306例创伤性颅脑损伤的流行病学研究

目的探讨创伤性颅脑损伤的发病因素与临床特点,为临床预防和治疗措施提供参考依据。方法分析我院2011-06-2014-06急诊科收治的306例创伤性颅脑损伤患者的临床资料,将所选患者的年龄、性别、受伤原因、受伤地点、职业、治疗方法及预后进行回顾性分析。结果创伤性颅脑损伤患者男性高于女性;发病率最高年龄段为30~45岁;受伤地点以街道、公路为主,交通事故导致颅脑损伤最多,占49.62%;损伤类型中以中重型颅脑损伤多见,占75.82%;车祸导致死亡人数占总死亡人数的70.97%。结论颅脑损伤的发生在年龄、职业及地点的分布上有一定的规律可循,根据不同人群、职业特点及高发地段因地制宜的采取预防及干预措施,可明显降低重型颅脑损伤的发病率及病死率[1]。     

重庆市秀山县颅脑损伤流行病学特点

目的分析重庆市秀山县颅脑损伤发生流行病学特点。方法采集秀山县2011-03—2013-03所有颅脑外伤病例,分析患者临床资料,了解颅脑损伤发生的概况、发生原因及临床特征。结果 2a中收治颅脑损伤1 434例。男∶女=2.2∶1,其中小儿(≤14岁)261例(18.2%),成年(15~59岁)835例(58.2%),老年(≥60岁)338例(23.6%)。轻型颅脑损伤1 132例(78.9%),中型颅脑损伤187例(13.0%),重型和特重型颅脑损伤115例(8.1%)。交通伤616例(43.0%),跌伤520例(36.3%),其他原因受伤298例(20.7%)。结论秀山县颅脑损伤发病率及病死率高,需改进抢救设备及措施,培养相关人才。     

甘肃陇东南地区颅脑损伤流行病学分析

目的调查分析甘肃陇东南地区的颅脑损伤流行病学现状及预后影响因素,为本地区颅脑损伤的预防与控制提供科学依据。方法收集2008年10月~2010年6月某医院神经外科颅脑损伤患者病历资料,填写《颅脑损伤流行病学调查表》,提取数据,用SPSS 17.0进行统计分析。结果共收集1014例颅脑损伤患者,男女性别比例为3.7∶1,年龄为34.3±19.7岁(1~83岁),患者主要以初中以下文化程度农民为主;致伤机制以摔伤为主(406,40.0%),其次为车祸(333,32.8%),18~65岁组所占比例最高,每年春节所在月份发生颅脑损伤最多。等级回归分析显示就诊时间、受伤机制及程度等是影响颅脑损伤预后的重要因素。结论深入研究甘肃陇东南颅脑损伤的致伤原因、分布人群和发生时间的根本原因,提出针对性防控措施,降低颅脑损伤发生概率,并尽可能缩短损伤后就诊时间,提高本地区颅脑创伤救治整体水平。     

外伤性硬膜下积液78例临床分析

我科从二995年至1998年对1792例颅脑损伤病例进行了回顾性分析发现颅脑损伤后出现硬脑膜下积液78例,占同期颅脑损伤病人的4.35％。1 临床资料11 一般资料78例中男50例,女28例。年龄4-72岁,平均36.7岁。受伤原因:车祸伤50例,跃打伤     

华东地区颅脑交通伤临床及流行病学特点

目的调查与研究华东地区的颅脑交通伤流行病学,为颅脑交通伤的预防与治疗提供科学依据。方法从2004年华东六省一市颅脑创伤住院患者数据库中整群抽取颅脑交通伤患者,用SPSS 13.0统计软件包分析。结果 7 369例颅脑交通伤患者中男女之比为2.72:1。平均年龄(39.28±16.51)岁。25～44岁年龄组所占比例最大,为43.7%。受伤人员中行人所占比例最大,为33.3%。以每年1月份发生颅脑交通伤最多,占13.90%。一天中有一半以上的颅脑交通伤发生在上午7～10时及下午5～9时,分别占23.7%和31.5%。所有住院患者中死亡858例(11.6%),存活6511例(88.4%)。Logistic回归分析显示年龄、颅脑损伤严重度、首送医院、省份、交通伤发生的季度和医院等级等都是影响患者住院期间死亡的重要因素。结论我国应加大颅脑交通伤高发时间段,也就是一天中的早晚上下班高峰以及一年中的第一季度尤其是1月份的道路交通管理,加强中青年男性的道路安全教育,加大对高龄人群的道路交通保护。     

