老年重型颅脑外伤108例临床分析

目的总结影响老年重型颅脑外伤患者预后的因素及防治措施。方法分析108例60岁以上、GCS评分3~8分的颅脑外伤患者的临床资料,比较生存组与死亡组相关因素的差异。结果本组生存者66例,生存率61.1%;死亡42例,病死率38.9%;预后不良率68.5%。结论老年慢性疾病、颅脑损伤程度、多发伤及并发症是其四个重要的致死因素,积极诊治多发伤,防治并发症,能改善老年重型颅脑外伤患者的预后,提高患者的生存率。     

重型颅脑外伤后早期急性肾功能衰竭的临床分析

目的了解重型颅脑外伤患者早期发生急性肾功能衰竭的临床特点及防治。方法回顾性分析本院1998-01～2004—12重型颅脑外伤患者的临床资料，以重型颅脑外伤后24h是否出现急性肾功能衰竭为标准，将患者分为急性肾功能衰竭组和无急性肾功能衰竭组，对两组病例进行比较。结果182例重型颅脑外伤患者中，32例（17．6％）在颅脑损伤后24h发生急性肾功能衰竭，其中6例必须行肾脏替代治疗；重型颅脑外伤后早期发生急性肾功能衰竭者较无急性肾功能衰竭者死亡率高。结论重视重型颅脑外伤早期急性肾功能衰竭及其并发症，积极预防可改善病人预后。     

重型颅脑损伤老年患者的护理特点及体会

目的探讨重型颅脑损伤老年患者的护理特点及护理经验。方法回顾性分析2004年1月至2006年12月收治的61例老年重型颅脑损伤患者的临床护理情况。结果61例中，痊愈31例，中残9例，重残5例，植物状态生存2例，死亡14例。结论加强临床观察、呼吸道管理、营养支持、预防并发症以及心理护理是降低死亡率及致残率的有效方法。     

112例老年人急性重型颅脑损伤的特征与救治分析

目的 总结老年人重型颅脑损伤的临床特征与救治经验。方法 对我院1993年12月至2004年12月收治的112例老年重型颅脑损伤患者进行回顾性分析。结果 存活41例。死亡71例（死亡率63．4％）。35例获随访3个月～9年，17例恢复良好，轻残7例。中残6例，重残5例。结论 老年重型颅脑损伤患者全身并发症多，死亡率高，预后相对较差。早期诊断与积极的综合治疗措施是救治老年重型颅脑损伤患者的重要方法。     

重型颅脑损伤临床救治体会

目的总结重型颅脑损伤患者的救治经验。方法对90例重颅脑损伤患者的临床资料进行回顾性分析。结果手术治疗62例，保守治疗28例。治疗后3个月，按GOS评分评估患者预后：良好32例，中残15例，9重残，植物生存4例，死亡30例（手术治疗22例，保守治疗8例）。结论早期有效的综合治疗可降低重型颅脑损伤患者致残率和死亡率，改善患者的预后。     

老年人颅脑损伤的临床特征、预后及治疗体会

目的总结老年人颅脑损伤的临床特征、预后与治疗体会。方法对我院1998年12月至2006年12月收治的135例老年颅脑损伤患者的临床资料进行回顾性分析。结果存活81例，死亡54例（死亡率40％）。存活81例随访4个月～6年，恢复良好或轻残58例，重残20例，植物生存3例。结论老年颅脑损伤患者伤情严重、多变，并发症多，死亡率高，预后相对较差。早期诊断与治疗及早期防治各种并发症是提高老年颅脑损伤患者生存率和预后的重要方法。     

重型颅脑损伤为主的多发伤漏诊原因

目的探讨重型颅脑外伤为主的多发伤的漏诊原因。方法对2000～2009年收治的85例重型颅脑损伤患者的临床资料进行回顾性分析,所有病例均符合重型颅脑损伤合并其他部位损伤患者的诊断标准,并按GCS评分对伤情进行评估。结果颌面部15例,脊柱骨折9例,胸部损伤20例,四肢骨折17例,腹腔脏器损伤22例,复合伤37例,治愈65例,植物生存11例,死亡9例。结论重型颅脑损伤合并多发伤应整体全面分析病情,早期诊断早期处理,降低漏诊率及死亡率。     

