透析膜对重型脑损伤合并肾衰患者氧饱和度的影响

重型颅脑损伤合并急性肾衰者约占50％，死亡率可高达80％，血液透析（HD）是治疗重型颅脑损伤合并急性肾衰者的主要方法之一。笔者采用血氧饱和度检测仪检测重型颅脑损伤合并急性肾衰患者，应用不同膜材料透析时外周血血氧饱和度水平的变化，探讨不同透析膜对重型颅脑损伤合并急性肾衰患者血氧饱和度的影响。     

早期手术治疗四肢骨折合并重型颅脑损伤57例分析

目的探讨骨折合并重型颅脑损伤进行早期手术固定骨折对颅脑损伤治疗的临床意义。方法回顾分析重型颅脑损伤合并四肢骨折57例,对合并骨折进行早期手术固定。结果 57例四肢骨折中2例死于重型颅脑损伤,3例重残,5例中残,余获痊愈,且肢体功能恢复良好。结论对重型颅脑损伤合并骨折应尽早行手术治疗有利于颅脑损伤治疗及降低伤残率。     

儿童重型颅脑损伤的危险因素及干预对策

为了探讨儿童重型颅脑损伤的危险因素及干预对策，我们对1998年1月至2003年1月救治131例儿童重型颅脑损伤进行研究。     

重型颅脑损伤并发急性肾功能衰竭的监护

目的 探讨重型颅脑损伤并发ARF监护经验。方法 回顾性分析和总结7例重型颅脑损伤并发ARE的监测护理及救治的经过。结果 7例病人,治愈4例,死亡3例。结论 重型颅脑损伤并发ARF需要严密的监测与细致的护理,及时的透析,积极的防治并发症,才能有效的降低其死亡率。     

单纯重型颅脑损伤术后并发创伤性凝血病的临床分析

目的：探讨单纯重型颅脑损伤术后并发创伤性凝血病（TC）的多因素。方法采用Logistic回归模型回顾性分析TC的危险因素及重型颅脑损伤患者3个月死亡的独立危险因素。结果 GCS评分和D-二聚体浓度是术后TC发生的独立危险因素;GCS评分、瞳孔散大和TC是重型颅脑损伤患者3个月死亡的独立危险因素。结论早期针对诱因防治TC意义重大。     

重型颅脑损伤患者压疮危险因素评估及护理干预

目的评估重型颅脑损伤患者压疮的危险因素，针对性地进行护理干预，以预防压疮发生。方法对92例重型颅脑损伤患者采用压疮危险因素评分表进行评分，对压疮高危患者实施个体化、综合性的护理干预。结果入院时92例重型颅脑损伤患者压疮危险因素评分≤14分，均为压疮高危患者，出院时38例≤14分，住院期间无1例发生压疮。结论重型颅脑损伤患者入院时立即进行压疮危险因素评估并针对性地进行护理干预，能有效预防压疮。     

重型颅脑损伤合并肺部感染的治疗体会

目的探讨重型颅脑损伤患者合并肺部感染发生的原因，预防及治疗。方法回顾性分析近1年收治的91例重型颅脑损伤患者。结果91例发生肺部感染者仅22例(占24％)，因肺部感染未能控制合并多器官功能衰竭死亡者仅4例。结论对于重型颅脑损伤患者除给予综合治疗外，推荐使用沐舒坦以预防和控制肺部感染。     

重型颅脑损伤合并胸腹脏器损伤的救治体会

目的 重型颅脑损伤时注意胸腹脏器复合伤的存在及治疗。方法 对于重型颅脑损伤病人及时给予胸部X线或CT检查，行腹穿或腹部B超检查。结果 本组病例中有10例合并胸部损伤，13例合并腹部内脏损伤。结论 重型颅脑损伤合并胸腹脏器损伤，及时诊断和恰当的治疗，可减少低氧血症及低血容量给脑组织造成的继发性损害。     

重型颅脑损伤术后继发创伤性脑梗死的原因分析

目的 探讨重型颅脑损伤患者术后继发创伤性脑梗死的危险因素及防治措施. 方法 回顾性分析经开颅手术治疗的187例重型颅脑损伤患者的临床资料,根据术后半月内是否出现创伤性脑梗死分为创伤性脑梗死组与无创伤性腩梗死组,对可能造成创伤性脑梗死的因素,如性别、年龄、是否为多发伤、是否出现脑疝、是否合并有创伤性蛛网膜下腔出血等方面,进行统计学分析. 结果 本组187例重型颅脑损伤患者术后继发创伤性脑梗死21例,其中大面积脑梗死8例,非大面积脑梗死13例,创伤性脑梗死发病率11.23％.5例大面积脑梗死颅内压持续增高并形成脑疝再次手术扩大颅骨窗减压术;重型颅脑损伤术后是否出现创伤性脑梗死与性别无关(P＞0.05),与年龄、伤情、多发伤、创伤性蛛网膜下腔出血有关(P＜0.05). 结论 重型颅脑损伤继发创伤性脑梗死与性别无关,与年龄、是否出现脑疝、是否为多发伤、是否合并有创伤性蛛网膜下腔出血有显著相关性;早期诊断和早期综合治疗才能改善患者预后,提高疗效.     

