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1.
目的:探讨重型颅脑损伤患者减压术后继发性脑积水发生的影响因素.方法:回顾性分析2018年5月~2020年5月在深圳市宝安区福永人民医院行去骨瓣减压术治疗的92例重型颅脑损伤患者临床资料,记录术后1个月继发性脑积水发生情况,统计患者基线资料,经Logistic回归分析重型颅脑损伤患者减压术后继发性脑积水发生的影响因素.结...  相似文献   

2.
目的:探讨重型颅脑损伤患者术后发生脑积水相关因素分析。方法:选取2010-01—2016-01期间延安大学附属医院收治的196例重型颅脑损伤患者,将其分为脑积水组(29例)和非脑积水组(167例),采用χ2检验分析比较两组患者年龄、GCS评分、硬膜下血肿、开放性颅脑损伤、脑室出血等因素,多因素Logistic回归法分析影响脑积水发生的危险因素。结果:χ2检验显示,两组患者在入院时年龄≥50岁、GCS评分3~5分、硬膜下血肿、开放性颅脑损伤、脑室出血、中线移位程度、早期去大骨瓣减压、硬膜敞开、手术时间、双侧去骨瓣减压、腰穿脑脊液置换、早期颅骨缺损修补术等方面比较,差异有统计学意义(P<0.05);多因素Logistic回归分析提示,入院时硬膜下血肿、脑室出血、中线移位程度、早期去大骨瓣减压、硬膜敞开、双侧去骨瓣减压为危险因素,腰穿脑脊液置换、早期颅骨缺损修补术为保护因素,有统计学意义(P<0.05)。结论:重型颅脑损伤患者存在硬膜下血肿、脑室出血、中线移位程度≥12mm、早期去大骨瓣减压、硬膜敞开、双侧去骨瓣减压等情况时,要警惕术后发生脑积水的可能。  相似文献   

3.
目的探究重型颅脑创伤去骨瓣减压外科治疗后脑积水处理方法。方法对2012年1月至2015年12月在该院进行重型颅脑创伤去骨瓣减压外科治疗后脑积水手术治疗的80例患者进行回顾性分析,将80例患者按手术方式不同分为先行腹腔分流术(VPS)组、后行VPS组、早期组和晚期组,先行VPS组即先行VPS再行颅骨术组(19例),后行VPS组即先行颅骨术后行VPS组(21例),早期组即早期(骨瓣减压术后3个月内)行脑室-腹腔分流术+颅骨修补术(20例),晚期组即晚期(骨瓣减压术后3个月后)行脑室-腹腔分流术+颅骨修补术(20例),比较4组患者手术有效率、术后并发症(包括分流过度、头皮感染、术后发热等症状)比例和术后实验室观察指标(包括脑脊液蛋白、脑脊液白细胞和氯化物)方面的差异。结果先行VPS组、后行VPS组、早期组和晚期组手术有效率分别为89.5%、90.1%、90.0%、95.0%,4组比较差异无统计学意义(P0.05)。4组患者术后脑脊液蛋白水平分别为(0.21±0.88)、(0.24±0.56)、(0.27±0.77)、(0.26±0.65)g/L;脑脊液白细胞水平分别为(0.05±0.02)、(0.07±0.02)、(0.06±0.12)、(0.06±0.11)×10~9/L;氯化物水平分别为(68.0±10.0)、(67.6±9.8)、(69.8±10.9)、(65.4±0.92)g/L,4组患者3项指标比较差异均无统计学意义(P0.05)。先行VPS组分流过度患者为6例,为最多,而头皮感染、脑脊液漏例数是4组患者中最少的;后行VPS组术后发热例数最多;早期组头皮感染例数为4例;晚期组例数均衡。结论先行VPS再行颅骨术、先行颅骨术后行VPS、早期行脑室-腹腔分流术+颅骨修补术、晚期行脑室-腹腔分流术+颅骨修补术4种手术方法均可实现脑积水的有效治疗,且治疗效果相近。  相似文献   

4.
目的:探讨动脉瘤性蛛网膜下腔出血(SAH)后慢性脑积水的危险因素。方法:将208例经CT证实为蛛网膜下腔出血(SAH)、数字减影血管成像(DSA)确诊为颅内动脉瘤的患者根据出血2周后CT检查有无脑积水分为脑积水组(25例)和非脑积水组(183例),分析两组患者在性别、年龄、高血压史、Hunt—Hess分级、多次出血、动脉瘤位置、脑室积血、急性脑积水等方面的差异。结论:脑积水组和非脑积水组在性别、年龄、发病后的Hunt—Hess分级、多次出血、脑室积血、急性脑积水等方面存在显著差异,为动脉瘤性蛛网膜下腔出血(SAH)后慢性脑积水的危险因素。  相似文献   

