CT血管造影对重型颅脑创伤的早期监测及预后判定

目的 探讨CT血管造影(CTA)对重型颅脑创伤早期监测及预后判定的作用.方法 对58例重型颅脑创伤患者术前及术后使用128层螺旋CT行头颅CTA动态检查.结果 重型颅脑创伤后CTA显示脑血管主要发生五种变化:血管移位、动脉痉挛或闭塞、动脉穿支减少、脑深静脉狭窄或闭塞、大脑浅静脉狭窄或闭塞.大动脉痉挛或闭塞者预后差,大脑深静脉如大脑内静脉和基底静脉同时闭塞者预后极差,大脑浅静脉的狭窄或闭塞反映了颅内压的变化.结论 CTA可用于重型颅脑创伤的早期监测及预后判定.     

重型、特重型颅脑外伤性脑梗死相关危险因素分析

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case - fatality. Methods Gender, age, Glasgow coma scale ( GCS), the presence or absence of basicranial fracture, cerebral hernia or infection, surgical modality, hypotension, and the use of diuretics and hemorheologic agents were recorded and analyzed in 62 PTCI patients ( study group)and 680 patients without PTCI (control group) following severe and extremely severe head injuries.Results GCS, the presence or absence of cerebral hernia and/or infection, hypotension, the use of diuretics and hemorheologic agents were closely correlated with the occurrence of PTCI ( P ＜ 0. 05 ).Conclusion GCS, the presence of cerebral hernia and infection, hypotension, and over - dosage of diuretics are common risk factors for PTCI, and the use of hemorheologic agents is a protective factor of PTCI in patients with severe and extremely severe head injuries.     

控制减压治疗重型、特重型颅脑伤

目的 探讨控制减压治疗重型、特重型颅脑伤的临床疗效.方法 将128例重型、特重型颅脑伤随机分成两组进行前瞻性研究,采用控制减压手术方法者为治疗组,采用常规开颅者为对照组.结果 按GOS治疗结果,治疗组良好率较对照组提高17.2%,治疗组死亡率较对照组下降12.5%;术中脑膨出的发生率治疗组较对照组下降17.2%,迟发血肿的发生率治疗组较对照组下降7.8%,因迟发血肿引起的术中脑膨出治疗组较对照组下降12.5%(P＜0.05).结论 控制减压通过颅内压力的逐步释放,降低或延缓了因颅内迟发血肿引起的术中急性脑膨出,对改善重型、特重型颅脑创伤患者的预后起到了积极的救治作用.     

CT血管造影对重型颅脑损伤继发血管损害的诊断作用

重型颅脑损伤患者的预后与原发脑损伤的程度直接相关,更与脑血流障碍引起的继发性脑损害密不可分.以往有文献报道使用经颅多普勒观察颅脑损伤后脑血流的变化,但重型颅脑损伤后脑血管究竟发生了那些变化、针对这些变化如何指导临床进行救治却少有报道[1-4].我科自2008年8月至2009年10月使用128层螺旋CT对62例重型颅脑损伤患者行头颅CT扫描的同时行CT血管造影(CTA)动态监测,对继发性脑血管损害的诊断和治疗起到了积极的指导作用.现报告如下.     

重型创伤性脑损伤患者早期气管切开的应用及其意义

重型创伤性脑损伤( severe traumatic brain injury,sTBI)患者往往伴有严重的意识障碍和呼吸功能衰竭,气管切开建立人工气道伴以机械辅助通气(mechanical ventilation,MV)能保持这些患者呼吸通畅,避免严重的低氧血症.但气管切开的时机存在争议,主要原因是气管切开术后并发症,特别是呼吸机相关性肺炎(ventilator - associated pneumonia,VAP)的发生,对患者预后影响报道不一.     