重型颅脑损伤合并大面积脑梗死诊治分析

目的探讨重型颅脑损伤合并大面积脑梗死的发病机制及诊治方法。方法通过对我院2002年5月～2006年5月收治的18例重型颅脑损伤合并大面积脑梗死患者诊治、分析。结果18例患者中良好2例，中残4例，重残5例，植物生存1例，死亡6例。结论重型颅脑损伤并发大面积脑梗死预后较差，需及时CT复查，早期明确诊断，早期治疗，才能改善患者预后，提高疗效。     

The risk factors of nosocomial infection in severe craniocerebral trauma

Objective:To explore the risk factors of nosocomial infection in severe craniocerebral trauma and the way of prevention.Methods:The clinical data of 387 patients with severe craniocerebral trauma were reviewed.Results:The total nosocomial infection rate of this study was 22.99% .Pulmonary nosocomial infection presented most frequently.The G-bacilli were the most common infectious bacteria.The mortality rate of the infection group was 38.20%.Conclusions:Complications of nosocomial infection affect the prognosis of craniocerebral trauma patients.Nosocomial infection is related to the age of the patients, craniocerebral trauma severity, unreasonable utilization of antibiotics and invasive operations, such as tracheal cannula, mechanical ventilation,urethral catheterization and deep venous catheterization.Patients with severe craniocerebral trauma should be carefully treated and nursed to avoid nosocomial infection.In order to reduce the rate of nosocmial infection,intensive measurement should be adopted.     

重型颅脑损伤后上消化道出血的风险因素分析

目的：探讨重颅脑损伤后上消化道出血的风险因素。方法 回顾性分析了１５３例重型颅脑损伤的临床。结果 上消化道出血４９例。ＧＣＳ评分高低，去脑强直，中枢性高热，血糖浓度与上消化道出血显著相关，属于因素。结论在重型颅脑损伤的监护治疗中，应警惕上消化道出血的可能性，尤其是对具有出发因风险的病人。     

标准外伤大骨瓣开颅治疗重型额颞部颅脑损伤

目的:探讨标准外伤大骨瓣开颅在重型额颞部颅脑损伤中的应用价值。方法:采用美国标准外伤大骨瓣开颅术治疗重型额颞部颅脑损伤48例，术后均入神经外科重症监护病房，注意保持气道通畅，并给予脱水、促醒等对症支持治疗。结果:存活32例(66．7％)，其中良好21例，中残6例，重残3例，植物生存2例，死亡16例。结论:标准外伤大骨瓣开颅术是治疗重型额颞部颅脑损伤的良好术式。     

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Ourhospitalhadadmittedandtreated2 16 5casesofcraniocerebraltraumacomplicatedwiththoraco abdomialinjuriesbetweenJuly 1993andJune 2 0 0 3.Aretrospectivestudywascarriedouttoexploretheoptimaltreatmentforcraniocerebraltraumacomplicatedwiththoraco abdominalinjuries.METHODSClinicaldataAtotalof 2 16 5cases (112 5malesand 10 4 0females)ofcraniocerebraltrauma (CCT)complicatedwiththoraco abdomialinjurieswereincludedinthestudy (averageage ,35 .5 years) .Causesofinjuriesweretrafficaccidentin 1384 (6 3…     

Results of internal elastic plate osteosynthesis of simple femoral shaft fractures in polytraumatized patients. An alternative procedure

Summary Primary medullary nailing of femoral fractures is burdened by the risk of central and pulmonary complications in patients with polytrauma, especially in conjunction with craniocerebral or thoracic trauma. This also applies to unreamed medullary nailing. Primary treatment with external fixation necessitates secondary surgery with an altered procedure, the timing of which is not predictable. Plate osteosynthesis with anatomical repositioning of the fragments and rigid fixation is a technically demanding procedure, but can lead to fragment necrosis due to fragment denudation. In a prospective study conducted from 1 September 1994 to 30 June 1996 on 17 polytraumatized patients (average ISS: 30 points), simple femoral stem fractures (A-1 to B-3 of the AO-classification) were stabilized by elastic plate osteosynthesis using biological technique. While cautiously preserving the periosteal and muscle connections to the bone, a plate is inserted as a bridge without any interfragmentary compression. At least two to four holes are left free in the center of the plate. This allows micro-movements in the fracture gap without the risk of material fatigue. All of the fractures were immediately stabilized on the day of the accident. In four patients with severe craniocerebral trauma or manifest shock, the procedure was changed to plate osteosynthesis after application of primary external fixation. Secondary injuries (joint and pelvic fractures or craniocerebral trauma) delayed early loading in 12 cases. Four patients were mobilized postoperatively under partial loading. A fixation callus was radiologically detectable on average 6 weeks after surgery. This often allowed additional loading, depending on the secondary injuries. Full loading was possible after 14 weeks. Complications included one case of surgery-related malpositioning, one soft-tissue infection, one case of plate detachment after a fall and one case of periosseous calcification. There were no cases of bone infections or pseudoarthroses. Elastic plate osteosynthesis is thus a conservative osteosynthesis procedure with a low complication rate in polytraumatized patients, even in those with simple femoral fractures.      

