联合内外减压术治疗老年重型颅脑损伤合并脑疝的手术效果

重型颅脑损伤合并脑疝是神经外科较为严重的急性创伤之一,患者多病情复杂且发展迅速,临床治疗不及时或处理不当则会导致患者病情加重,具有较高的致残和致死率,严重影响患者的生命安全及预后[1,2].老年患者因各项脏器功能不断减退,导致患者死亡率较高,其主要致死或致残原因为颅脑损伤后形成血肿、脑水肿及脑肿胀,致使患者颅内压升高[3].目前临床多采用手术治疗,及时有效地诊断患者伤情是临床手术治疗的关键[4].     

立体定向钻颅抽吸术治疗高血压脑出血148例临床观察

经CT定位实施立体定向钻颅抽吸术治疗高血压脑出血148例。术后早期死亡17例,再出血13例（均发生在术后24h以内）。术后6个月随访106例,恢复良好45例。立体定向钻颅抽吸术治疗高血压脑出血,可改善患者愈后,术前证实有出血倾向者慎行该疗法。     

细孔钻颅血肿清除术治疗老年高血压脑出血的疗效及康复效果

<正>高血压脑出血是老年患者常见疾病,6个月病死率可高达50%〔1〕。常规治疗方法包括内科保守治疗、开颅手术治疗等。由于老年高血压脑出血患者自身条件限制,导致内科保守治疗、开颅手术治疗效果均不甚理想〔2〕。本文旨在探讨细孔钻颅血肿清除术治疗老年高血压脑出血的临床疗效及预后。1资料和方法1.1一般资料选取120例老年高血压脑出血患者,根据治疗方法分成对照组和观察组各60例。对照组男36例,女     

超低位大骨瓣开颅颞肌下减压术治疗重型颅脑损伤伴脑疝的临床效果分析

目的分析超低位大骨瓣开颅颞肌下减压术治疗重型颅脑损伤伴脑疝的临床效果。方法选择2008年10月—2013年10月安阳市中医院神经外科确诊的重型颅脑损伤伴脑疝住院患者85例,将其按照入院顺序编号分为标准组42例和低位组43例。标准组患者行标准大骨瓣减压术治疗,低位组患者行超低位大骨瓣开颅颞肌下减压术治疗。术后48 h和48~72 h对比两组患者颅内压变化、瞳孔回缩情况及脑池显示情况,并比较两组临床疗效。结果低位组平均颅内压低于标准组(P0.01)。术后48 h,低位组单侧瞳孔回缩率和双侧瞳孔回缩率高于标准组;术后48~72 h,低位组双侧瞳孔回缩率高于标准组(P0.05)。术后48 h和48~72 h,低位组双池显示率高于标准组(P0.05)。低位组总有效率为97.7%(42/43),高于标准组的80.9%(34/42)(P0.05)。结论超低位大骨瓣开颅颞肌下减压术治疗重型颅脑损伤伴脑疝患者效果确切,能有效降低颅内压,促进瞳孔回缩和改善神经功能缺损程度。     

细孔钻颅术治疗高血压脑出血150例疗效观察

自2005年10月起，我科共应用细孔钻颅术治疗高血压脑出血150例，疗效较好。现报告如下。 临床资料：本组150例，男82例、女68例，年龄36—78岁。其中右侧出血78例，左侧出血72例；内囊出血64例，     

亚低温疗法联合去骨瓣减压术治疗老年重型颅脑损伤患者的临床效果观察

目的观察亚低温疗法联合去骨瓣减压术治疗老年重型颅脑损伤患者的临床效果。方法选取2009年4月—2015年4月黄冈市罗田县人民医院收治的老年重型颅脑损伤患者60例,采用随机数字表法分为对照组和观察组,每组30例。对照组患者行去骨瓣减压术,观察组患者在对照组基础上采用亚低温疗法。比较两组患者术后6个月预后及术后并发症发生情况。结果观察组患者术后6个月预后优于对照组(P<0.05)。观察组患者术后癫痫、脑积水发生率低于对照组(P<0.05),而两组患者术后肺炎、颅内感染、上消化道出血发生率比较,差异无统计学意义(P>0.05)。结论亚低温疗法联合去骨瓣减压术能有效改善老年重型颅脑损伤患者预后,降低术后并发症发生率。     

