衢州地区急性颅脑创伤患者院前及急诊救治现状分析

目的对颅脑创伤患者的院前急救和急诊室救治现状进行流行病学调查和研究。方法以2009年衢州地区颅脑创伤住院病人为研究对象,对年龄、性别、致伤原因、致伤日期和时间、现场急救、伤员转运方式、受伤-急诊专科救治时间、受伤一首次头颅检查时间、急诊室急救现状和治疗结果等因素进行分析。结果青壮年男性是急性颅脑创伤的高发人群;交通事故是致伤的主要因素,厂矿企业相关性损伤发生率明显增高。专业人员现场急救和救护车转运比例很低。损伤至入院急救时间最短的是乡镇卫生院,但损伤至专科诊治时间和获首次头颅CT检查时间最长。颅脑创伤以闭合性损伤为主,但急诊科最常用的急救措施是清创缝合。结论颅脑创伤是一种发生率较高,危险性较大的创伤性疾病,可以通过加强相关法律法规和知识普及、教育进行预防,通过对相关医护人员培训和改善医院、尤其是基层医院的医疗设备,降低病死率和致残率。     

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。     

交通事故所致颅脑损伤患者的心理卫生特点及其相关因素分析

目的探讨交通事故所致颅脑损伤患者心理卫生特点及其相关因素，为临床干预提供依据。方法采用结构式问卷和心理测量量表对符合要求的交通事故所致125例颅脑损伤患者的心理卫生情况及其相关因素进行调查。这些问卷和量表包括症状自评量表、艾森克人格问卷、应付方式问卷、社会支持评定量表和生活质量综合评定问卷。结果交通事故后颅脑损伤患者心理卫生状况低于正常人群（P〈0.05）；患者心理卫生与社会支持、应对方式、人格特征、生活质量、事故处理满意度、受伤时间等均有不同程度相关，Logistic回归分析显示，患者心理障碍主要相关因素包括心理功能、躯体功能、退避和事故处理满意度。结论多种因素影响到交通事故后颅脑损伤病人心理卫生，需要医护人员和社会的综合干预才能有效提高病人心理健康水平。     

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]。     

颅脑损伤伴视神经损伤86例临床分析

目的分析颅脑损伤与视神经损伤的相关因素。方法对外伤性视神经病变86例临床资料进行回顾性分析。结果交通事故为最多致伤原因(53.4%),致伤部位以眼眶部间、直接受伤最为常见(54.7%,其中眉弓部直接致伤为25.6%);伤后无光感13例(13眼),有光感及以上73例(87眼)。6个月以上随访视力进步43例(50.0%)。颅脑损伤后有光感以上视力比无光感、伤后无昏迷比有昏迷视力恢复好。视力恢复还与是否有骨折和视觉诱发电位结果有关。结论颅脑损伤后有无昏迷、视力有无光感是影响视神经损伤预后的主要因素。视神经管断层摄影及视觉诱发电位检查是评价预后的有效指标。     

50例交通事故致颅脑损伤后精神障碍分析

随着我国处理交通事故法规的不断完善，交通事故致颅脑损伤后精神障碍已日益受到人们的重视。交通事故所致颅脑损伤后精神障碍是指在交通事故中颅脑遭受直接或间接外伤后，所产生的各种精神障碍。此类案例在临床诊断及法医学鉴定中较为常见。笔收集50例交通事故致颅脑损伤后精神障碍的法医学鉴定资料进行分析，目的是探讨颅脑损伤后精神障碍的相关因素及伤残评定要点。     

颅脑外伤后脑梗死危险因素分析

目的分析探讨颅脑外伤后脑梗死的发生机制以及危险因素。方法采用回顾性研究方法,调查110例颅脑外伤病例,分析颅脑外伤后脑梗死的相关因素。结果颅脑损伤后并发脑梗死与GCS评分、年龄、有无蛛网膜下腔出血、有无脑疝、是否有高血压病史有关,差异有统计学意义(P<0.05),与患者性别、受伤原因以及类型无关,差异无统计学意义(P>0.05)。结论中、重型颅脑外伤患者有脑疝、蛛网膜下腔出血及高龄、合并高血压病史易发生外伤性脑梗死。对脑外伤的及早综合治疗,积极预防脑梗有助于改善患者预后,降低致残及死亡率,提高患者的生存质量。     

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。     

颅脑外伤所致智力障碍研究

目的：了解车祸所致颅脑外伤患者智力受损情况,探讨其影响因素。方法：对105例颅脑损伤患者进行回顾性分析。结果：智力受损99例,占94.3%,左半球受损比例高于右半球,中重度智力受损组颞叶受损、额叶受损、颅骨骨折、脑干损伤、3个以上脑叶同时受损,均明显高于轻度智力受损组。结论：颅脑外伤引起智力受损发生率较高,智力损害与受伤种类、严重程度和部位有明显关系。     

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。     

交通事故性重型颅脑损伤院前急救与预后关联分析(附1107例报告)