外伤性大脑纵裂血肿41例治疗体会

目的提高对外伤性大脑纵裂血肿的认识,探讨大脑纵裂血肿的发生机制、临床表现和治疗方法。方法回顾性分析2000年1月至2009年1月收治的41例外伤性大脑纵裂血肿患者的临床资料。41例患者中,直接手术13例,15例行颅内压监护,其中5例因颅内压进行性增高行开颅手术,余13例先行保守治疗,其中3例因意识下降及出现较重的神经功能障碍行开颅手术。结果出院时根据GOS评分进行疗效评定,恢复良好30例,中残6例,重残3例,植物生存1例,死亡1例。结论对外伤性大脑纵裂血肿的患者,治疗方法包括保守治疗及手术治疗,颅内压变化、神经功能障碍及意识障碍等是手术治疗的重要依据。     

重型、特重型颅脑外伤性脑梗死相关危险因素分析

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case - fatality. Methods Gender, age, Glasgow coma scale ( GCS), the presence or absence of basicranial fracture, cerebral hernia or infection, surgical modality, hypotension, and the use of diuretics and hemorheologic agents were recorded and analyzed in 62 PTCI patients ( study group)and 680 patients without PTCI (control group) following severe and extremely severe head injuries.Results GCS, the presence or absence of cerebral hernia and/or infection, hypotension, the use of diuretics and hemorheologic agents were closely correlated with the occurrence of PTCI ( P ＜ 0. 05 ).Conclusion GCS, the presence of cerebral hernia and infection, hypotension, and over - dosage of diuretics are common risk factors for PTCI, and the use of hemorheologic agents is a protective factor of PTCI in patients with severe and extremely severe head injuries.     

重型、特重型颅脑外伤性脑梗死相关危险因素分析

目的 探讨重型、特重型颅脑外伤性脑梗死的发生机制及危险因素,为降低外伤性脑梗死的发生率和病死率提供依据.方法 对62例外伤性脑梗死患者(研究组)与680例未发生脑梗死的重型、特重型颅脑外伤患者的性别、年龄、伤情(GCS评分)、颅底骨折、脑疝、感染、手术、低血压、脱水药、活血药等因素进行调查和对照分析.结果 伤情、脑疝与否、感染与否、低血压、脱水药及活血药的使用与否等因素与外伤性脑梗死的发生密切相关(P＜0.05).结论 伤情、脑疝与否、感染与否、低血压、脱水药的过量使用等是外伤性脑梗死的常见危险因素,活血药的使用是外伤性脑梗死的保护因素.

Abstract：

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case - fatality. Methods Gender, age, Glasgow coma scale ( GCS), the presence or absence of basicranial fracture, cerebral hernia or infection, surgical modality, hypotension, and the use of diuretics and hemorheologic agents were recorded and analyzed in 62 PTCI patients ( study group)and 680 patients without PTCI (control group) following severe and extremely severe head injuries.Results GCS, the presence or absence of cerebral hernia and/or infection, hypotension, the use of diuretics and hemorheologic agents were closely correlated with the occurrence of PTCI ( P ＜ 0. 05 ).Conclusion GCS, the presence of cerebral hernia and infection, hypotension, and over - dosage of diuretics are common risk factors for PTCI, and the use of hemorheologic agents is a protective factor of PTCI in patients with severe and extremely severe head injuries.     

兔外伤性脑梗死模型的制备及其影响因素

目的建立兔外伤性脑梗死(TCI)动物模型,为进一步研究TCI的发生机理、早期预防和治疗提供基础。方法将130只健康新西兰白兔随机分成实验组和对照组。采用硬膜外球囊注生理盐水法制作急性TCI动物模型,实验组按加压大小及持续时间再分12个亚组,每组10只动物。对照组球囊内不注入水。各实验组颅内压维持到预设时间后快速一次性减压,减压12h后使用头颅CT、MRI以及组织病理学检查对各组模型建立情况进行评价分析。结果在对照组及颅内压20mmHg持续的不同时间的各亚组动物,头颅CT、MRI、2,3,5-氯化三苯基四氮唑(TTC)染色及组织学检查均无异常。颅内压30mmHg维持120min组8只模型制作成功,MRI检查见梗死区脑组织弥散成像为高信号,TTC染色可见异常表现。颅内压40mmHg维持120min组死亡5只,5只建模成功,颅内压50mmHg各组动物均在加压后60min内死亡。结论通过硬膜外球囊加压,颅内压为30mmHg维持120min可以建立TCI模型。采用该法建立TCI模型与颅内压大小及维持时间有关。