low reported risk of serious hemorrhagic complications.

Concurrent Spinal Trauma in Patients with Traumatic Head Injury: A Seven-Year Retrospective Analysis

BACKGROUND Assessing spinal injuries in patients with traumatic head injuries is crucial due to their potential to alter functionality and increase mortality rates. This single-center retrospective study was conducted to understand the prevalence and characteristics of concurrent spinal injuries in adults with traumatic head injury from April 2015 to April 2022. MATERIAL AND METHODS The study incorporated demographic, clinical, traumatological, and hemodynamic data from 1,501 adult patients presenting with traumatic head injuries. Spinal injuries were identified through symptoms, physical signs, and radiological findings. RESULTS During the study period, 179 patients (12%) were reported with associated spinal injuries. These patients were predominantly male (p=0.0012), aged 65 years or above (p=0.0452), had thoracic injuries (p=0.0004), and arrived at the emergency department more than three hours post-trauma (p=0.0004). Most injuries were caused by motor vehicle accidents (p=0.0412) or falls from heights greater than 3 meters (p=0.0481). In addition, these patients had higher Abbreviated Injury Scale scores (≥2, p=0.0391), Eppendorf-Cologne Scale scores (≥2, p=0.0412), and lower systolic and diastolic blood pressure readings (p=0.0481, p=0.0412) along with lower heart rates (p=0.0482). However, no correlation was found between systolic and diastolic pressures and age among patients with spinal injuries. CONCLUSIONS This study reveals that the prevalence and severity of spinal injuries in patients with traumatic head injuries are influenced not only by demographic and clinical parameters, but also by the degree and extent of head trauma.

Effect of Ulinastatin Combined with Xingnaojing Injection on Severe Traumatic Craniocerebral Injury and Its Influence on Oxidative Stress Response and Inflammatory Response

Objective

This study is aimed at exploring the effect of ulinastatin combined with Xingnaojing injection on severe traumatic craniocerebral injury and its influence on oxidative stress response and inflammatory response in patients.

Methods

A total of 100 patients with severe traumatic craniocerebral injury admitted to our hospital from January 2018 to January 2020 were selected and equally assigned into a study group (50 cases) and a control group (50 cases) according to a random sampling method. Patients in study group received treatment of ulinastatin combined with Xingnaojing injection, while those in control group were treated with ulinastatin only. The study compared the two groups on the oxidative stress response, inflammatory response, the therapeutic effect, and the incidence rate of adverse reactions.

Results

It is observed that patients in study group obtained lower levels of free cortisol (FC) and norepinephrine (NE) in the serum and higher level of total thyroxine (TT4) after treatment compared with those in control group with significant difference (P < 0.05); in the meantime, they were examined to have significantly fewer oxidative stress response products, lower serum inflammatory factor level, and serum indicator levels of craniocerebral injury as opposed to those in control group, suggesting significant differences (P < 0.05); study group demonstrated higher treatment response rate and lower incidence rate of adverse reactions compared with control group with a significant difference (P < 0.05).

Conclusion

The study found that ulinastatin combined with Xingnaojing infection has a significant effect in the treatment of severe traumatic craniocerebral injury, which can reduce the degree of craniocerebral injury and the level of inflammatory factors in the serum of patients. It is worthy of being promoted and applied clinically.