武汉市儿童脑外伤患者家庭负担的前瞻性研究

目的了解武汉市儿童脑外伤后家庭负担变化的基本状况.方法以0～17岁脑外伤患者作为研究对象进行前瞻性研究,分别于儿童住院期间及出院6个月后,利用以上经过检验的家庭负担测量工具,测量儿童家庭所承受的压力和负担及其变化,并利用儿童行为量表（CBCL）对脑外伤后儿童的社会行为能力进行评估.结果113例儿童在脑外伤发生前、住院期间及出院6个月后随访时家庭功能评价问卷（APGAR）平均得分分别为7.96、6.94、7.60分,配对t检验显示,家庭功能在外伤发生后发生障碍,6个月后恢复到外伤发生前的水平,但重度脑外伤对家庭功能的影响在出院6 个月后仍未得到恢复.住院期间疾病家庭负担会谈量表（FBS）得分最高的3个维度分别为家庭经济负担、家庭日常生活、家庭娱乐活动.出院6个月后FBS量表总得分下降,家庭成员心理健康维度得分最高,其次为家庭经济负担维度和家庭关系维度,配对t检验结果表明脑外伤对家庭成员心理健康的影响在儿童出院6个月后尚未得到消除.113例儿童出院6个月后CBCL得分均在正常范围内.结论脑外伤发生后家庭APGAR得分降低,FBS得分提高,表明脑外伤儿童的家庭受到伤害事件的影响,其家庭负担加重,家庭功能发生障碍.随着疾病的康复,除重度脑外伤组以外,脑外伤儿童的家庭功能均可恢复正常.     

Epidemiological aspect of traumatic brain injury in Northeast Italy

Background: Traumatic brain injuries (TBIs) remain an important public health problem in developed countries. Hospital records were reviewed to ascertain the epidemiology of TBIs in Northeast Italy. Methods: The annual rates of TBI-associated hospitalisation were estimated by analysing data collected from hospital records from 1996 to 2000. TBIs were identified according to the Centers for Disease Control and Prevention definition and the ICDMAP-90 was used to assess their severity. Findings: 55,368 TBIs were collected between 1996 and 2000, with an overall 29.4% decline in the number of cases. As for severity, moderate TBIs dropped by 34.1%, whereas a less conspicuous decline was observed for mild injuries. Severe injuries remained stable between 1996 and 1999, but rose in 2000, when the unclassified injuries were better distributed. Concerning outcome, fatal TBIs dropped slightly, but only in 2000. Causes of TBI were recorded in 59.2% of cases: 48.5% were motor vehicle accidents, 8.8% occurred at work and 12.2% at home. There were more males than females in all age groups. The highest number of cases per 100,000 person of motor vehicle accidents was recorded among 16–25 year-old and 36.5% occurred at weekends. Domestic accidents showed two age peaks, in children and the elderly. Occupational accidents occurred at all working ages, tending to decline with older age. Interpretation: Better health care and educational campaigns may have contributed to the declining rate of TBI-associated hospitalisation. Special efforts should be made to further reduce the motor vehicle accidents involving young people and welfare programs are needed to limit the risk of falls and contain functional impairment in the elderly.     

免疫营养支持对颅脑损伤病人影响的系统评价

目的:系统评价以谷氨酰胺(Gln)为主的免疫营养支持对颅脑损伤病人的影响. 方法:计算机检索Pubmed,Embase,Cochrane Library,中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(维普)、中国期刊全文数据库(CNKI)和中华医学会数字化期刊(万方)等,全面收集有关Gln用于颅脑损伤病人营养支持效果的随机对照试验(RCT).检索时间截止为2013年7月.经两名研究者独立纳入、排除文献,资料提取及质量评价后,采用RevMan5.2软件进行分析. 结果:共纳入14个RCT,合计689例病人.系统评价结果显示,肠内Gln给药亚组与对照组比,能降低腹泻发生率[RR=0.57,95％ CI(0.36,0.89),P=0.01],缩短住院时间[SMD=-8.00,95％ CI(-15.36,-0.64),P=0.03],差异均有统计学意义.肠外Gln给药亚组与对照组比,能降低肺部感染率[RR =0.45,95％ CI(0.25.0.84),P=0.01]和血糖水平[RR=-2.31,95％ CI(-3.44,-1.18),P＜0.01],差异均有统计学意义.而在治疗有效率、病死率、泌尿系感染、总蛋白含量、清蛋白含量、IgA水平和GCS评分方面,差异均无统计学意义. 结论:①肠内给予Gln营养治疗能有效地降低腹泻发生率,提高总蛋白水平,缩短住院时间;②肠外给予Gln营养治疗能有效地降低肺部感染发生率,降低血糖水平;③前两者均不能降低病人的治疗有效率、病死率、泌尿系感染和GCS评分,不能升高病人的总蛋白含量、清蛋白含量和IgA水平.     