重型颅脑损伤病人颅内压变化及纳洛酮的治疗作用

目的观察重型颅脑损伤患者颅内压变化及大剂量纳洛酮的治疗效果。方法选择重型脑损伤患者（GCS计分3—8分）82例。随机分治疗组42例，除采用临床综合治疗外并应用大剂量纳洛酮；对照组仅采用临床综合治疗，监测颅内压及常规临床监护，观察病人预后。结果重症颅脑外伤病人颅内压增高明显，颅内压．急剧升高与死亡率明显相关。纳洛酮治疗组颅内压明显低于对照组，预后较对照组好，并发症少。结论重症颅脑外伤颅内压水平与病人预后明显相关。大剂量纳洛酮能够改善重症颅脑损伤引起的脑水肿、高颅压，进而改善脑组织缺氧，改善病人预后。     

颅脑外伤合并多发伤患者的生存状况研究

目的探讨颅脑外伤合并多发伤患者生存状况的影响因素,以指导临床预后判断和治疗。方法根据预后不同将我院收治的142例颅脑外伤合并多发伤患者分为生存组和死亡组,采用单因素分析和Logistic回归分析影响患者预后的因素。结果单因素分析表明,收缩压、GCS评分、伤后时间、血糖、颅内压、合并伤部位是颅脑外伤合并多发伤患者预后的影响因素,多因素Logistic回归分析表明收缩压70mmHg、GCS评分≤8分、伤后时间≥5h、血糖≥1 3mmol/L、合并胸腹部联合伤是颅脑外伤合并多发伤患者预后的独立危险因素。结论患者的伤情、伤后时间、并发症是影响颅脑外伤合并多发伤患者预后的关键所在,应当尽早救治,并重视并发症的治疗。     

颅脑外伤患者免疫水平及感染风险的分析研究

目的 探讨不同程度颅脑外伤患者的免疫功能、感染风险及对预后的影响。方法 南京大学医学院附属南京鼓楼医院重症医学科2016年9月—2019年9月收治的急性颅脑外伤患者86例;按格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分标准分为轻中型组(24例)和重型组(62例)。收集两组患者入院时一般资料、炎症指标及免疫指标;并统计入院1～3 d、4～7 d、7～14 d内的新增感染患者例数及入院14 d内的死亡例数。以入院14 d内出现死亡为预后指标,分析影响颅脑外伤患者入院14 d内预后的相关因素。结果与重型组相比,轻中型组患者的血白细胞(WBC)计数、C反应蛋白(C-reactive protein,CRP)、血降钙素原(procalcitonin,PCT)水平均显著降低,血淋巴细胞(CD4+、CD8+)、人类白细胞抗原-DR(human leukocyte antigen-DR,HLA-DR)水平均显著升高。经多因素Logistics回归分析显示,WBC、PCT、入院后第1～3 d内发生感染是影响预后的独立危险因素,HLA-DR是影响预后的独立保护因素。结论 重型颅脑外伤患者比轻中型患者的免疫功能更低下、感染出现时间更早、感染程度更重,且易合并多部位感染。早期血WBC、PCT水平、入院后第1～3 d内发生感染是影响患者生存的独立危险因素;而HLA-DR是影响生存的独立保护因素。入院时应评估患者的感染情况及免疫功能,并动态监测;尽早控制感染、提高免疫水平,以改善患者的预后。     

重型颅脑损伤并发急性呼吸窘迫综合征的高危因素及综合治疗

目的 分析重型颅脑伤继发急性呼吸窘迫综合征(ARDS)的高危因素,根据高危因素采取综合治疗措施.方法 对我科近5 年来28 例重性颅脑损伤合并ARDS 的病人资料进行回顾性分析,对患者发病的高危因素及治疗方法 进行讨论.结果 28 例患者均诊断明确,16 例抢救成功,12 例死亡.结论 重型性颅脑损伤后并发ARDS ...     

New perspectives in neurotrauma research

Traumatic brain and spinal cord injuries are severe burdens for the patients, their relatives, the health care providers and society as a whole. Recent data demonstrate the magnitude of the problem: It is mostly a disease of the young gen-eration (age 20-45 years) with mortality rates for severe traumatic brain injury (TBI) between 40-50%. In approximately 60% of cases, multiple trauma is accompanied by head injury. The outcome of TBI is determined not only by the extent and severity of the primary insult, but also by the degree of secondary brain damage. In the subgroup of severe TBI (GCS相似文献   

