Clinical Observation Of Stellate Ganglion Block In The Treatment Of Postoperative Complications After Craniocerebral Trauma

BackgroundAt the present stage of our country,traumatic brain injury?TBI?is mainly caused by traffic accident,which is second only to limb injuries.TBI has been become a cosmopolitan public healthy problem.Each year the number of patients with TBI caused by various reasons is more than 10 million,and there are 600000 patients are Chinese.Because of the TBI and its complications,there are about one hundred thousand people lost their lives,and disability,death and complications caused by TBI bring about heavy financial burden to families and society.The incidence of pulmonary infection caused by the tracheal intubation after TBI was about 18.5%to69.2%,and the mortality rate was about 20.4%-47%^[1].Patients with TBI often leads to complications such as swallowing disorders,pulmonary infection,cachexia and so on,and the swallowing disorder is the most common among them.The incidence that TBI leads to swallowing disorder in patients with various reports differs,roughly30%⁶8%^[2].As one of the most common complications,the swallowing disorder not only brings about aspiration pneumonia,cacotrophia and so on,but also increases the burden of families and society.A study shows that the risk of pneumonia in patients with dysphagia increased by 3 times,and 10%of stroke patients died of pneumonia^[3].There is no special treatment for craniocerebral trauma with dysphagia,and rehabilitation therapy is mainly used for dysphagia after stroke.But the main cause of craniocerebral trauma with dysphagia is dysphagia and cognitive disorder;therefore,more training for pharynx is needed and training on eating related cognition should be strengthened.Due to adjoining the anatomic relationship between the swallowing organs and the respiratory tract,under normal circumstances,the body can ensure that food and breathing go all the way.Due to the high central damaged,the patients'with craniocerebral trauma nerve conduction pathways that govern swallowing function are interrupted.Therefore,we should also pay attention to dysphagia in solving the problem of lung infection,but the current situation is that the two are often regarded as two independent problems,or just think that swallowing disorders are the cause of aspiration pneumonia,which not given enough attention.Most of the patients with endotracheal intubation due to TBI are severe patients,and lack of ability and enthusiasm for active participation in treatment.Dysphagia in patients with craniocerebral trauma and dysphagia after stroke are different in pathological mechanism;however the clinical research and treatment methods are very limited at present.Indwelling nasogastric tube is a common treatment for dysphagia in China.However,this method can lead to gastroesophageal reflux,gastric ulcer and oral function loss.In the platform of Zhengzhou University dysphagia Research Institute combining with the abundant case information of the First Affiliated Hospital of Zhengzhou University,on the basis of regular rehabilitation training,such as swallowing training and physical therapy,implement the stellate ganglion block therapy,and observe the clinical efficacy of swallowing function,cognition,functional independence and nutrition in patients with craniocerebral trauma.PurposeClinical observe of stellate ganglion block in the treatment of dysphagia in patients with craniocerebral trauma.MethodsCollect 56 patients who get tracheotory tube after traumatic brain injury and swallowing disorder and get pulmonary infection from January 2017 to January 2018in the first affiliated hospital of Zhengzhou University Huiji district CGMH rehabilitation medicine treatment,and randomly divided them into control group and observation group.Patients in both groups were treated with swallowing function training,physical factor therapy,occupational therapy,introduction education,head acupuncture,body acupuncture,anti-inflammation and phlegm application.and placebo injection therapy?2ml physiological saline+1ml vitamin B12,1ml:0.5mg?.On the basis of routine rehabilitation treatment,the observation group was treated with stellate ganglion block?2ml lidocaine injection,specification:5ml:0.1g and 1ml vitamin B12,specification:1ml:0.5mg?.There were 28 cases in the observation group,with an average age of 40.2 plus or minus 7.4 years and man to female ratio is17:11.The control group had 28 patients with an average age of 38.0 plus or minus10.8 years old and male to female ratio 19:9.Thirty days before and after treatment,assess the two groups patients respectively improved Kubota test classification standard of drinking water,BMI?Body Mass Index,BMI?,swallowing function,evaluation function in patients with Independence?the Functional Independence Measure,FIM?scores.On admission,the patients were recorded with the basic condition and history of stroke,Glasgow Coma Scale?GCS?presented by the Glasgow craniocerebral injury research institute?Glasgow Coma Scale?and Jennet.Results1.After thirty days of treatment,the results which were statistically analyzed were before and after treatment,swallowing dysfunction scores in both the treatment group and the observation group decreased,and the observation group decreased significantly,and the difference was statistically significant?P<0.05?;.2.After thirty days of treatment,the results which were statistically analyzed were before and after treatment,the nutritional indexes of the treatment group and the observation group were improved compared with those before treatment,and the observation group decreased significantly,and the difference was statistically significant?P<0.05?.3.After 30 days of treatment,the results which were statistically analyzed were before and after treatment,GCS and FIM scores of the treatment group and observation group before and after treatments were improved compared to the previous ones,with significant difference in the observation group,and the difference was statistically significant?P<0.05?.ConclusionStellate ganglion block treatment can improve swallowing,nutrition and lung infection in patients with craniocerebral trauma,and improve their independent living ability.