高压氧治疗儿童中重型颅脑外伤的疗效分析

目的分析高压氧治疗对儿童中重型颅脑外伤的疗效。方法选择61例儿童颅脑外伤病例,将其随机分为高压氧治疗组(36例)和对照组(25例),分别于入院时和受伤后第14天及治疗后3个月、6个月观察两组患儿的疗效。结果治疗前两组患儿GCS评分无统计学差异(P0.05),治疗后第14天,高压氧治疗组GCS评分高于对照组,差异有统计学意义(P0.05)。随访第3个月和第6个月,高压氧治疗组GOS评分高于对照组,差异有统计学意义(P值均0.05)。结论高压氧是一种治疗儿童中重型颅脑外伤的有效方法,值得推广。     

小儿颅脑外伤的临床特点与急救

报告52例小儿颅脑外伤的急救治疗结果。轻型颅脑损伤21例(40.4%),中型颅脑损伤19例(36.5%),重型颅脑损伤12例(23.1%)。41例(90.4%)有昏迷史,5例(9.6%)表现意识朦胧、嗜睡。手术治疗20例(38.5%),非手术治疗32例(61.5%)。恢复良好者27例(51.9%),中残16例(30.8%),重残4例(7.7%),死亡3例(5.8%),退院2例(3.9%)。作者认为正确掌握小儿颅脑外伤特点、手术和非手术治疗适应症及急救措施有助于指导临床工作。     

126例儿童颅脑外伤患者致伤因素及临床特点回顾性分析

目的 分析需住院或留院观察的颅脑外伤（TBI）患儿的致伤因素及临床特点。方法 收集2014年1月1日至2016年8月31日于急诊科就诊且需留院治疗的126例TBI患儿的临床资料,对其致伤因素及部分临床特点做回顾性分析。结果 126例TBI患儿中,男95例,女31例,年龄2.8（0.8,5.5）岁,以 < 1岁者最多（48/126,38.1%）,死亡26例。TBI类型前2位是硬膜外血肿（54.0%）、蛛网膜下腔出血（50.8%）,入院24 h内有83例（65.9%）患儿Glasgow昏迷量表评分≤ 8分。不同年龄组TBI致伤因素、发生场所各不相同。TBI最常见的前2位致伤因素为坠落/摔伤（51.6%）和道路交通伤害（42.9%）。与其他年龄段相比,< 1岁患儿最易发生坠落/摔伤（46%,P=0.023）。道路交通伤害所致TBI高发年龄段为3~6岁（35%,P < 0.001）。伤害发生场所集中于家中（47.6%）和公路/街道（45.2%）;所有家中致伤患儿中,< 1岁组所占比例最高（48%,P=0.002）,3~6岁患儿主要受伤地点为公路/街道（53%）。造成TBI患儿死亡的首位致伤因素是道路交通伤害（69%）;死亡病例中,以 < 1岁患儿最多（62%）。结论 不同年龄组TBI患儿的致伤因素和发生场所不尽相同。1岁以下儿童发生TBI比例高、死亡人数最多,多为家中发生坠落/摔伤所致。3~6岁儿童易因道路交通伤害发生TBI。道路交通伤害最易导致死亡。     

婴幼儿急性颅脑损伤临床分析

目的 探讨3岁以下婴幼儿急性颅脑损伤的特点.方法 回顾性分析49例3岁以下婴幼儿急性颅脑损伤资料,临床主要表现为:抽搐、呕吐、前囱门隆起紧张,意识障碍,局灶性神经系统体征,贫血及呼吸紊乱窘迫.分为三组:轻度颅脑损伤(19例),中度颅脑损伤(22例),重度颅脑损伤(8例),头颅CT显示:①均有颅内出血,包括急性、亚急性硬膜下血肿(SDH)和蛛网膜下腔出血(SAH),最常见出血部位为大脑镰,小脑幕及大脑凸面;②伴局灶性或弥漫性(大面积)脑实质低密度.多发生在6个月以下的婴幼儿,伴大面积低密度灶患儿多预后不良.结果按GOS预后评级,良好39例,中残6例,重残2例,死亡2例.结论 婴幼儿生理特点有其特殊性,依据婴幼儿急性颅脑损伤的特点,早期采取积极有效的治疗措施,可降低病死率及致残率,婴幼儿神经系统修复能力强,与成人相比多预后良好.     

