Clinic Influencing Factors And Nursing Observation Indicators Of Early Mental Disorders Caused By Acute Craniocerebral Injury

Background:Traumatic brain injury is one of the most common clinical traumas,the incidence is the first two of the total body trauma.In addition,the death and disability of this disease is at the top,with the characteristics of high incidence,high mortality,and high morbidity.Although quick development of health care system has reduced mortality in traumatic brain injury,the mental disorders after head injury is still very common,which were more significantly happened than the general population.The occurrence is affected by various factors such as personal factors,injury factors and psychosocial factors etc.The common clinical manifestations are complex,and there are no objective indicators to assess.Therefore it is difficult to discovery timely,intervention and treatment,the prognosis and quality of life of patients is affected,but also the social burden and even harm will be severed.In this study,we explored the influencing factors of early acute brain injury mental disorders,combined with serological changes to find a more objective indicator which can help clinical nursing observation and discovery.We also try to seek the possible correlated trends,to clarify the pathogenesis,screening high-risk patients,establish effective clinical observations and interventionsObjective:1.Analyze the correlation among the basic situations of patients with acute brain injury,injury severity,location and nature of mental disorders.2.Monitor serum IL-1?,IL-6,TNF-a and cortisol change of patients with acute brain injury early mental disorders.3.Analyze the relevance between the occurrence rate of acute brain injury earlier described mental symptoms and serum IL-1?,IL-6,TNF-a,cortisol change.4.Explore more objective clinical assistant indicators of acute brain injury early mental disorders,find the time when mental disorders happened,to help clinical and nursing auxiliary work on psychiatric symptoms observation and discovery.Methods:1.Select 260 trauma surgery patients hospitalized with acute brain injury in emergency department of Southwest Hospital,the Third Military Medical University,use homemade acute brain injury patient evaluation form to assess and collect patients' data,including demographic data(gender,age of the patient,education level,occupation,etc.),damage(nature of injury,site of injury,injury severity(GCS and ISS score),etc.)and psychological symptoms(time mental symptoms,the type of performance,duration,manner,etc.).Learn the occurrence of mental disorders in patients with early acute brain injury,through statistical methods to analyze the incidence of acute mental disorders early in patients with brain injury and influencing factors.2.We received the peripheral venous blood samples of the 260 cases patients with acute brain injury after injury admissions of 1 day,3 days,7 days,15 days,21 days,30 days to use ELISA assay to detect serum IL-1?,IL-6,TNF-a and cortisol levels.Diagnosis of mental disorders was according to the diagnostic criteria for organic mental disorders which was setted in the Chinese Classification of Mental Disorders Diagnostic Criteria 3rd edition(CCMD-3).We invited psychiatrist,clinical psychologist for clinical assessment,according to whether psychiatric symptoms were divided into groups(mental disorders,MD group)and non-mental disorder group(no mental disorders,NMD group),compared serum IL-1?,IL-6,TNF-a,cortisol levels and trends between the two groups.3.According to the results of previous studies,construct the observation indicators of clinical nursing to the patients with early mental disorders after acute craniocerebral injury.Results:1.181 cases with the early psychiatric symptoms occurred in the 260 acute craniocerebral injury patients,the incidence was 69.6%.2.Acute craniocerebral injury patient's age,education level,severity and site of brain injury were all influencing factors associated with the occurrence of the early psychiatric symptoms(P <0.05).Logistic regression analysis showed that age,the degree of head injury and brain injury site of the patients were risk factors to affect patients with mental disorders.3.The serum IL-1?,IL-6,TNF-a and cortisol levels were significantly elevated in patients of all two groups(P<0.05).After the first day of the two groups were injured,serum IL-1?,IL-6,TNF-a content had no difference.However,in the first 3 days,7 days,15 days,21 days,30 days after injury,the serum IL-1?,IL-6,TNF-a of mental disorder are significantly higher than non-group(P <0.05).Mental disorder groups reached the peak in the first seven days after injury,then gradually decreased,but was still higher than the non-disorder group in 30 days after injury.24 hours after injury,cortisol level was increased and to the third day got the peaked,followed by a decreasing trend but higher than non-mental disorders group(P< 0.05).4.Constructed the observation indicators of clinical nursing to the patients with early mental disorders after acute craniocerebral injury.Conclusion:1.The incidence of acute brain injury patients with early signs of psychiatric symptoms is high.Their age,educational level,extent and location of brain injury are factors causing mental disorders,suggesting that in the clinical treatment of patients with traumatic brain injury,we should be targeted to make assessment of high-risk patients,and timely observe patients with psychiatric symptoms,take appropriate intervention and treatment measures.2.Patients with acute brain injury early mental disorders may have an inflammatory response and again immune cell activation,resulting in increased serum IL-1?,IL-6,TNF-a and cortisol level,these changes may relate with the degree of injury,but also as the indicators of changes in the disease.Dynamic detection of serum IL-1?,IL-6,TNF-a and cortisol levels for the clinical assessment of acute brain injury early symptoms of mental disorders,development and observation provide guidance,also have important clinical significance for follow-up treatment,care and other interventions.3.The serum IL-1?,IL-6,TNF-a and cortisol have differences at observed time points after injury.To patients with early signs of mental disorders,in addition to the dynamic observation and evaluation,particular attention should be done day 3 to day 7 after injury,which was a high incidence period happened the symptoms of mental disorder,this period may be a important time point when patient's condition will change.