210例重型颅脑损伤病死率的探讨

目的探讨降低重型颅脑损伤病死率的方法。方法回顾性总结了1996年1月至2007年12月收治的210例重型颅脑损伤,依时间顺序分为三组：A组,1996年1月至1999年12月70例;B组,2000年1月至2003年12月73例;C组,2004年1月至2007年12月67例。A、B、C组手术数分别为34例、48例、42例,手术率分别为48．5％、65．7％、62．6％。结果收治重型颅脑损伤210例,死亡102例,病死率为48．5％,B组手术率最高,病死率最低,早期手术病死率低于晚期手术病死率。结论为了降低病死率,适宜的手术率是基础,颅内血肿的早期诊断、早期手术是关键,综合性治疗是不可忽视的因素。     

小儿脑损伤并继发性癫痫临床分析

目的探讨小儿脑损伤后继发性癫痫发作特点及预后。方法对56例患儿采用全身型螺旋电脑断层扫描及脑电图进行检查,并排除遗传代谢性疾病。按发作类型选择抗癫痫药物治疗,并给予运动功能训练、认知训练以及视力、听力障碍干预治疗。结果全部病例均有脑损伤病史,头颅电脑断层扫描均有不同程度改变,其中窒息20例(35.7%),颅内出血14例(25.0%),早产12例(21.4%),宫内发育不良6例(10.7%),黄疸4例(7.1%)。合并听力障碍5例(8.9%),皮质盲2例(3.6%),智力发育落后32例(57.1%),6例(10.7%)为发育边缘。经抗癫痫治疗结果1周内控制者26例(46.4%),半月内控制者20例(35.7%),1~2个月控制者8例(14.3%),2个月未控制者2例(3.6%)。结论①继发性癫痫高危因素依次为窒息、颅内出血、早产、宫内发育不良及黄疸等;②继发性癫痫可表现为不同类型发作,许多患儿早期表现为惊跳而误诊;③婴儿期继发性癫痫疗程可依原发病控制情况而定,用药后症状很快改善,控制效果好;④对高危儿脑损伤后行脑电图检查有助于癫痫的早发现、早治疗,对防治二次脑损伤发作有重要价值。     

道路交通事故致颅脑损伤住院患者影响因素的研究

目的分析并探讨交通事故致颅脑损伤住院患者的影响因素。方法采用现场调查的方法,调查分析2012年10月-2013年7月期间因道路交通伤入住3家综合性医院的住院患者的伤害发生情况。结果本研究共调查388例道路交通伤住院患者,平均年龄为（40．20±18．38）岁,男女性别比为2．15：1。19—64岁年龄段为交通伤的主要年龄段。在交通伤住院患者中,颅脑损伤患者共225例,占调查人数的58．O％,其中男性166名（73．8％）,女性59名（26．2％）。摩托车驾驶员为主要的道路使用者类型,其次为行人及摩托车乘客。患者平均年龄为（39．18±18．68）岁。多因素Logistic回归分析结果表明,性别、职业、道路使用者类型、交通控制方式为交通事故致颅脑损伤的危险因素。结论男性、军人、无业或退休人员、机动车驾驶员、标志标线的交通控制方式为交通事故致颅脑损伤的影响因素。     

Reconstructing self-narratives in coping with traumatic brain injury

This study examined qualitative data from ten individuals with traumatic brain injuries (TBI) who felt at ease with their current situations. An analysis based on the grounded theory method revealed that one's experience of coping or adjustment to the disability was represented as narratives about him or herself. Each one with TBI reconstructed certain self-narratives in coping with their changed self-images and daily lives. The common narratives were classified into five categories: "the self better than others," "the grown self," "the recovering self," "the self living here and now," and "the protesting self." These self-narratives reflected renewed ways to view the selves, which were conceptualized to be intact "in spite of TBI" or to be worthwhile "because of TBI." The informants achieved this conceptualization by managing their perspectives on time or on space. This classification will serve as a framework for rehabilitation practice and for future research.     

创伤性脑损伤后肠黏膜细胞凋亡和c-fos基因表达

目的:研究创伤性脑损伤(TBI)后小肠黏膜细胞凋亡及c-fos基因表达,探讨肠黏膜上皮细胞凋亡在破坏肠黏膜屏障中的作用及c-fos基因表达与凋亡的关系.方法:雄性Wistar大鼠,随机分为假手术(对照)组和脑创伤后3 h、12 h、24h、72 h和7 d组,采用自由落体撞击致重型颅脑损伤.在各时相点取空肠近端,应用TUNEL法观测小肠黏膜细胞凋亡,应用免疫组化法观察c-fos基因的表达.结果:①凋亡细胞以肠黏膜上皮细胞为主;②脑损伤后3 h肠黏膜上皮即出现明显凋亡,凋亡细胞的数量以伤后72 h最多,分布于绒毛顶端,后延伸至绒毛中下部;③脑损伤后肠黏膜上皮细胞的c-fos基因表达逐渐增强,主要出现在上皮细胞、平滑肌细胞和淋巴细胞,伤后24h、72h和7d的表达明显升高.结论:创伤性脑损伤可引起大鼠小肠黏膜细胞明显凋亡和c-fos基因的显著表达.