亚低温治疗重症颅脑损伤患者的临床效果观察

目的探讨亚低温治疗重症颅脑损伤的临床效果。方法选择我院重症颅脑损伤的患者98例,将其随机分为治疗组和对照组,各49例。治疗组根据患者情况入院后或手术后实行亚低温治疗;对照组在常温下进行对症、支持等常规治疗。结果治疗后,治疗组良好率为42.9%,并发症发生率为18.4%;对照组良好率为20.4%,并发症发生率为42.9%。两组患者良好率和并发症发生率比较,差异均有统计学意义(P<0.05)。结论亚低温治疗重症颅脑损伤患者的临床效果较好,但应注意防止并发症的发生。     

高压氧治疗颅脑损伤的临床疗效观察

目的观察高压氧治疗颅脑损伤的临床疗效。方法选择2011—2013年我院收治的颅脑损伤患者200例,将其随机分为观察组和对照组,各100例。对照组患者常规采用手术、药物及物理康复等治疗方式,观察组患者在对照组治疗的基础上同时实施高压氧治疗。治疗前后应用颅脑损伤残疾评定量表(DRS)与格拉斯哥昏迷量表(GCS)对患者病情进行评定,并比较两组患者临床疗效。结果观察组总有效率为89%(89/100),高于对照组的74%(74/100)(P0.05)。治疗前两组患者DRS和GCS评分比较,差异均无统计学意义(P0.05);治疗后观察组DRS评分低于对照组,GCS评分高于对照组(P0.05)。结论高压氧治疗颅脑损伤疗效显著,可以促进患者神经系统功能的恢复,有效保障患者的生命质量。     

颅压平口服液结合早期康复训练治疗创伤性颅脑损伤的临床研究

目的探讨颅压平口服液结合早期康复训练对急性颅脑损伤的临床疗效及其机制。方法45例创伤性颅脑损伤（TBI）患者随机分为药康组、康复组、对照组,对照组按神经外科西医常规治疗;康复组按西医常规治疗加用早期康复训练;药康组在康复组的基础上加用颅压平口服液,每6h一次,每次40mL。对3组治疗前后及组间神经功能缺损评分（GCS评分）、Barthel指数评分进行比较。结果药康组显愈率为86．6％,总有效为93．33％,明显优于对照组和康复组。3组治疗后Barthel指数评分比较药康组明显优于对照组（P〈0．01）,康复组优于对照组（P〈0．05）,药康组与康复组间比较无统计学意义（P〉0．05）。结论颅压平口服液结合早期康复训练在缓解和消除急性颅脑损伤临床症状、改善患者日生活常能力（ADL）,降低伤残率,提高生活质量方面起到了较好的临床疗效。     

高频重复经颅磁刺激结合高压氧治疗重度颅脑损伤昏迷患者的疗效观察

目的 探讨高频重复经颅磁刺激结合高压氧对重度颅脑损伤昏迷患者的治疗效果.方法 以随机数字表法将2019年2月至2020年2月收治的76例重度颅脑损伤昏迷患者分为对照组38例与观察组38例.对照组予以高压氧治疗,观察组在对照组基础上实施高频重复经颅磁刺激治疗.观察两组患者治疗前、治疗4周后觉醒意识、脑血流动力学及神经电生...     

微创血肿碎吸术联合头部低温治疗高血压性脑出血脑疝的效果

目的　探讨高血压性脑出血脑疝 (HIHCH)的治疗方法。方法　采用微创血肿碎吸术联合头部低温的方法治疗了 132例患者 ,并与未行头部低温治疗的 131例相匹配患者进行比较。结果　治疗组神经功能缺损评分和日常生活能力评分明显改善 ,优于对照组 ,病死率、再出血率明显低于对照组。结论　微创血肿碎吸术联合头部低温是治疗HIHCH较为有效的方法。     

Nonsurgical treatment of drooling in a patient with closed head injury and severe dysarthria

The purpose of this investigation was to measure the effectiveness of the antimuscarinic drug atropine sulfate in the treatment of chronic drooling in a patient with a history of severe closed head injury and resultant widespread oral neuromuscular and higher cortical disturbances. Results of the A-B-A-B-A-B withdrawal paradigm, chosen to demonstrate the functional relationship between drug therapy and the degree of drooling, revealed that administration of atropine sulfate reduced by more than 50% of baseline levels the amount of resting secretion, intraoral accumulation, and pharyngeal-laryngeal pooling of saliva, with negligible side effects. These results are discussed and compared to the alternative drug and surgical approaches to the alternative drug and surgical approaches to treatment that have been the primary focus of recent research on drooling.     