Correction of lipid peroxidation disorders of patients in the acute period after craniocerebral trauma]

In sufferers at the acute period of mild and severe craniocerebral trauma, the processes of peroxide oxidation of lipids become essentially more active. The antioxidative function of an organism decreases. Changes in the metabolic processes are the most pronounced in patients under 44 years and in women of different age in severe craniocerebral trauma. The authors recommend to include into the complex of treatment in craniocerebral trauma the intensive antioxidant therapy together with surgical intervention.     

Clinical analysis of craniocerebral trauma complicated wiht thoracoabdominal injuries in 2 165 cases

OBJECTIVE: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. METHODS: A total of 2165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. RESULTS: After treatment, 2024 (93.49%) cases survived and the other 141 (6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 (46.71%) and 53 (24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%-65.96% and 28.57% respectively, indicating a significant difference (P<0.05). CONCLUSIONS: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.     

颅脑外伤所致精神障碍发生情况及其影响因素分析

【摘要】〓目的〓探讨并分析颅脑外伤所致精神障碍发生情况及其影响因素,旨在为颅脑外伤所致精神障碍防治提供参考依据。方法〓选取我院神经外科2011年8月至2013年8月收治的117例颅脑外伤患者为研究对象,笔者查阅大量参考文献,采用自编问卷收集颅脑外伤术中的临床资料,运用SPSS 19.0统计软件包进行统计和分析找出颅脑外伤所致精神障碍原因和影响因素。结果〓颅脑外伤所致精神障碍发生率为38.46%(45/117),以躁狂型最多见。多因素Logistic回归分析示额叶损伤(β=4.14,P<0.001)、颅内感染(β=5.81,P<0.001)、低氧血症(β=6.40,P<0.001)和脑室受压(β=7.17,P<0.001)是颅脑外伤所致精神障碍的危险因素。结论〓颅脑外伤所致精神障碍发生率较高,在对颅脑损伤患者进行临床医治过程中,针对高危人群,加强巡视和监督,及时发现患者精神症状,根据患者的精神障碍类型给予针对性的治疗和护理干预,有利于疾病的恢复,改善患者的预后。     

The safety of gadolinium in patients with stage 3 and 4 renal failure.

BACKGROUND: Although there is a well-documented risk of acute renal failure (ARF) with the iodinated contrast agents, intravenous gadolinium-based contrast agents are considered non-nephrotoxic and have been widely used for magnetic resonance imaging (MRI). However, debate continues regarding the safety issue of gadolinium, especially in patients with kidney failure. Therefore, we aimed to evaluate the safety of gadolinium in patients with stage 3 and 4 renal failure as well as risk factors for nephrotoxicity. METHOD: We retrospectively analysed 473 patients with chronic renal failure who underwent angiographic MRI procedures in our centre from February 1999 to March 2005 in whom gadolinium was used as the sole contrast agent at a dose of 0.2 ml/kg. Among them, 91 patients with stage 3 or 4 renal failure according to K/DOQI definition, who had available data in their files, were enrolled in the study. The ARF was defined as an increase of at least 0.5 mg/dl in serum creatinine level over baseline after using gadolinium. RESULTS: Eleven of 91 (52 males, 39 females; median age 59 years; median estimated glomerular filtration rate (eGFR) 33 ml/min/1.73 m2) patients developed ARF (12.1%). The median eGFR was lower in patients with ARF than in those who did not develop ARF. The risk factors for ARF were baseline eGFR, older age, diabetic nephropathy and low baseline haemoglobin and albumin levels. Baseline eGFR and diabetic nephropathy were determined as the independent risk factors in regression analysis. CONCLUSIONS: An ARF can occur after gadolinium-based contrast agents in patients with moderate to severe chronic renal failure. Risk factors for ARF after gadolinium toxicity include diabetic nephropathy and low GFR.     

Gunshot wounds of the brain in civilians

Summary Both metabolic rate and protein catabolism are known to increase following severe head trauma, but the etiology of this hypermetabolism is unknown. To further investigate the problem, we studied the metabolism of 17 patients with indirect calorimetry who had severe craniocerebral trauma only and who required ICP monitoring for management. Patients were studied daily and immediately after ICP spikes greater than 20 mmHg, prior to treatment with hyperventilation, osmotic diuretics, or barbiturates. Oxygen consumption (VO₂) was correlated with ICP. Two groups of patients were identified. Group I patients were treated with hyperventilation and osmotic diuretics while Group II patients additionally received cerebral metabolic depressants. Group I had a significant correlation coefficent between VO₂ and ICP. Significant hypercatabolism early in the post trauma period was demonstrated by increased urine urea nitrogen. Our observations suggest that in patients with craniocerebral trauma, elevated ICP is associated with increased oxygen consumption, protein catabolism and systemic hypermetabolism. Cerebral metabolic depressants blunted increases in VO₂ which were seen with elevated ICP.