目的 探讨院前急救在时间环节上对交通事故性重型颅脑损伤预后的重要性,为我国相关部门制定预防和控制措施提供参考依据.方法 根据珠江医院神经外科制定的<交通事故性重型颅脑损伤统计表>严格筛选出合格病例,对其相关资料进行统计学分析,主要分析急救接报时间与到达现场时间差的不同时间段以及现场抢救中不同时间段与患者预后的相关性.结果 急救接报到到达现场时间段以及现场抢救时间段与患者预后均存在负相关关系(rs=-0.10,P=0.002;rs=-0.06,P=0.034),即随着接报到到达现场时间的增加及随着现场抢救时间的增加,患者死亡率及致残率逐渐增高,预后越差.结论 通过建立和完善急性颅脑损伤预防和控制中心,科学制定院前急救、转运等各项救治制度,尽量缩短路途耽搁时间及现场抢救时间,提高急救反应速度,可提高救护质量,减少死亡率和致残率.

Abstract：

Objective To analyze the importance of pre-hospital emergency treatment in patients with severe head injury in traffic accidents in terms of time and explore the general rule of severe head injury in traffic accidents to provide some evidence for relevant authority making the prevention and control measures of acute traumatic brain injury. Methods The patients were selected according to "statistical table of severe head injury in a traffic accident" established by our department; their correlated data were statistically analyzed. Based on the time intervals between receiving telephone time asking for first-aid and arriving to location of incidence, and time intervals between time of giving first-aid and injured time, the regularity of prognosis was analyzed.Results With the prolonged time intervals between time of giving first-aid and injured time, the mortality and disability rates gradually increased,followed by poor prognosis, which indicated that the prognosis was negatively correlated to the delayed time on the way and the on-site rescue time (rs=-0.10,P=0.002; rs=-0.06,P=0.034). Conclusion Prevention and control center for acute brain injury should be built and the roles for pre-hospital emergency treatment and transportation should be established to decrease the injured time (the delayed time on the way and the on-site rescue time) to improve the quality of care, and to reduce the death and disability in patients with severe head injury in traffic accidents.     

深圳市急性颅脑损伤十年住院病例回顾性调查

目的统计深圳市十年来颅脑外伤的住院病历资料,以了解其流行病学特征,为有效防治颅脑创伤提供依据。方法抽取全市所有创伤病例总数的20%进行创伤流行病学调查统计,再抽取其中颅脑外伤病例进行分析。结果近十年来深圳市共有35万创伤住院患者,按等概率抽样抽取创伤病历55241份,其中颅脑创伤病历10067份,占19.3%。年发生率由1994年的84.22/10万至2003年的132.29/10万,平均年龄28.79岁,交通意外占56.9%:平均住院日17天,平均住院费用10947元人民币。结论颅脑损伤是创伤中最严重的损伤,交通事故是第一位原因,青年男性是最易发生伤害的人群。     

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients. Received: 20 April 1998 / Accepted: 9 October 1998     

新生儿颅脑损伤的产科因素分析

目的探讨影响新生儿颅脑损伤的产科因素。方法选取2015-03—2016-08于我院进行分娩,后转入儿科并接受颅脑超声检查后确诊为颅脑损伤的患者40例(观察组),选取同期非颅脑损伤患者40例为对照组,对2组临床资料进行回顾性分析。结果孕周小、新生儿体质量轻会增加新生儿脑损伤的风险,复杂性单绒毛膜双胎也是引发新生儿颅脑损伤的重要危险因素。结论分娩孕周越早,新生儿发生颅脑损伤的风险越高,特别是30周且新生儿体质量1.5kg时,风险系数明显增高,复杂性单绒毛膜双胎也是导致新生儿发生颅脑损伤的重要危险因素。     

小儿重型颅脑损伤临床特点分析

目的 分析总结小儿重型颅脑损伤的临床特点。方法 回顾性研究小儿重型颅脑损伤患的致伤原因、损伤类型、临床表现，以及救治方法和预后状况。结果 本组共458例，男性317例，女性141例。年龄1个月～15岁。车祸伤185例，坠落伤159例，二合计占75．1％。闭合性颅脑损伤357例，开放性颅脑损伤101例。合并颅内血肿162例(35．4％)；并发颅骨骨折221例，其中凹陷骨折82例。全组均有不同程度的意识障碍，有生命体征变化253例(55．2％)；癫痫发作107例(23．4％)。367例施行血肿清除、去骨瓣减压、凹陷骨折复位术等手术治疗，另外91例保守治疗。恢复良好337例(73．6％)；中残27例(5．9%)；重残12例(2．6％)；植物生存7例(1．5％)；死亡75例(16．4％)。结论 小儿重型颅脑损伤的主要临床特点是原发性脑损伤表现重；生命体征紊乱明显；颅骨凹陷骨折和颅缝分离多见；囟门闭合前后临床特征不同；对冲性颅内血肿发生率低；癫痫发生率高；预后较成人好。     

Epidemiology, prevention and countermeasures against severe traumatic brain injury in Japan and abroad.