迟发性外伤性颅内血肿122例临床分析

目的 探讨迟发性外伤性颅内血肿(DTIH)的临床特点、诱发因素及防治措施。方法 对我科自2001-01-2003-06收治的122例DTIH病人的临床及影像学资料进行回顾性分析。结果 DTIH占颅脑损伤病人的8．97％，死亡率23．8％。占同期颅脑损伤术中急性脑膨出病因的35．7％。中老年患者占DTIH患者的45．9%。DTIH发生在24h内占82％，72h内占97．5％。结论 DTIH多发生在颅脑损伤后72h内，伤后24h内发生率较高。多见于中老年患者。DTIH是颅脑损伤术中发生急性脑膨出的重要原因。早期诊断和早期治疗是预后良好的关键。     

影响颅脑损伤后精神障碍的相关危险因素分析

目的探讨影响颅脑损伤后精神障碍的相关危险因素。方法收集我院2012年1月至2015年1月我院收治的187例颅脑损伤患者的临床资料,按照是否出现精神障碍将所有患者分为病例组(精神障碍组)和对照组(非精神障碍组),比较两组患者相关临床资料的差异,并利用Logistic回归分析探讨影响颅脑外伤后精神障碍的相关危险因素。结果 187例颅脑损伤患者出现75例精神障碍(发病率40.1%);单因素分析提示两组患者在教育程度、受伤至急救时间、GCS评分≤8分、颅内血肿、额叶损伤、损伤范围、低氧血症、伤后昏迷存在统计学差异(P0.05);经过多因素Logistic回归分析最终筛选出GCS评分≤8分、颅内血肿、额叶损伤、损伤范围、低氧血症是颅脑损伤后发生精神障碍的高危因素。结论颅脑损伤后精神障碍发生率较高且受到多种因素的影响,临床中应当重视此类高危因素,以制定相关干预措施降低精神障碍发生率。     

迟发性外伤性颅内血肿122例临床分析

目的探讨迟发性外伤性颅内血肿(DTIH)的临床特点、诱发因素及防治措施。方法 对我科自2001—01~2003-06收治的122例DTIH病人的临床及影像学资料进行回顾性分析。结果 DTIH占颅脑损伤病人的8.97％,死亡率23.8％。占同期颅脑损伤术中急性脑膨出病因的35.7％。中老年患者占DTIH患者的45.9％。DTIH发生在24h内占82％,72h内占97.5％。结论 DTIH多发生在颅脑损伤后72h内,伤后24h内发生率较高。多见于中老年患者。DITH是颅脑损伤术中发生急性脑膨出的重要原因。早期诊断和早期治疗是预后良好的关键。     

重型颅脑损伤术中急性脑膨出与损伤部位的相关性分析

目的探讨重型颅脑损伤病人开颅术中发生急性脑膨出与脑组织受伤部位的相关性。方法回顾性分析237例重型颅脑损伤开颅手术病人的临床资料及随访结果,术中发生急性脑膨出共71例,将其分为原发性术中脑膨出(Ⅰ型)和继发性术中脑膨出(Ⅱ型)。分析各型临床特点,采用综合治疗措施。根据伤后6个月GOS预后评分判断病人预后。结果 237例中,71例额部损伤病人发生Ⅱ型脑膨出1例,166例侧方损伤病人(额颞顶部损伤)发生Ⅰ型脑膨出56例,Ⅱ型14例;额部损伤病人术中脑膨出发生率明显低于侧方损伤病人(P0.01)。按术后6个月GOS评分,Ⅱ型脑膨出病人预后明显优于Ⅰ型(P0.01)。结论额叶损伤病人极少发生Ⅰ型脑膨出,可能与额叶损伤极难导致静脉回流受阻有关,颅脑损伤术中脑膨出的分型能反映临床特点及预后,对选择手术方式有指导意义。     

神经外科颅脑外伤患者预后影响因素分析

目的分析颅脑外伤患者预后的影响因素。方法回顾性分析自2009-08—2013-08收治的150例颅脑外损伤患者的临床资料,总结其受伤至入院时间、血肿量、年龄、格拉斯哥昏迷评分(GCS)、中线移位、颅脑损伤类型及硬膜下血肿、并发症(高钠血症)等相关指标。并应用Logistic回归分析处理影响颅脑外伤患者预后情况的各种因素。结果颅脑外伤患者预后良好率80.50%(120/150);致残率19.50%(29/150),GCS为最大的影响因素。结论诸多因素均可影响颅脑损伤患者的预后,且各因素均存在相互作用,患者受伤后,应及时入院,及早采取相关治疗措施,针对性地采取干预措施来改善预后。     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Bibliography of officers of department of mental hygiene

Psychiatric Quarterly -