5.
将收治的120例重型颅脑损伤患者随机分为观察组和对照组各60例,对照组采用常规去骨瓣减压术治疗,观察组采用大骨瓣减压术治疗,观察两组的治疗效果及术后不良反应。结果观察组治疗效果明显优于对照组(P〈0.05)。大骨瓣减压术应用于重型颅脑损伤的临床效果十分显著,有效提高了患者的康复率和生活质量,值得推广。  相似文献   

6.
目的 探讨颅脑外伤患者血肿清除术后脑积水发生的影响因素.方法 选取2017年10月~2020年10月于我院接受治疗的颅脑外伤患者100例,所有患者均接受血肿清除术治疗,根据术后是否发生脑积水,分为发生组与未发生组;统计所有患者临床资料,并将可能的影响因素纳入,经单因素与多因素分析找出颅脑外伤患者血肿清除术后脑积水发生的...  相似文献   

7.
目的探讨重型颅脑损伤术后发生外伤性脑积水的危险因素。方法选取2018年1月~2019年1月我院收治210例重型颅脑损伤患者临床资料,所有患者均接受手术治疗,记录患者一般资料,对可能会引起重型颅脑损伤术后发生外伤性脑积水的各因素进行分析。结果术后发生外伤性脑积水患者42例,术后未发生外伤性脑积水患者168例。两组年龄对比,差异无统计学意义(P>0.05);发生组术前GCS评分3~5分、术后GCS评分3~8分、去骨瓣减压术、术后颅内感染占比均高于未发生组,差异有统计学意义(P<0.05);经Logistic回归分析发现,术前GCS评分3~5分、术后GCS评分3~8分、去骨瓣减压术、术后颅内感染为导致重型颅脑损伤术后外伤性脑积水发生的危险因素(OR>1,P<0.05)。结论围术期GCS评分、去骨瓣减压术、术后颅内感染均为重型颅脑损伤术后外伤性脑积水的危险因素,临床应对应采取有效干预措施,以减少预后风险。  相似文献   

8.
外伤性颅脑损伤在急诊外科是常见病,积极保护脑干功能是提高外伤性颅脑损伤抢救成功率的关键,CT影像学检查可早期做出恰当的病情评估及预后判断,从而可采取相应的治疗措施来阻断病情的发展。CT扫描征象包括有基底池的状况、中线移位情况、外伤性蛛网膜下腔出血的严重程度、脑室系统受压情况及颅内损伤灶性质和范围等。  相似文献   

9.
去骨瓣减压与保留骨瓣治疗重型颅脑损伤对比分析   总被引:3,自引:1,他引:3  
本组 130例病例来自陕西中医学院附属医院及杭州市红十字会医院神经外科 1999年 1月~ 2 0 0 1年 12月收治的重型颅脑损伤患者 ,探讨重型颅脑损伤患者去骨瓣减压的价值。一、临床资料与方法1.一般资料 :本组 130例 ,男性95例 ,女 35例 ,年龄 18~ 6 6岁 ,平均38岁。入院时间 0 5~ 2 4h ,平均 3 8h。入院时格拉斯哥昏迷评分 (GCS) 3~ 8分。一侧瞳孔散大 31例 ,双侧瞳孔散大 11例 ,去皮层状态 6例。临床分组采用入院后随机原则分为去骨瓣减压组 (n =71)、手术后保留骨瓣组 (n =59)。入院时CT检查 :硬膜下血肿 4 3例 ,脑挫裂伤脑内…  相似文献   