儿童症状性癫(癎)308例病因分析

目的 探讨儿童症状性癫(癎)常见病因及不同年龄段病因构成特点.方法 以2004年1月至2007年1月在湖南省儿童医院神经内科住院的308例症状性癫(癎)患儿为病例组,同期住院的202例非(癎)性发作患儿为对照组,采用前瞻性调查方法并通过自制问卷调查表对两组患儿的家长进行调查;对所有病例均进行了详细体格及神经系统检查;所有患儿均查脑电图、头颅CT和(或)头颅MRI.采用单因素和多因素分析;对各组病因构成比进行?检验.结果 (1)单因素分析显示围生期损伤、先天性脑发育异常、颅内感染、热性惊厥、神经皮肤综合征、颅脑外伤等与儿童症状性癫(癎)相关(P<0.05).将其引入多因素Logistic回归模型,显示儿童症状性癫(癎)与围生期损伤、先天性脑发育异常、颅内感染、热性惊厥有显著相关.(2)相似文献   

小儿颅脑损伤16例手术治疗分析

目的 探讨小儿颅脑损伤的临床特点及治疗经验.方法 分析16例颅脑损伤患儿的损伤类型及临床表现梅点.结果 16例患儿中治愈出院14例,占87.5%,好转1例,占6.25%,死亡1例,占6.25%.结论 儿童颅脑损伤病情严重,且变化快而复杂,生命体征紊乱明显.尽早确诊,及时治疗是提高生存质量的关键.     

儿童颈椎外伤的诊断及治疗

目的 探讨儿童颈椎外伤的临床特点、诊断、治疗方法及难点和要点.方法 回顾性分析我院1995年1月至2005年12月期间治疗的儿童颈椎外伤病例的临床资料,同时检索分析国内外关于儿童颈椎外伤的文献.结果 11例患儿纳入本研究,其中男8例,女3例;平均年龄(12.1±4.0)岁;受伤机制包括坠落伤(3例),运动伤(3例),车祸伤(2例),直接暴力伤(2例),因娱乐致伤(1例).受伤部位分布为C1-34例,C4-77例.4例合并神经系统症状,其中1例为无骨折脱位型脊髓损伤.4例接受手术治疗,7例行保守治疗.结论 儿童颈椎外伤相对少见,其在临床表现、影像学检查及治疗方法上均存在与年龄相关的特点.熟悉这些特点对儿童颈椎外伤患儿的诊断及治疗至关重要.     

儿童重症监护病房急性颅内出血病因和预后分析

目的调查儿童重症监护病区(PICU)急性颅内出血的病因和预后。方法对2000年1月~2004年12月我院PICU危重病患儿中,急性颅内出血患儿临床资料进行回顾性病因和预后分析。结果近5年来共收治急性颅内出血患儿58例,病因是迟发性维生素K(VitK)缺乏症28例,颅脑外伤16例,脑血管畸形6例,病毒性脑炎2例,血友病、血小板减少症、脑肿瘤破裂各1例,不明原因3例。其中15例放弃治疗,9例并发继发性脑梗塞。8例死亡(病死率13.8%)。结论迟发性VitK缺乏症和颅脑外伤是PICU小儿颅内出血的主要原因,预防性应用VitK或改变喂养方式可能降低婴儿早期颅内出血发病率。颅内出血预后较差,重在预防。     

重症小儿胸部损伤诊治的临床观察

目的 探讨重症小儿胸部损伤的诊断治疗原则.方法 回顾分析1998年3月～2007年10月收治的117例重症胸部损伤患儿,其中男83例(71%),女34例(29%),车祸伤50例,锐器伤46例,高处坠落伤15例,挤压伤4例,枪弹伤2例.发生休克29例(32%).92例(79%)给予胸腔闭式引流等保守治疗,25例(21%)接受剖胸手术.结果 109例(93%)患儿治疗后恢复良好,8例(7%)死亡,均为多发伤,其中手术中死亡2例,分别为合并颅脑损伤和脾破裂.结论 小儿胸部损伤病情多样,正确及时的诊治措施是抢救患儿生命的关键.     

儿童颅脑损伤的临床特点

目的　探讨儿童颅脑损伤的特点。方法　对儿童颅脑损伤患儿 98例临床表现及预后进行分析 ,并与成人颅脑损伤比较。结果　儿童颅脑损伤后腹痛、脑梗死、癫发生率均高于成人组 (P <0 .0 5 ) ,两组预后存在差异 (P <0 .0 5 )。结论　儿童颅脑损伤后临床表现较重 ,但预后较成人好     

Frequency of intracranial pressure monitoring in infants and young toddlers with traumatic brain injury.

