OBJECTIVE: To investigate the method of promoting wakefulness in patients with cerebral surgical coma.
METHODS: Patients in cerebral surgical coma were randomly given conventional treatment (treatment methods included surgical intracranial hematoma removal and decompression, cranial pressure reduction, hemostasis, |application of antibiotics, cerebral protective agents and brain cell metabolic activators, etc.) or high-dose brain-awakening sedative treatment immediately on this basis, and hyperbaric oxygen treatment was given at an early stage after the condition was relatively stable, and the therapeutic effects were observed.
Results: 47 coma patients, 33 cases were cured, with a cure rate of 70.21%; 2 cases were disabled, with a disability rate of 10.64%; 9 cases died, with a mortality rate of 19.15%. Compared with 62 comatose patients treated conventionally, the efficacy was significantly different by chi-square test, 0.05>P>0.01.
Conclusion: The combination of high-dose awakening sedation and early application of hyperbaric oxygen can effectively inhibit cerebral edema, open the body and stop spasm, promote coma awakening, reduce mortality and disability, and improve the prognosis of comatose patients.
Key words: cerebral surgical coma, awakening cerebral sedation dose, early treatment with hyperbaric oxygen.
Coma caused by increased intracranial pressure is the main cause of death in patients with traumatic brain injury. In recent years, we have applied high dose of brain-awakening sedative and early hyperbaric oxygen therapy to save patients in cerebral surgical coma, and achieved better results, which are reported below.
Clinical data
1.1 General data: Since 1999, we have applied high-dose brain-awakening sedation combined with early hyperbaric oxygen therapy to treat 47 patients in cerebral surgery coma, including 38 patients in traumatic coma, 6 patients in coma caused by hypertensive cerebral hemorrhage, and 3 patients in coma caused by other reasons. The 62 patients with similar conditions and treatment methods were admitted as the observation group.
1.2 Treatment methods: The treatment methods included surgical intracranial hematoma removal and decompression, cranial pressure reduction, hemostasis|application of hormones, antibiotics, cerebral protective agents and brain cell metabolic activators. The treatment group was given high-dose wake-up call treatment immediately after admission. 20~40ml per day (regular amount 2~8ml), and after the condition is relatively stable, hyperbaric oxygen therapy was given once a day at an early stage.
1.3 Efficacy criteria
1.3.1 Cure: clear consciousness, disappearance of clinical symptoms and signs, adults can work normally, children can go to school.
1.3.2 Disability: neurological dysfunction of different degrees remains.
1.3.3 Death
1.4 Treatment results: see Table 1
By chi-square test, 0.05>P>0.01, there is a significant difference in the efficacy of the two groups.
Typical cases.
Injured by 10,000 volts of high-voltage electricity, cardiac and respiratory arrest, pupil patient, male, 20 years old. Scattered, with loss of reflex to light. After resuscitation, with the injury 15 minutes after the heartbeat and respiratory recovery, breathing 2 ~ 3 times per minute, heart rate of 120 times per minute, frequent convulsions, about 6 hours after the pupil back to 2mm, blood pressure back up, breathing 26 ~ 40 times per minute; given dehydration, lowering cranial pressure, application of cerebral protective agents, supportive treatment, while giving brain awakening static 20ml added to 5% glucose 250ml sedation, 1 day twice, 3 days later The patient was discharged after 39 days of treatment with clear consciousness, fluent speech, normal vision and hearing, and normal movement of the extremities.
Male, 17 years old, sustained coma after injury caused by car accident, treated outside hospital for 5 days, transferred to our hospital due to aggravation of his condition. The patient was in a deep coma with no response to strong stimulation of the limbs; diagnosis: “primary brainstem injury”. The patient was immediately given 20ml of brain-awakening sedative once a day and hyperbaric oxygen, etc. The patient woke up after 6 days and was discharged after 41 days of treatment.
Male, 65 years old, was admitted to the hospital with sudden coma for 3 hours. The cranial CT showed cerebral hemorrhage in the left basal ganglia area with a volume of about 50 ml.
Discussion
2.1 Various diseases in brain surgery can cause increased intracranial pressure, and coma due to increased intracranial pressure is the main cause of death in brain surgery patients. Early application of hyperbaric oxygen therapy provides high partial pressure of oxygen, constricts cerebral blood vessels, reduces intracranial pressure and promotes recovery of nerve cell function; hyperbaric oxygen also dilates vertebral artery, increases blood supply to brainstem, stimulates upward reticular activation system and promotes awakening. This shortens the coma time and reduces complications. Reduce the mortality and disability rate.
2.2 There are more discussions on cranial brain and cranio-cerebral diseases in Chinese medicine, and there is the following discussion in Nei Jing: “The head is the house of essence. “The man is the sea of the brain, and the brain is the sea of the medulla.” “If there is a surplus of marrow sea, it will be light and strong; if there is a deficiency of marrow sea, the brain will turn to tinnitus, the eyes will see nothing, and the slack will lie down.” Hua Tuo’s book Zhong Zang Jing discusses about the symptoms of increased intracranial pressure caused by brain diseases and its serious hazards. The General Record of Shengji also discusses the treatment of open cranio-cerebral injury: “Where the brain is injured by the object, broken and the marrow out, the treatment is also rapid, cover the head for the clear yang will be, fontanelle by the object, if the brain is broken marrow out, the audit in the rescue, death is not a whirlwind.”
2.3 According to the theory of ancestral medicine, for coma with convulsions, sedation and enlightenment treatment are appropriate. The main ingredients of Awakening Brain Jing Injection are musk, ice chips, gardenia, yujin, etc. It has the functions of aromatic enlightenment, awakening the brain and stopping spasms, clearing heat and cooling blood, moving qi and activating blood, detoxifying and relieving pain. Therefore, it has a good effect on coma caused by cranio-cerebral diseases, which can shorten the coma time, reduce the complications related to coma and decrease the mortality rate. We also observed that within a certain range, the drug dose was positively correlated with the efficacy.
2.4 The results showed that the combination of high-dose wakefulness sedation and early application of hyperbaric oxygen can effectively inhibit cerebral edema, open the body and stop spasm, promote coma awakening, reduce mortality and disability, and improve the prognosis of comatose patients.