On patients with severe traumatic brain injury care in the hyperbaric oxygen treatment

[Abstract] Objective: To discuss the 72 patients with severe traumatic brain injury patients undergoing single-person hyperbaric oxygen chamber pressure of oxygen in the process of care and treatment measures. METHODS: Single pressurized oxygen chamber, treatment pressure is 0.2Mpa, once a day, 10 days for a course of treatment in the rest two days, were treated with 1-6 courses of treatment. Results: The average treatment 20 times, according to Glasgow outcome efficacy of the standard of five grade classification, a good 60 cases, the residual eight cases, four cases of severe disability, vegetative state with no deaths and Conclusion: Hyperbaric oxygen treatment of severe head injury patients can effectively reduce the mortality and morbidity, promote patient wake up early, improve quality of life.


1 Clinical General Information
Choose from June 2004 to November 2006 in our hospital neurosurgery hospital with severe head injury 72 hyperbaric oxygen therapy patients, diagnostic brain injury diagnostic criteria, including 49 males and 23 females, aged 15 - 56 years, mean age 35.5 years old. admission Glasgow score <8 points and rescue the patient by conventional craniotomy, the vital signs, body temperature <38.5.C, CT, under the dynamic and clinical observation of no significant bleeding, signs of herniation , 4-10 days after the injury received hyperbaric oxygen therapy in this group received hyperbaric oxygen treatment, 20 cases of disturbance of consciousness, irritability in 20 cases, organ cut in 12 cases, craniotomy in 20 cases.

2 Care
2.1 before treatment and assessment visits: before treatment by the Gaoyayangke nurses to the wards access to medical records, to understand the disease dynamics, assessing patients' health status, to obtain the support of family friends. Each patient received treatment for 15-20 minutes in advance to evaluate the patient to grasp the situation of missionary knowledge to help replace the HBO special cotton clothing, to drain urine, is strictly prohibited cell phones, lighters, flammable, explosive materials with one compartment inside. Rucang assess the patient again before consciousness, pupil, blood pressure, etc., and make a record, according to the patient's specific circumstances, to develop individualized exercise cabin plans, and take anticipatory care measures [1].

2.2 Psychological care: the first patients receiving hyperbaric oxygen therapy generally have a special mental process. In addition to general safety in the cabin before the missionary movement and the correct guidance and effective regulator, but in all aspects throughout the timely and effective communication and skill The operation compartment skills are also important. nurses adjust cabin temperature and note plus decompression, patient preferences play music, eye contact lens through the window, so that patients feel that nurses on the side, to increase the patient's sense of security, reduce anxiety and fear mental [2]
2.3 postural care: patient supine, elevation of brain edema in patients with head 15-20 degrees to reduce intracranial pressure, surgery patients to avoid pressure on the wound, wound dressing and observe the situation, alert to the wound bleeding comatose head to side, keeping the airway open, to have intracranial hypertension, intracranial hematoma in patients after surgery to eliminate, not hip flexion 90 degrees, so as not to increase abdominal pressure, prompting increased intracranial pressure and worse. the soft deep coma preventive pillow on the shoulder and neck, lower jaw elevation, so that oral secretions and vomit easy out. Physical natural place.

2.4 Observation and catheter care: an open cabin and must be fixed before a variety of catheter drainage tube, maintaining unobstructed drainage. Observe the nature of fluid drainage, color, volume, preventing drainage of fluid reflux there tracheal tube (with air bags) patients , Rucang out before the gas inside the balloon, and then injected into the 4-5ml normal saline, because the water there can be no compression, no compression or expansion when pressurized balloon rupture caused by compression of the trachea into account. Links to free download http://www.hi138.com 2.5 suffocation observation and care: the patient unconscious to keep the airway open, head to one side or the lateral position to prevent choking from vomit to attract. Tracheotomy and sputum of patients before treatment for excessive inhalation and suctioning. Rucang ready before the emergency drugs and equipment, properly fixed tracheal tube to avoid loss and displacement, remove the cover of the saline gauze to prevent aspiration cabin blocked airway. the treatment of facial and respiratory observe whether there is breath, difficulty breathing symptoms.

2.6 Observation and nursing of irritability: A severe irritability, entrance to the former doctor to give sedatives in the treatment of patients remain quiet state, increasing the oxygen effect, prevent the onset of traumatic epilepsy. Bound the limbs of mild irritability to avoid extubation from injury or damage to cabin equipment, pay attention to elastic fit, too compact to prevent blood circulation disorders, such as pressure stages of irritability, excessive sweating, etc., may be cabin temperature is too high, too fast due to the boost, moderate to adjust cabin pressure rate can be alleviated, but if you do not appear to ease, and continue flushing, shortness of breath, suggesting that high fever, extravehicular decompression treatment should be stopped, while in the decompression stage, such as increased irritability and a change of consciousness, suggesting that the condition changes should be slow spacewalk. extravehicular consciousness after the inspection, pupils, etc., if an exception should be immediately reported to the doctor for further treatment.

2.7 oxygen toxicity, decompression sickness and nursing observation: The main symptoms of oxygen toxicity is feeling chest pain when inhaling deeply, and cough, particularly poor state of the body, fatigue, pulmonary infection or fear of patients, strict control pressure, oxygen safe range when the process closely observe whether the pale, cold sweats, dizziness, chest pain, hallucinations, convulsions and other symptoms of cerebral oxygen toxicity aura and if oxygen masks should immediately remove, reduce pressure spacewalk.

3 Discussion
As a special treatment, hyperbaric oxygen has been widely used in clinical diseases, we changed the previous practice of simply operating compartment, properly handle a variety of catheters, close observation of the disease, caused by improper care and treatment to prevent complications in the treatment of or patient Information collected again after treatment to assess the effect of operating cabin care, reducing the adverse psychological reactions, and to ensure patient safety and treatment, patients generally satisfied.

4 Conclusion
After two years of practice, our hospital with severe head injury patients in the hyperbaric oxygen therapy in no case of anxiety, irritability, catheter loss, suffocation, decompression sickness, oxygen toxicity and other adverse reactions, patients can reduce mortality and cause disability rate, and promote the patient wake up early, improve quality of life.

References
[1] Zhongcheng editor, Neurosurgery, Wuhan: HBO University, Hubei Science and Technology Press ,1998,284-285
[2] Li Wen-jen, Ni country altar editor, hyperbaric oxygen study, Shanghai: Shanghai Science and Technology Press ,1998,351-355 Links to free download http://www.hi138.com