10.
目的 分析婴幼儿颅脑损伤后外部性脑积水(EH)的危险因素.方法 回顾性分析我院2004年3月至2009年4月收治的178例颅脑损伤婴幼儿患者的临床资料,对婴幼儿脑损伤后EH的相关临床因素进行单因素和Logistic回归分析.结果 单因素分析结果 显示:年龄、伤后GCS评分、昏迷时间、脑挫裂伤、蛛网膜下腔出血和继发癫痫均是婴幼儿EH的危险因素(P均<0.05),性别、是否合并创伤性湿肺和甘露醇的使用剂量与EH相关性较小(P均>0.05),婴幼儿颅脑损伤后EH的发生率为14%(25/178),年龄(OR=0.5743)、伤后昏迷时间(OR=3.0628)、伤后GCS评分(OR=1.5628)、蛛网膜下腔出血(OR+3.7093)、脑挫裂伤(OR=4.7892)和外伤后癫痫(OR=2.9976)均是婴幼儿EH的危险因素(P均<0.05).结论 患儿≤2岁、伤后GCS评分低、昏迷时间长、有脑挫裂伤、蛛网膜下腔出血和合并癫痫发作可以增加婴幼儿颅脑损伤后EH危险性,此研究可为婴幼儿颅脑损伤后EH的预防提供参考.
Abstract:
Objective To analyze the risk factors for the external hydrocephalus (EH) after traumatic brain injury in the infants. Methods The clinical data of 178 cases of infants and young children with traumatic brain injury from March 2004 to April 2009 were retrospectively analyzed. Univariate and logistic regression analysis were performed to identify the clinical risk factors for EH after traumatic brain injury. Results By univariate regression analysis, age, GCS score after trauma, coma duration, brain contusion, subarachnoid hemorrhage and epilepsy were risk factors for external hydrocephalus in the infants and young children (Ps < 0.05). Gender,traumatic wet lung and usage of mannitol were less relevant to EH (Ps >0. 05). The incidence of EH after traumatic brain injury in the infants and young children was 14% (25/178 ). Age ( OR = 0.5743 ) , coma duration after trauma (OR =3.0628) ,subarachnoid hemorrhage (OR =3.7093),brain contusion(OR = 4.7892) and post-trauma epilepsy (OR =2. 9976) were risk factors for EH (Ps < 0. 05). Conclusion Younger than 2 years old, low GCS score, long coma duration, brain contusion, subarachnoid hemorrhage and epilepsy would increase the risk of EH after traumatic brain injury in the infants and young children. This study provides information for the prevention of EH after traumatic brain injury in the infants and young children.  相似文献   

11.
目的探讨影响重型颅脑损伤患者发生脑积水的相关因素。方法回顾性分析127例重型颅脑损伤患者的临床资料,采用非条件Logistic回归,对去骨瓣减压术、弥漫性蛛网膜下腔出血、脑室内出血、术前GCS评分、患者年龄、性别与发生脑积水是否相关进行分析。结果Logistic回归显示去骨瓣减压术(P=0.004)、术前蛛网膜下腔出血(P=0.011)、年龄(P=0.018)及脑室出血(P=0.003)与发生脑积水相关,具有统计学意义。结论行去骨瓣减压术治疗、术前有弥漫性蛛网膜下腔出血、高龄及有脑室内出血是重型颅脑损伤患者发生脑积水的重要危险因素。  相似文献   

12.
The purpose of this study was to identify risk factors that may be predictive of posttraumatic stress disorder (PTSD) in children after a traumatic injury. The study was a retrospective review of data collected from 337 pediatric trauma patients treated in a multidisicplinary outpatient clinic. Results from Chi-square and t-test analyses indicated that gender, ethnicity, age, and injury severity were not risk factors for PTSD. However, mechanism of injury, specifically a gun shot wound (p =.001), was associated with development of PTSD, as was body area of injury, specifically the abdomen (p =.001). Psychiatric screening of patients with gun shot wounds and wounds to the abdomen may help with the early identification and treatment of PTSD.  相似文献   

13.
重型颅脑损伤后脑积水原因及其治疗   总被引:14,自引:1,他引:14  
目的 分析重型颅脑损伤后脑积水的原因和治疗体会。方法 对我院18例重型颅脑损伤后脑积水的临床资料进行回顾性分析。结果 经治疗后本组18例患者中恢复良好12例,中残3例,重残2例,死亡l例。结论 分析脑积水原因,并针对其病因和积水不同时期,采取相应的措施,如侧脑室外引流,病因治疗或行内分流术。  相似文献   

14.
Sympathetic storming after severe traumatic brain injury   总被引:1,自引:0,他引:1  
Lemke DM 《Critical care nurse》2007,27(1):30-7; quiz 38
  相似文献   

15.

Purpose

To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO2) after severe traumatic brain injury (TBI) and to examine its impact on outcome.

Methods

This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO2 was monitored. The relationship between Hgb—categorized into four quartiles (≤9; 9–10; 10.1–11; >11?g/dl)—and PbtO2 was analyzed using mixed-effects models. Anemia with compromised PbtO2 was defined as episodes of Hgb?≤?9?g/dl with simultaneous PbtO2?Results We analyzed 474 simultaneous Hgb and PbtO2 samples from 80 patients (mean age 44?±?20?years, median GCS 4 (3–7)). Using Hgb?>?11?g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO2, PaCO2), Hgb?≤?9?g/dl was the only Hgb level that was associated with lower PbtO2 (coefficient ?6.53 (95?% CI ?9.13; ?3.94), p?2?p?=?0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score.