On the basis of accurate statistical reports in regard to traffic accidents and safety in Japan, it is clear that traffic accidents on the road, injured victims and all other losses due to these accidents have been increasing since around 1980. Nevertheless, the number of deaths due to traffic accidents has been gradually declining over the last six years. More detailed analysis of data revealed that the most significant factor for the recent reduction of traffic accident deaths was the marked reduction of deaths related to head injury. From the neurosurgical viewpont, the Japanese Data Bank Committee for Traumatic Brain Injury began its formal activity in 1998. Although the registered number of severe head injuries is statistically too small at present to arrive at conclusions, some interesting points draw our attention. As for intracranial pathology diagnosed by the image of cranial CT scans, two thirds of nontraffic cases have focal brain lesions alone. On the other hand, in traffic cases one third of patients have focal lesions alone and one fourth have diffuse brain lesion exclusively. In this study, in 23% of traffic accidents and 12% of nontraffic accidents, consumption of alcohol led indirectly to head injuries. The schedule and details of countermeasures taken against traffic accidents are discussed from an international viewpoint.     

轻中型颅脑损伤合并颈椎骨折的临床诊治

目的总结轻中型颅脑损伤合并颈椎骨折的临床诊治经验，提高对颅颈联合伤的认识和重视程度。方法对我科近两年收治的42例轻中型颅脑损伤合并颈椎骨折患者的临床资料进行回顾性分析。结果行颅脑CT检查显示，29例可见不同程度的脑挫裂伤、硬膜外血肿、硬膜下血肿、脑内血肿或混合型血肿；颈椎CT和X线平片显示，单侧关节突骨折脱位14例，棘突骨折8例，单纯椎体楔形压缩性骨折8例，爆裂性骨折3例，齿突骨折7例，枢椎椎弓骨折2例；经CT血管造影或磁共振血管造影证实颈椎骨折合并椎动脉损伤7例。所有患者均未行开颅手术，针对颈椎骨折。采用颈托或颈围固定、枕颌带牵引等非手术治疗20例，另22例接受Crutchfield钳颅骨牵引、颈前路齿突骨折螺丝钉固定术或钢板内固定术治疗。出院时GOS分级5级24例．4级18例。结论颅颈联合伤在临床上并不少见，应高度重视对颅脑损伤患者的颈部检查和保护，早期应进行颈椎CT扫描并预防椎动脉等血管损伤并发症。     

急性重型颅脑损伤后全身炎症反应综合征的临床研究

目的探讨急性重型颅脑损伤全身炎症反应综合征(SIRS)发生的临床意义。方法74例急性重型颅脑损伤患者,根据诊断标准,其中43例伤后并发SIRS,分析SIRS发生的相关因素以及其与病情轻重、预后的关系。结果急性颅脑损伤后SIRS的发生与脑挫裂伤、颅内高压、蛛网膜下腔出血或血肿破入脑室、高血糖以及开颅手术显著相关;与性别、年龄无关;存在SIRS的急性颅脑损伤患者的死亡率及多脏器功能障碍率较对照组明显升高。结论急性重型颅脑损伤常合并全身炎症反应综合征(SIRS),系多种因素诱导的一种病理过程,对损伤的脑组织和脑外器官的功能恢复有重要影响。发生SIRS提示脑组织广泛损害,临床症状重,预后较差。     

Traffic accidents involving psychiatric patients

The present investigation analyzes the characteristics of traffic accidents involving psychiatric patients and comprises all persons who during the period 1970–74 have been admitted to a psychiatric in-patient institution and who during the period 1972–74 have been involved in a traffic accident causing bodily injury. AAccidents with psychiatric patients involved constitute about 5.7 % of all traffic accidents reported in Denmark. Compared with the total group of accidents, they are characterized by an overrepresentation of women and of persons in the age group 25–54 years. Accidents with psychiatric patients are over-represented during the period July-September, and in areas densely built up. The accidents tend to be more complicated, and the psychiatric patients are more likely to get injured and be hospitalized due to the accident. The investigation is based exclusively on routinely collected data. The limitations with which the results are encumbered and the problems concerning methodology and comparison of merent studies are discussed.     

颅脑损伤所致轻度智力缺损和边缘智力司法精神病学鉴定的对照分析

目的：探讨交通事故中颅脑损伤所致轻度智力缺损和边缘智力司法鉴定的特点。方法：对236例交通事故司法鉴定中轻度智力缺损（轻度组）68例和边缘智力（边缘组）168例患者的鉴定资料进行分析,所有案例鉴定时均作头颅CT及脑电图检查。结果：轻度组有88．2％（60／68例）、边缘组有20．2％（34／168例）的患者为中重度以上颅脑损伤（x。=100．2,P〈0．01）。轻度组脑外伤后格拉斯哥昏迷量表评分（t=14．1）、昏迷时间（t=4．6）及头颅cT结论（x。=80．7）均明显重于边缘组（P均〈0．01）。轻度组有14．7％（10／68例）、边缘组有36．9％（62／168例）的患者智商检查和鉴定结论不一致。轻度组鉴定时的头颅cT软化灶（）（2=41．5）、脑电图异常（X2=76．9）均多于边缘组（P均〈0．01）。结论：轻度智力缺损较边缘智力患者颅脑损伤程度重,头颅CT软化灶及异常脑电图改变多,智商低。