OBJECTIVE: To examine the use of intracranial pressure monitors and treatments for elevated intracranial pressure in brain-injured children of <2 yrs of age and compare them with the recently published management guidelines. DESIGN: Prospective, population-based study. SETTING: All pediatric intensive care units in the state of North Carolina. PATIENTS: All patients of <24 months of age admitted to a pediatric intensive care unit with a traumatic brain injury between January 2000 and December 2001. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Use of intracranial pressure monitoring devices and treatments for elevated intracranial pressure were measured. There were 136 children admitted to a pediatric intensive care unit with brain injury. A total of 54 (39.7%) had an admission Glasgow Coma Score of < or =8, and 80% were infants. Thirty-three percent of children with a Glasgow Coma Score of < or =8 received monitoring. Hyperosmolar therapy was the most frequently used treatment (57.1%). Treatment for elevated intracranial pressure was more common in, but not limited to, children with monitors. Logistic-regression modeling showed that children of < or =12 months of age had an odds ratio of 0.2 (95% confidence interval, 0.1-0.6) of receiving a monitor compared with children aged 12-24 months. CONCLUSIONS: Brain injury in young children may lead to many years of lost quality of life. The utility of monitoring intracranial pressure in infants has not been well established, which may be a reason for its low use. As most infants with traumatic brain injury survive, high-quality studies with neurodevelopmental measures as the primary outcome are urgently needed to document best practice in this subpopulation.     

Pilot study to determine the hemodynamic safety and feasibility of magnesium sulfate infusion in children with severe traumatic brain injury.

OBJECTIVE: Magnesium sulfate is neuroprotective in preclinical models, but there are limited safety data regarding its clinical use for pediatric traumatic brain injury. We conducted a pilot study in children with severe traumatic brain injury to a) examine if magnesium sulfate decreases mean arterial pressure, decreases cerebral perfusion pressure, increases intracranial pressure, or adversely effects cardiac conduction; and b) determine the feasibility of a multiple-center trial of magnesium sulfate. DESIGN: Double-blinded, placebo-controlled, randomized pilot trial with repeated measurement of hemodynamic variables. SETTING: Two pediatric trauma centers. PATIENTS: Six children (3 months to 18 yrs) with severe traumatic brain injury. INTERVENTIONS:: Magnesium sulfate (50 mg/kg) bolus followed by (8.3 mg/kg/hr) infusion for 24 hr vs. equivolume placebo. MEASUREMENTS AND MAIN RESULTS: We screened 96 patients with severe traumatic brain injury during 24 months; 20 were eligible for enrollment, six provided informed consent, four received magnesium sulfate, and two received placebo. Before and after study drug infusion, we repeatedly measured blood ionized magnesium concentration, mean arterial pressure, cerebral perfusion pressure, intracranial pressure, heart rate, and corrected QT interval. Mean age (7.9 yrs), mean highest Glasgow Coma Scale score (6), gender (33% boys), inflicted injury rate (17%), and case mortality rate (17%) did not differ between those enrolled and those not enrolled. Compared with baseline, magnesium sulfate did not change cerebral perfusion pressure, intracranial pressure, heart rate, or corrected QT interval. Mean arterial pressure was unchanged until the late phase of magnesium sulfate infusion, when mean arterial pressure rose (82 +/- 5 vs. 93 +/- 6 mm Hg, p < .05). Sixty-four percent of corrected QT interval determinations obtained in the first 6 days after injury exceeded 440 msecs; 12% were >600 msecs. CONCLUSIONS: In children with severe traumatic brain injury, magnesium sulfate administration did not decrease mean arterial pressure or cerebral perfusion pressure or adversely effect cardiac conduction. Our data suggest that enrollment of brain-injured children in a therapeutic trial remains challenging. These results provide information important for clinical trials of magnesium sulfate in children with severe traumatic brain injury.     

Increased cerebrospinal fluid concentrations of soluble Fas (CD95/Apo-1) in hydrocephalus.