Conclusions

In this cohort of severe TBI patients whose PbtO2 was monitored, a Hgb level no greater than 9?g/dl was associated with compromised PbtO2. Anemia with simultaneous compromised PbtO2, but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.  相似文献   

16.
Hoffman JM, Dikmen S, Temkin N, Bell KR. Development of posttraumatic stress disorder after mild traumatic brain injury.ObjectiveTo examine the incidence of and factors associated with the development of posttraumatic stress disorder (PTSD) 6 months after civilian mild traumatic brain injury (MTBI).DesignSecondary analysis of a randomized controlled trial of telephone follow-up versus usual care to reduce MTBI symptoms and improve function.SettingIn-person and telephone interviews.ParticipantsProspectively studied participants (N=239) with MTBI enrolled in the emergency department.InterventionsNot applicable.Main Outcome MeasuresSecondary analysis with main outcome measure of Posttraumatic Stress Disorder Checklist–Civilian Version.ResultsAt 6 months after MTBI, 17% of participants met criteria for diagnosis of PTSD. Logistic regression predicting PTSD from baseline characteristics showed that participants who were Hispanic versus white, non-Hispanic and who, at the time of injury, described themselves as less happy and believed they would be more affected by their injury were significantly more likely to have PTSD.ConclusionsRates of PTSD in civilian MTBI in this study are consistent with prior research. Results suggest that personality characteristics and attribution regarding the injury may impact the development of PTSD. Early interventions addressing risk factors may prevent or reduce the likelihood of developing PTSD.  相似文献   

17.
目的探讨重型颅脑损伤发生脑积水的原因及防治措施。方法回顾性分析2004年~2010年作者收治的643例重型颅脑损伤患者,对其中47例并水患者行脑室-腹腔分流术。结果脑室-腹腔分流术在临床上收效良好。结论 重型颅脑损伤所引发的脑积水并发症患者,及时采取脑室-腹腔分流术,可明显降低伤残率和病死率。  相似文献   

18.
Objective: This research examined the long-term outcomes of rehabilitation patients with moderate to severe traumatic brain injury (TBI).

Design: Retrospective cohort study.

Setting and subjects: We examined consecutive records of persons with moderate to severe traumatic brain injury who were discharged from a large rehabilitation hospital in Pennsylvania from 1973 to 1989. We interviewed consenting participants (n = 306) up to 24 years post-injury.

Main outcome measures: Self-rated health, activity limitations, employment, living arrangements, marital status, Community Integration Questionnaire, and use of rehabilitation services.

Results: Participants were most limited in activities such as managing money and shopping. Twenty-nine per cent of our participants were working full time. There were significant relationships between activity limitations and residual cognitive impairment at follow-up. Self-rated health was correlated with most instrumental activities of daily living.

Conclusion: Our findings document health and function in a large post acute TBI population and implications for rehabilitation are discussed.  相似文献   

19.
Objective: To describe employment outcome four years after a severe traumatic brain injury by the assessment of individual patients’ preinjury sociodemographic data, injury-related and postinjury factors.

Design: A prospective, multicenter inception cohort of 133 adult patients in the Paris area (France) who had received a severe traumatic brain injury were followed up postinjury at one and four years. Sociodemographic data, factors related to injury severity and one-year functional and cognitive outcomes were prospectively collected.

Methods: The main outcome measure was employment status. Potential predictors of employment status were assessed by univariate and multivariate analysis.

Results: At the four-year follow-up, 38% of patients were in paid employment. The following factors were independent predictors of unemployment: being unemployed or studying before traumatic brain injury, traumatic brain injury severity (i.e., a lower Glasgow Coma Scale score upon admission and a longer stay in intensive care) and a lower one-year Glasgow Outcome Scale–Extended score.

Conclusion: This study confirmed the low rate of long-term employment amongst patients after a severe traumatic brain injury. The results illustrated the multiple determinants of employment outcome and suggested that students who had received a traumatic brain injury were particularly likely to be unemployed, thus we propose that they may require specific support to help them find work.

  • Implications for rehabilitation
  • Traumatic brain injury is a leading cause of persistent disablity and can associate cognitive, emotional, physical and sensory impairments, which often result in quality-of-life reduction and job loss.

  • Predictors of post-traumatic brain injury unemployment and job loss remains unclear in the particular population of severe traumatic brain injury patients.

  • The present study highlights the post-traumatic brain injury student population require a close follow-up and vocational rehabilitation.

  • The study suggests that return to work post-severe traumatic brain injury is frequently unstable and workers often experience difficulties that caregivers have to consider.

  相似文献   

20.
目的 分析重症创伤性颅脑损伤后血清垂体前叶激素的变化及相关因素.方法 回顾性分析2018年6月至2020年6月晋城市人民医院收治的重症创伤性颅脑损伤患者109例的临床资料,在颅脑损伤后1~3d采取静脉血检测血清垂体前叶激素水平,按照是否出现血清垂体前叶激素分泌异常分为正常组(n=60)与异常组(n=49),对影响血清垂...  相似文献   

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