SU1232224A1 - Method of lowering intracranial hypertension of patients with serious craniocerebral trauma - Google Patents

Description

The invention relates to medicine, namely to neurosurgery.

The purpose of the invention is the elimination of blood loss due to the fact that the blood extracted from the bulb of the internal strap vein is immediately injected into the femoral artery.

The method is carried out as follows.

A patient with the appearance of pronounced hypertension after removal of an intracranial hematoma or crush area on the side of the pathological process introduces catheters into the bulb of the internal strap vein and into the femoral artery and measures the venous pressure in the internal strap vein, after which Connect the catheters and the continuous syringe with a pre-heparinized tee nozzle. Depending on the level of venous pressure, 50-250 ml of blood are drawn from the bulbus of the celiac vein, which, after its oxygenation, is introduced into the femoral artery through a tee attachment and a catheter puncturing it. The introduction of blood into the femoral artery is due to the need for temporary discharge of the right atrium and continues under the control of venous pressure in the internal venous vein until it is reduced to normal values. Depending on the condition of the patient and the magnitude of the venous pressure, re-infusion can be repeated.

Example 1. Patient P. Diagnosis: open craniocerebral injury, cerebral injury, severe degree, with a crush area of the left temporal lobe. Subarachnoid hemorrhage, chipped depressed fracture of the parietal and temporal bones with the transition to the base of the skull. An operation was performed to remove a depressed fracture and a crush area of the left temporal lobe. In the postoperative period, the clinical picture of the disease was dominated by signs of hypertension-dislocation syndrome - coma, lateral mydriasis, spontaneous squint, lack of pupillary reactions to light. Corneal reflexes on the left are missing, on the right - on the verge of loss. Adinami, the tone of the muscles is low. Symptom Babinsky from two sides. In order to reduce intracranial hypertension, the proposed method was used. After measuring the venous pressure in the internal celiac vein, which was equal to 240 mm of water. In the patient, 80 ml of venous blood was withdrawn from the bulb of the left internal strap vein, which was introduced into the aforementioned artery via a tee attachment and a catheter puncturing the femoral artery. After that, the venous pressure decreased to 140 mm of water. Art., intracranial - up to 98 mm of water Art. The degree of impairment of consciousness significantly decreased, the patient began to respond to pain irritation, there was

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targeted defensive movement in the left hand, decreased stem symptoms. During the day, 3 sessions were performed under pressure control in the left internal vein belt.

Example 2. Patient S. Diagnosis: closed injury of the skull and brain. Brain contusion of severe degree with compression of the left hemisphere with subdural hematoma and the predominant lesion of the trunk at the mesencephalic level. Foci of crush left temporal and frontal lobes. Subarachnoid hemorrhage either. Fracture of the frontal and parietal bones with the transition to the base of the skull to the right. Soft tissue in the occipital region.

Eight hours after the injury, the operation was performed: decompressive trepanation in the left fronto-parietal-temporal region. Removal of subdural hematoma and foci of crushing of the frontal and temporal lobes.

On the 5th day after the operation, the patient's condition remained severe. Consciousness is disturbed - sopor. Pulse 106 per minute, rhythmic. Blood pressure (BP) 150 / / 90 mmHg. Art. Venous pressure in the left inner belt of Vienna 230 mm of water Art. Central venous pressure (CVP) 20 mm of water. Art. In accordance with the proposed method, autohemotransfusion is carried out: 250 ml autologous blood from the left internal vein of the vein after oxygenation and stabilization in the solution of the glucira is transferred driply after 3 hours to the right subclavian vein, after which the pulse rate, arterial pressure and central venous pressure did not change and the venous pressure in the internal belt vein decreased to 150 mm of water. Art. At the same time, positive dynamics are noted in the neurological status in the form of an awareness from a stupor to a deep stun: tasks (opens eyes, shakes hands upon request), disappearance of squint, targeted movements for painful irritations. The control electroencephalogram (EEG), compared with the EEG data made before autohemotransfusion, showed a significant positive trend in the form of a decrease in diffusion changes, local changes and degree of irritation of stem structures.

Example 3. Patient B., entered 40 minutes after suffering a head injury. Diagnosis: closed injury of the skull and brain. Brain contusion with a severe degree with a predominant lesion of the right half of the meat and the trunk at the mesocephalo-bulbar level. Subarachnoid hemorrhage. Foci of crush frontal and temporal lobes on the right. Subdural hematoma in the right fronto-temporal region. Fracture of the base of the skull.

2 hours after the injury, the operation is performed: decompressive craniotomy

in the right fronto-temporal region with calling for the fedny line. Removal of subdural hematoma and foci of crushing of the right frontal lobe.

On the first day after surgery, the patient’s condition is extremely severe. Pulse 112 per minute, blood pressure130 /

/ 90 mmHg In neurological status: consciousness lost due to the type of deep coma. The right pupil is wider than the left. Photoreaction and corneal reflexes are absent. Symptom Babinsky from two sides. For pain irritation - extensory convulsions. On the EEG, the alpha rhythm is represented by single deformed elements, recording, in combination with high-amplitude theta and delta waves, mainly from both sides, inhibition of bioelectric activity. There is no response to photostimulation. In accordance with the proposed method, autohemotransfusion is performed. After reinfusion, 50 ml of blood (without oxygenation) from the right internal strap vein into the femoral artery revealed a decrease in both intracranial pressure and venous pressure in the internal strap

vein. In neurological status, a decrease in extensor seizures is noted. On EEG. After renfusion, a positive trend is revealed in the form of an increase in the curve of more frequent rhythms and an increase in the amplitude of biopotentials in the dark occipital region, mainly in the right half of the field. The degree of irritation of the trunk at the interencephalic level and of the phenomena of separation of stem structures decreased (mostly on the right).

Conducted in connection with the repeated deterioration of the patient's condition and an increase in venous pressure in the internal venous vein and intracranial pressure on the 7th day

After the operation, repeated reinfusion of auto-blood in the amount of 160 ml from the internal strap vein into the femoral artery leads to a decrease in venous and intracranial pressure. At the same time, there was a positive effect on the EEG in the form of

An increase in the amplitude values of potentials in the parietal-occipital lead to the right, which indicates a decrease in the phenomenon of separation of stem structures, is more to the right.

Claims (2)

1. METHOD FOR REDUCING INTRACRANIAL HYPERTENSION IN PATIENTS WITH SEVERE CRANIAL BRAIN INJURY with the presence of foci of brain crushing in the postoperative period by dosed withdrawal of blood from a vein, characterized in that, in order to exclude blood loss, venous pressure is determined and the venous output is determined and the value is preliminarily determined. from a bulb of the internal jugular vein on the side of the brain crush site of 50-250 ml of blood, after which, according to indications, the same blood is injected into the femoral artery or peripheral vein. 2. The method according to π. 1, characterized in that the blood is oxygenated before administration. yoo yo yoo 4 ^