老年重型颅脑损伤患者的围手术期治疗

目的 总结６７例格拉斯哥昏迷量表（Ｇｌａｓｇｏｗ ｃｏｍａ ｓｃａｌｅ,ＧＣＳ）３～８分老年重型颅脑损伤患者的围手术期治疗经验。方法 对我科１９９２年２月至１９９８年１０月收入院行手术治疗的６７例老年重型颅脑损伤患者进行回顾性分析。结果 ６７例老年重型颅脑损伤患者中存活４５例（６７．２％）,其中恢复良好和中残３４例（５０．７％）,重残１１例（１６．５％）,死亡２２例（３２．８％）。结论 积极的围手术期治疗,包括院前急救、颅内血肿的早诊早治、骨瓣减压、颅压监护、亚低温治疗、脑血管痉挛的治疗、各种并发症的防治及全身支持治疗等措施。可改善老年重型颅脑损伤患者的预后。     

重症胰腺炎治疗的实验和临床研究

近年来由于重症胰腺炎发病率的增高 ,国内外进行了广泛而深入的实验和临床研究 ,以挽救更多的生命。目前已达到一些共识 ,对特发性重症胰腺炎基本上以内科保守治疗为主 ,有大胆石嵌于壶腹者 ,在保持内境稳定之下先作Ｏｄｄｉ括约肌切开取石 ,解除梗阻。坏死伴有感染 ,腹腔内有脓肿而抗生素能控制 ,经皮穿刺引流成功者 ,仍保守治疗 ,抗生素不能控制者 ,应早期扩创 ,清除坏死组织 ,并行规范积极的内科治疗。重症胰腺炎不论其为何种病因引起 ,其发病过程可分三期 :局部炎症坏死期 ,全身性炎症反应期 ,多器官功能不全期。其发病机制可参见文献[1…     

微创血肿引流术治疗老年人重型脑出血的效果评价

目的　探讨老年人重型脑出血的有效治疗方法。方法　采用微创引流清除血肿的方法治疗了 35例患者 ,同时选择与之相匹配的、同期住院的、只行内科治疗的老年人重型脑出血患者 4 0例作对照。结果　微创治疗组的总有效率 (77.14 % )及BarthelIndexes(BI) (6 2 .2 1± 2 6 .5 8分 )均明显高于内科治疗组 (P <0 .0 5 ) ,并且其脑疝发生率(2 2 .86 % )及消化道出血发生率 (2 2 .86 % )明显低于内科治疗组 (P <0 .0 5 )。结论　微创引流清除血肿术是一种抢救老年人重型脑出血的有效治疗方法     

高压氧辅助治疗重型颅脑损伤的疗效观察

目的探讨高压氧辅助治疗重型颅脑损伤的疗效。方法将58例重型颅脑损伤患者随机分为治疗组(30例)和对照组(28例)。治疗组在神经外科常规治疗的基础上进行高压氧治疗,对照组仅进行神经外科常规治疗。治疗后6个月应用格垃斯哥预后量表(Glasgow outcome scale,GOS)判定疗效。结果治疗组的疗效优于对照组(P<0.01)。结论高压氧辅助治疗重型颅脑损伤有较好的疗效,有一定的临床应用价值。     

重型颅脑损伤患者早期冰敷的效果观察

目的探讨早期冰敷对重型颅脑损伤患者的效果观察。方法回顾性分析2005-04～2007-03未常规使用冰敷治疗的重型颅脑损伤患者50例和2007-04～2009-03常规使用冰敷治疗的重型颅脑损伤患者50例,对两组患者生命体征、高温持续时间、平均昏迷时间、病死率进行比较。结果两组患者在生命体征、高温持续时间、平均昏迷时间、病死率方面有明显差异。结论早期冰敷降温治疗重型颅脑损伤患者疗效确切,明显降低病死率,对提高患者生存率及生活质量有重要的意义。     

