Treatment of severe craniocerebral injury Our hospital has admitted 179 patients with craniocerebral injury from September 2000 to December 2005, including 68 cases of heavy craniocerebral injury, due to the seriousness of such injuries, if not actively resuscitated and correctly treated, will lead to an increased rate of death and disability. In this paper, 68 cases of heavy craniocerebral injury patients were admitted and treated with comprehensive treatment methods, as well as the timing of surgery, injury judgment, surgical operations and other aspects are analyzed and discussed, and are reported below. 1, clinical data 1.1 General information The group of 47 male cases, 21 female cases, age 4 years old to 62 years old, according to the GLS score are 3 points to 8 points, including 43 cases of car accident injuries, 15 cases of fall injuries, 4 cases of blow injuries, 6 cases of other injuries. 1.2 Clinical manifestations 65 cases of patients with persistent coma, 3 cases with intermediate wakefulness, with one side of the pupil scattered score of 3 to 8 points, including 43 cases of car accident injuries, 15 cases of fall injuries, 4 cases of blow injuries, and 6 cases of other injuries. 1.2 Clinical manifestations: 65 cases of patients in continuous coma, 3 cases with intermediate wakefulness, 19 cases with dilated pupils on one side, 32 cases with dilated pupils on both sides, and 17 cases with no change in pupils. Among the 68 cases, there were 57 cases of skull fractures, including 38 cases of linear fractures, 12 cases of depressed fractures and 7 cases of comminuted fractures. 15 cases of severe brain contusions and 54 cases of intracranial hematomas were found in the cranial tissue damage by CT scan. All patients with intracranial hematoma had different degrees of contusions and 6 cases of brainstem injury. Of the 54 cases of intracranial hematoma, 14 cases were epidural, 16 cases were subdural, 10 cases were intracranial hematoma, and 14 cases were mixed hematoma. There were 23 cases of combined injuries to other parts of the body. 1.3 Treatment Among the 68 cases in this group, 52 cases were craniotomized, 23 cases were designed for bone flap craniotomy, 21 cases were designed for lunar window craniotomy, 8 cases were treated with both methods, 3 cases died during resuscitation and preoperative preparation due to compound injuries as well as severe brain injuries, 13 cases were treated with conservative comprehensive treatment, a total of 29 cases died, 26 cases recovered well, 6 cases were mildly disabled, 4 cases were severely disabled, and 3 cases survived vegetatively. 2. Discussion 2.1 Resuscitation starts from the reception of the patient. Since all the casualties in this group were very critical when they came to the hospital, the resuscitation started from the reception of the patient, and a comprehensive examination of the disease was made, so that the general assessment, surgical resuscitation, auxiliary examination, preparation of the operation department and preparation of related departments were carried out simultaneously, and the operation started within 2 hours for those who had indications for surgery. 2.2 Surgical operation For patients with hyperacute craniocerebral injury, the hematoma can be drained by cone cranial puncture in the ward to reduce the pressure shaving of the local and distant parts of the hematoma and to gain time for surgical preparation. When making bone flap craniotomy, instead of cutting the dura mater after the bone flap is fully turned up to remove the hematoma, a cross-shaped incision should be made first in the first borehole and some of the accumulated blood should be excluded outside the dura mater, which can relieve the intracranial pressure in advance. 2.3 Keep the airway smooth in patients with heavy craniocerebral injury with coma, due to the weakening or disappearance of cough and swallowing reflexes, as well as the occurrence of neuroprototype pulmonary edema, oral and respiratory secretions, vomit is easy to aspirate. Therefore, it is easy to perform tracheal intubation and tracheotomy as early as possible. 2.4 Control of intracranial pressure We routinely apply 20% mannitol and high-dose dexamethasone intravenously every 6 h to 8 h. Tachykinin 20 mg to 40 mg can also be used between two doses, but high-dose mannitol is likely to cause acute renal failure. Severe trauma and high-dose hormone application can cause stress ulcers, and the application of dehydrating drugs can cause disturbance of water-electric balance, which should all be taken seriously in mind. 2.5 Brain function recovery Reduce the basal metabolic rate, reduce the body’s energy consumption, strengthen nutritional support heavy craniocerebral injury stress period, high basal metabolic rate, and often have increased muscle tone, tonic convulsions, central hyperthermia, infection, energy consumption, the application of sedatives, inotropic hibernation, hypothermia so that the body is in a sub-cold state, brain function recovery often and systemic factors also have a certain relationship, nutritional support is also indispensable For poor self-feeding ability or simply can not eat, can be as soon as possible intravenous high nutrition. For no abdominal disorders, no abdominal distension and good bowel sounds, early nasal feeding is available to enable patients to recover early. 2.6 hyperglycemia treatment In the acute phase of severe craniocerebral injury, blood glucose is elevated and consistent with craniocerebral injury, and because of brain injury, brain hypoxia, glucose anaerobic enzymolysis is accelerated, its degradation products lactic acid accumulation, acidosis aggravates nerve cells, brain ischemia, edema and necrosis. Also because high blood sugar can increase brain damage in patients with craniocerebral injury, therefore, patients with craniocerebral injury should check blood sugar urgently before glucose infusion, review blood sugar during and after surgery, and apply insulin to control blood sugar in a timely manner. 2.7 Early improvement of cerebral circulation in acute brain injury due to the application of large doses of dehydrating agents, the patient is in a dehydrated state. Also due to brain injury, cell deformation ability is reduced and cell aggregation is enhanced, which increases blood viscosity and causes serious obstruction of cerebral tissue circulation perfusion. Cerebral ischemia is the basis for causing secondary injury. Therefore, early application of drugs to improve microcirculation and antithrombotic therapy may be a new way to prevent cerebral ischemia and secondary brain damage after trauma. 2.8 Comprehensive treatment, strengthen nursing care and prevent complications Anti-inflammatory, hemostatic and cerebral activator treatment should be given along with the above treatment. After severe traumatic brain injury, lumbar puncture treatment can be performed several days after the peak of cerebral edema to drain the bloody cerebrospinal fluid and inject a small amount of filtered air, which is effective in reducing hydrocephalus and improving cerebral circulation; strengthening nursing care, preventing and treating complications, such as oral care, tracheotomy care, urinary care, regular turning and back patting to prevent decubitus ulcers, and ward cleaning and disinfection are all helpful in the treatment of traumatic brain injury.