Early rehabilitation of comatose patients after traumatic brain injury

Background and purposeAs a result of improvements in the rescue system and progress in intensive care therapy, an increasing number of patients have survived severe traumatic brain injury in recent years. Early and consistent administration of the correct rehabilitation programme is of crucial importance for the restoration and improvement of cerebral function, as well as social reintegration. This prospective study was conducted at the neurosurgical department of a university hospital to assess the one-year outcome of comatose patients after severe traumatic brain injury.Material and methodsTwenty-seven patients were included. Patients received multimodal early-onset stimulation and continuous inpatient and outpatient rehabilitation therapy. One-year outcome was assessed by means of the Glasgow Outcome Scale, Barthel Index, Functional Independence Measure (FIM) and need of care.ResultsSeven patients died, 4 remained in a vegetative state, 7 were severely disabled, 6 were moderately disabled, and 3 achieved a good recovery 12 months after injury. Median Barthel Index was 65 and median FIM score was 84. The majority of patients were still at least intermittently dependent on care.ConclusionsDespite intensive rehabilitation treatment, severe traumatic brain injury is still burdened with significant mortality and morbidity.     

重型颅脑损伤开颅术中急性脑膨出的防治

目的 探讨重型颅脑损伤患者开颅术中急性脑膨出的原因及防治措施.方法 回顾性分析43例术中出现急性脑膨出的重型颅脑损伤患者的临床资料.结果 本组病人术中急性脑膨出的原因包括迟发性颅内血肿21例,弥漫性脑肿胀13例,长时间脑疝(2 h以上)4例,外伤性大面积脑梗死3例,术中低血压或低氧血症2例.出院后半年按GOS评定预后:恢复良好14例,重、中残6例,植物生存3例,死亡20例.结论 术前详细了解受伤机制,认真研究影像学资料对术中脑膨出的预判具有重要意义;针对不同病因的综合治疗有助于改善患者预后及降低患者死亡率.     

Increased serum-GFAP in patients with severe traumatic brain injury is related to outcome

OBJECTIVES: Several studies have established the relevance of S-100 in blood as a marker of brain damage after traumatic brain injury. However, a more specific marker is required and glial fibrillary acidic protein (GFAP) is considered to be a good candidate. METHODS: In order to assess the increase of GFAP in serum (s-GFAP) after a severe traumatic brain injury (TBI) we collected daily serum samples from 59 patients with severe TBI starting on the day of the trauma. S-GFAP was measured using a sandwich ELISA. The Glasgow outcome scale (GOS) assessed outcome after 1 year. RESULTS: All but one patient had maximal s-GFAP values above the laboratory reference value (median increased 10-fold). The highest detected levels were seen during the first days after TBI and then decreased gradually. Patients with unfavourable outcome had significantly (p<0.001) higher maximal s-GFAP values in the acute phase compared with patients with favourable outcome. All patients (n=5) with s-GFAP>15.04 microg /L died (reference level<0.15 microg/L). We found no significant difference in the maximal s-GFAP levels of patients with isolated brain injury in comparison with patients with multiple traumas. CONCLUSION: Serum-GFAP is increased during the first days after a severe traumatic brain injury and related to clinical outcome.     

Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis

Compelling evidence suggests the advantage of hyperbaric oxygen therapy (HBOT) in traumatic brain injury. The present meta-analysis evaluated the outcomes of HBOT in patients with traumatic brain injury (TBI). Prospective studies comparing hyperbaric oxygen therapy vs. control in patients with mild (GCS 13–15) to severe (GCS 3–8) TBI were hand-searched from medical databases using the terms “hyperbaric oxygen therapy, traumatic brain injury, and post-concussion syndrome”. Glasgow coma scale (GCS) was the primary outcome, while Glasgow outcome score (GOS), overall mortality, and changes in post-traumatic stress disorder (PTSD) score, constituted the secondary outcomes. The results of eight studies (average age of patients, 23–41 years) reveal a higher post-treatment GCS score in the HBOT group (pooled difference in means = 3.13, 95 % CI 2.34–3.92, P < 0.001), in addition to greater improvement in GOS and lower mortality, as compared to the control group. However, no significant change in the PTSD score was observed. Patients undergoing hyperbaric therapy achieved significant improvement in the GCS and GOS with a lower overall mortality, suggesting its utility as a standard intensive care regimen in traumatic brain injury.     