BACKGROUND AND AIMS: The ventricular enlargement observed in children with chronically raised intracranial pressure (ICP) causes a secondary loss of brain tissue. In animal studies of hydrocephalus, programmed cell death (apoptosis) has been found as a major mechanism of neuronal injury. One of the regulators of the apoptotic cell death programme is the receptor mediated Fas/Fas ligand interaction. METHODS: The apoptosis regulating cytokines soluble Fas (sFas) and soluble Fas ligand (sFasL) were studied in the cerebrospinal fluid (CSF) of 31 hydrocephalic children undergoing shunt surgery for symptomatic hydrocephalus and 18 controls. RESULTS: High concentrations of sFas were observed in children with hydrocephalus (median 252 ng/ml); in controls sFas was below the detection limit (0.5 ng/ml). sFasL was undetectable in all but one sample. CONCLUSION: High concentrations of sFas in the CSF of children with hydrocephalus suggest intrinsic sFas production, potentially antagonising pressure mediated Fas activation.     

振幅整合脑电图对新生儿低血糖脑损伤患儿的脑功能监测意义

目的 探讨振幅整合脑电图(amplitude integrated electroencephalography,aEEG)在新生儿低血糖脑损伤急性期的改变以及其与疾病预后的相关性.方法 研究纳入2011年1月至2015年7月泉州市儿童医院新生儿重症监护室收治的47例新生儿低血糖脑损伤患儿.记录患儿的临床资料和治疗转归;采用aEEG进行脑功能监测;采用首都儿科研究所《0~6岁小儿神经心理发育检查表》进行患儿生后6月龄智能评估;分析aEEG背景活动分类,癫痫性电活动,睡眠觉醒周期,异常程度等参数与新生儿低血糖脑损伤患儿近期临床预后的相关性.结果 急性期aEEG波形:连续正常电压9例,不连续电压29例,连续低电压3例,爆发抑制6例;39例(83.0%)患儿记录到癫痫性电活动:单次惊厥、反复惊厥、惊厥持续状态分别为:11例、20例、8例;睡眠觉醒周期:无21例,不成熟17例,成熟9例.aEEG异常程度判定:正常7例,轻度异常9例,重度异常31例,其中重度异常中23例预后不良,包括死亡3例及随访至生后6月龄智能发育商≤69者20例.aEEG背景活动、睡眠觉醒周期分类以及aEEG异常程度与患儿临床近期预后通过双向有序等级相关性分析提示存在相关性(r=0.714、0.696、0.746,均P<0.001).结论 aEEG可以用于评估新生儿低血糖脑损伤患儿临床脑功能损伤严重程度及近期预后,是其脑功能监测的有用工具.     

Emergency management of increased intracranial pressure

Primary neurological injury in children can be induced by diverse intrinsic and extrinsic factors including brain trauma, tumors, and intracranial infections. Regardless of etiology, increased intracranial pressure (ICP) as a result of the primary injury or delays in treatment may lead to secondary (preventable) brain injury. Therefore, early diagnosis and aggressive treatment of increased ICP is vital in preventing or limiting secondary brain injury in children with a neurological insult. Present management strategies to improve survival and neurological outcome focus on reducing ICP while optimizing cerebral perfusion and meeting cerebral metabolic demands. Targeted therapies for increased ICP must be considered and implemented as early as possible during and after the initial stabilization of the child. Thus, the emergency physician has a critical role to play in early identification and treatment of increased ICP. This article intends to identify those patients at risk of intracranial hypertension and present a framework for the emergency department investigation and treatment, in keeping with contemporary guidelines. Intensive care management and the treatment of refractory increases in ICP are also outlined.     

Management of severe traumatic brain injury

Traumatic brain injury (TBI) causes significant morbidity and mortality in children. Physiological insults worsen morbidity and mortality and are particularly common in the pre-hospital setting. Management of severe TBI in the ICU is largely focused on the management of raised intracranial pressure and preservation of cerebral perfusion. Few randomised controlled trials have been undertaken in children with TBI.     

Monitoring intracranial pressure in paediatric brain injury

Acute paediatric brain injury is a major cause of mortality and morbidity worldwide. Historically raised intracranial pressure (ICP) has been the hallmark for escalating management in acute brain injuries, however there is limited evidence behind this, and no UK approved guidance advocating its use. This article summarises the current role of ICP monitoring within traumatic and non-traumatic paediatric brain injury and discusses the evidence base for different modalities and their uses.     

Intensive care unit variables and outcome after pediatric traumatic brain injury: a retrospective study of survivors.