异丙托溴铵雾化吸入治疗重型颅脑损伤合并创伤性湿肺疗效观察

目的分析并探讨异丙托溴铵雾化吸入治疗重型颅脑损伤合并创伤性湿肺的临床效果。方法选取来我院接受治疗的重型颅脑损伤合并创伤性湿肺患者50例,随机分为观察组与对照组,每组25例。两组患者均给予常规的支持治疗,在此基础上,观察组给予异丙托溴铵联合雾化治疗,对照组仅给予雾化吸入治疗。观察两组患者治疗前后血气分析指标和机械通气时间,计算氧和指数。结果观察组治疗后氧和指数为(354.76±31.71)mmHg,机械通气时间为(219.54±35.63)h。对照组治疗后氧和指数为(314.76±30.68)mmHg,机械通气时间为(254.29±36.74)h。观察组治疗后氧和指数明显高于对照组,且机械通气时间短于对照组。经统计学检验,差异具有统计学意义(P0.05)。两组患者治疗后各项血气指标均有明显改善,观察组PaO_2指标与对照组相比,改善更加明显。经统计学检验,差异具有统计学意义(P0.05)。结论异丙托溴铵联合雾化治疗重型颅脑损伤合并创伤性湿肺的临床效果显著。     

Reduced functional residual capacity and abnormal oxygenation in patients with severe head injury

Severe head injury often results in hypoxemia, but the pathophysiology of this phenomenon is unclear. We studied 24 patients hospitalized after severe head injury to determine whether the abnormality of oxygen transfer as measured by venous admixture (Qs/Qt) was associated with a reduction in functional residual capacity (FRC) and also what changes in these variables could be induced by positive end-expiratory pressure (PEEP). Mean FRC was 68 percent of the value predicted for the upright position, and mean Qs/Qt was 0.196. The FRC and Qs/Qt were significantly related so that patients with the lowest FRC had the highest Qs/Qt (p less than 0.001). The FRC was small enough to expect closure of small airways in many of these patients. The addition of 10 cm H2O of PEEP resulted in an increase in FRC of 28 percent (+/- 15 percent [SD] of the value predicted for upright posture; Qs/Qt declined by 0.05 (+/- 0.05 [SD] ). Most of these patients had no spontaneous breathing due either to the severity of the brain injury or to the therapeutic hyperventilation and muscular paralysis employed to control intracranial pressure. We conclude that FRC is often reduced in patients hospitalized after severe head injury and that associated abnormalities of ventilation-perfusion matching often lead to an elevated Qs/Qt. Therapy with PEEP in the range of 10 to 15 cm H2O was well tolerated by our patients and can be used safely to reduce Qs/Qt.     

Efficacy of core decompression plus bone graft with minimal incision in 41 patients with osteonecrosis of the femoral head

Aim: In this study, which is an experimental before‐after‐study, we evaluated the efficacy of core decompression in 56 hips of 41 patients with non‐traumatic osteonecrosis of the femoral head. Method: Fifteen (36%) patients were male and 26 (64%) were female. The mean age of patients was 30 years. Thirty‐six (88%) patients had long‐term histories of steroidal use. Thirty‐three (80%) patients had a history of underlying disease. The mean duration of follow‐up was 55 months (14–122 months). Results: According to Ficat classification, seven hips were in stage 1, 21 in stage 2A, 23 in stage 2B, and five in stage 3. Evaluation criteria according to Harris hip score (HHS), radiographic changes and total hip arthroplasty (THA) necessity were assessed in each stage. The result of core decompression and graft was remarkable compared with preoperation status. HHS increased from 82 to 91 in stage 1; 73 to 89 in stage 2A; 70 to 85 in stage 2B and 63 to 71 in stage 3 post‐operatively (P‐value < 0.05). Discussion: In the last follow‐up, which the was same for all 41 patients, there was no need for THA in all cases; but 5/56 hips (9%) exhibited radiographic progression of at least one Ficat stage. This method did not have any major complications, as only three cases had superficial wound infection. Conclusion: Good and safe clinical results of this method and the availability of this surgical treatment and also early return of patients to ordinary activities make us satisfied with applying this method.