强化胰岛素控制血糖对重度颅脑外伤患者的疗效及分析

目的阐述强化胰岛素治疗控制血糖对NICU内重度颅脑外伤患者的感染率,NICU住院时间,神经功能预后及死亡率的影响。方法将202例入住NICU的重度颅脑外伤(TBI)患者前瞻性地随机分为两组,分别接受强化胰岛素治疗和传统的胰岛素治疗。结果随访6个月的总体死亡率,传统治疗组(Conventional Insulin Therapy,CIT)与强化治疗组(Intensive Insulin Therapy,IIT)相似(P=0.84)。接受CIT的患者感染率明显高于接受IIT组(P0.05)。接受IIT的患者在NICU的住院时间少于CIT组(P0.05)。研究期间的两组院内死亡率相似(P=0.90)。接受IIT的患者组随访6个月的GOS评分高于CIT组(P0.05)。结论强化胰岛素治疗能有效改善重症颅脑外伤患者预后。     

Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes

BackgroundTraumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment.ObjectiveThe aim of this study was to examine the relationship between cEEG findings in pediatric traumatic brain injury and neurocognitive/functional outcomes.MethodsThis study focuses on a subgroup of a larger prospective parent study that examined children admitted to a level-1 trauma hospital. The subgroup included sixteen children admitted to the pediatric intensive care unit (PICU) who received cEEG monitoring. Characteristics included demographics, cEEG reports, and antiseizure medication. We also examined outcome scores at the time of discharge and 4–6 weeks postdischarge using the Glasgow Outcome Scale — Extended Pediatrics and center-based speech pathology neurocognitive/functional evaluation scores.ResultsSixteen patients were included in this study. Patients with severe TBI made up the majority of those that received cEEG monitoring. Nonaccidental trauma was the most frequent TBI etiology (75%), and subdural hematoma was the most common lesion diagnosed by CT scan (75%). Fifteen patients received antiseizure medication, and levetiracetam was the medication of choice. Four patients (25%) developed seizures during PICU admission, and 3 patients had subclinical seizures that were detected by cEEG. One of these patients also had both a clinical and subclinical seizure. Nonaccidental trauma was an etiology of TBI in all patients with seizures. Characteristics of a nonreactive pattern, severe/burst suppression, and lack of sleep architecture, on cEEG, were associated with poor neurocognitive/functional outcome.ConclusionContinuous electroencephalography demonstrated a pattern that associated seizures and poor outcomes in patients with moderate to severe traumatic brain injury, particularly in a subgroup of patients with nonaccidental trauma. Best practice should include institution-based TBI cEEG protocols, which may detect seizure activity early and promote outcomes. Future studies should include examination of individual cEEG characteristics to help improve outcomes in pediatric TBI.     

Caffeine prevents acute mortality after TBI in rats without increased morbidity

Severe traumatic brain injury (TBI) is associated with a high incidence of acute mortality followed by chronic alteration of homeostatic network activity that includes the emergence of posttraumatic seizures. We hypothesized that acute and chronic outcome after severe TBI critically depends on disrupted bioenergetic network homeostasis, which is governed by the availability of the brain's endogenous neuroprotectant adenosine. We used a rat lateral fluid percussion injury (FPI) model of severe TBI with an acute mortality rate of 46.7%. A subset of rats was treated with 25mg/kg caffeine intraperitoneally within 1 min of the injury. We assessed neuromotor function at 24h and 4 weeks, and video-EEG activity and histology at 4 weeks following injury. We first demonstrate that acute mortality is related to prolonged apnea and that a single acute injection of the adenosine receptor antagonist caffeine can completely prevent TBI-induced mortality when given immediately following the TBI. Second, we demonstrate that neuromotor function is not affected by caffeine treatment at either 24h or 4 weeks following injury. Third, we demonstrate development of epileptiform EEG bursts as early as 4 weeks post-injury that are significantly reduced in duration in the rats that received caffeine. Our data demonstrate that acute treatment with caffeine can prevent lethal apnea following fluid percussion injury, with no negative influence on motor function or histological outcome. Further, we show epileptiform bursting is reduced after caffeine treatment, suggesting a potential role in the modulation of epilepsy development after severe injury.     

DIC评分在颅脑损伤中的临床应用研究

目的分析弥散性血管内凝血（DIC）评分与颅脑损伤病人病情及预后的关系,探讨其在颅脑损伤中的临床应用价值。方法采用前瞻性研究设计方法,测定并记录110例颅脑损伤病人伤后DIC评分、GCS评分及随访6个月时的GOS评分。采用SPSS15.0软件包进行统计分析。结果至随访结束,本组死亡19例。D-二聚体升高是颅脑损伤后最常见的凝血异常指标（56例,占50.9%）。DIC评分0、1、2、3、≥4分者分别为32、26、15、20、17例,病死率分别为0、0、0、20%、88.2%。GCS评分、GOS评分与DIC评分之间存在高度相关关系。结论DIC评分是评估颅脑损伤病人病情及预后的可靠指标;DIC分值越高,病人病情越重,预后越差。