OBJECTIVE: Traumatic brain injury is a leading cause of death and disability in children. Hypotension has been associated with poor survival and outcome in children after traumatic brain injury, but the effect of acute hypertension is less certain. The objective was to obtain acute physiologic variables during the early hospitalization period in a cohort of children prospectively enrolled in another study. DESIGN: Retrospective chart reviews. SETTING: University-affiliated pediatric rehabilitation center. PATIENTS: Fifty-seven survivors, 5-17 yrs of age, admitted for rehabilitation between 1992 and 1995 after sustaining a traumatic brain injury. INTERVENTIONS: Standard of care. MEASUREMENTS AND MAIN RESULTS: Outcomes were assessed at 1 yr postinjury through cognitive testing of the child and parent interview of the child's global functional skills. Cognitive outcome was measured using the Performance IQ from the Wechsler Intelligence Scale for Children, Third Edition. Overall functional outcome was assessed using the Disability Rating Scale. CONCLUSIONS: This study suggests that early markers of secondary injury after moderate to severe traumatic brain injury in children may be predictive of long-term outcome. This study reinforces the need for longer term, systematic, and more precise measurements of outcomes in children with traumatic brain injury and prospective studies to examine the predictive value of acute management variables on multiple types of outcomes after traumatic brain injury in children.     

不同年龄组无颅脑损伤患儿扰动系数的变化特点

目的探讨不同年龄组无颅脑损伤患儿扰动系数的参考值及影响因素。方法前瞻性研究。选取2018年5月至2019年10月入住重庆医科大学附属儿童医院骨科的200例无颅脑损伤患儿为研究对象,根据年龄分为0~1岁、>1~3岁、>3~5岁、>5~16岁4组,每组50例,采用无创脑水肿动态监护仪对每例患儿进行监测,每次测量时间为15 min,间隔12 h重复测量,取2次测量值的均数为该患儿最终扰动系数值。利用方差分析比较不同年龄组患儿扰动系数的组间差异,利用秩和检验比较总体及各年龄组中不同性别患儿扰动系数的组间差异,通过绘制散点图及Loess局部加权非参数回归曲线分析扰动系数与年龄、体重、头围的关系。结果年龄0~1岁、>1~3岁、>3~5岁、>5~16岁4组患儿扰动系数的参考值分别为60±14、92±18、112±18、135±18,组间比较差异有统计学意义(F=175.690,P<0.01)。两独立样本秩和检验显示总体及各年龄组中男性患儿与女性患儿的扰动系数差异无统计学意义[103(81,125)比102(68,123),Z=-0.739,P=0.460;59(52,68)比57(53,65),Z=-0.243,P=0.808;88(81,105)比95(70,105),Z=-0.776,P=0.437;117(99,120)比113(101,123),Z=-0.170,P=0.865;137(123,143)比142(123,160),Z=-1.279,P=0.201]。年龄<5岁、体重<18 kg、头围<51 cm时,随着患儿年龄、体重、头围的增加,扰动系数也呈明显增大趋势;年龄>5岁、体重>18 kg、头围>51 cm时,随着年龄、体重、头围的增加,扰动系数的变化不明显,分别趋近于135、130、130。结论无颅脑损伤的患儿不同年龄段扰动系数的参考值范围不同。扰动系数与患儿的性别无关,与年龄、体重、头围有一定的关系。     

Increased cerebrospinal fluid concentrations of soluble Fas (CD95/Apo-1) in hydrocephalus

BACKGROUND AND AIMS—The ventricular enlargement observed in children with chronically raised intracranial pressure (ICP) causes a secondary loss of brain tissue. In animal studies of hydrocephalus, programmed cell death (apoptosis) has been found as a major mechanism of neuronal injury. One of the regulators of the apoptotic cell death programme is the receptor mediated Fas/Fas ligand interaction.
METHODS—The apoptosis regulating cytokines soluble Fas (sFas) and soluble Fas ligand (sFasL) were studied in the cerebrospinal fluid (CSF) of 31 hydrocephalic children undergoing shunt surgery for symptomatic hydrocephalus and 18controls.
RESULTS—High concentrations of sFas were observed in children with hydrocephalus (median 252 ng/ml); in controls sFas was below the detection limit (0.5 ng/ml). sFasL was undetectable in all but one sample.
CONCLUSION—High concentrations of sFas in the CSF of children with hydrocephalus suggest intrinsic sFas production, potentially antagonising pressure mediated Fas activation.