重型颅脑损伤合并失血性休克的救治

目的探讨重型颅脑损伤合并失血性休克的早期诊断和治疗。方法回顾性分析68例颅脑损伤合并失血性休克病例的临床资料。结果恢复良好33．8％，中残11．8％，重残17．6％，植物生存状态8．8％；死亡19例，占27．9％。死亡原因：脑干呼吸循环功能衰竭7例，脑疝合并严重失血性休克4例，失血性休克后DIC3例，术后非中枢性呼吸衰竭2例，长期昏迷多脏器功能衰竭3例。结论颅脑损伤合并失血性休克损伤病情重笃复杂，及早明确诊断、及时明确损伤的主次部位、正确把握手术时机、合理治疗是成功救治的关键。     

颅脑损伤患者并发呃逆的原因分析及护理对策

我院神经外科2007年1月～2008年6月收治颅脑损伤病人351例，28例出现呃逆，其中呃逆后并发急性胃黏膜病变的有15例，占53．5％；腹部不适4例，占14％；剧烈头痛、呕吐7例，占25％；烦躁不安9例，占28％。经过综合分析，颅脑损伤病人出现的呃逆多属于中枢性的，与多方面因素相关，主要与颅脑损伤的程度、地塞米松的应用、精神因素等关系密切，现将原因分析以及护理对策简述如下。     

颅脑损伤后低钠血症的临床诊治分析

目的总结颅脑损伤患者并发中枢性低钠血症诊断与治疗经验。方法对47例颅脑损伤后并发中枢性低钠血症患者的临床表现、实验室检查及治疗过程进行回顾性分析。结果20例抗利尿激素分泌异常综合征,其中治愈18例,死亡2例;27例符合脑性盐耗综合征,治愈20例,死亡7例。结论正确区分脑性盐耗综合征和抗利尿激素分泌不当综合征是保证有效治疗的关键。     

颅脑损伤术后脑梗死临床分析

目的探讨颅脑损伤术后脑梗死的临床特点、CT表现、发病机制及治疗。方法回顾分析1997—01—2003—12间．本院颅脑损伤术后脑梗死病例56例临床表现，均CT检查确诊。给予输血、输液、扩容、解痉、抗凝、活血化瘀、营养支持，开颅去骨瓣减压，吸氧，气管切开等治疗。结果临床表现与梗死范围有关，CT表现多种多样；点状、片状、单个脑叶、多个脑叶、及半球梗死；分析发病机制可能与多因素有关。3例失访，良好：15例占26．8％，显效：11例占19．6％，有效：10例占17．9％，无效：17例占30．4％。结论颅脑损伤术后脑梗死并非少见，颅脑损伤伴有休克、微循环障碍、脏器损伤、颈部损伤的患者，应警惕脑梗死的可能。早期发现，及时治疗是良好愈后的关键。     

颅脑损伤后长期昏迷患者的催醒治疗体会

目的探讨46例颅脑损伤后长期昏迷患者的催醒治疗方法.方法46例颅脑损伤后长期昏迷患者应用催醒药物、各种催醒训练的康复治疗和高压氧治疗等.结果46例颅脑损伤后长期昏迷患者中恢复良好者占13.0%,中残者占37.0%,重残者占19.6%,持续性植物生存状态者占10.9%,死亡者占19.6%.结论对颅脑损伤后长期昏迷患者不应放弃治疗,应尽早采取综合治疗措施行催醒治疗.     

ICU重症颅脑损伤并发肺部感染相关因素分析及对策

目的探讨重度颅脑损伤患者并发肺部感染的危险因素及防治措施。方法对本院ICU病房2009年1月～2010年6月收治的38例重度颅脑损伤并发肺部感染的患者进行回顾性分析,了解其流行病学、病原菌及耐药性、易感因素,从而寻找防治措施。结果ICU病房重度颅脑损伤并发肺部感染的主要病原菌以革兰氏阴性杆菌为主,占73．1％,其次是兰氏阳性球菌,占17．3％,真菌占9．6％。昏迷、卧床、年龄、胃内容物返流误吸、气管插管或气管切开、激素大量应用等为重度颅脑损伤患者并发肺部感染的危险因素。结论加强对相关危险因素的控制,可有效减少重度颅脑损伤患者并发肺部感染的可能。     

重型颅脑损伤并发急性呼吸衰竭继发肺部感染的护理

目的对重型颅脑损伤并发急性呼吸衰竭继发肺部感染的护理进行探讨。方法选取2010年3月至2013年3月期间我院收治的重型颅脑损伤并发急性呼吸衰竭继发肺部感染患者30例,对其临床资料进行回顾性分析。结果重型颅脑损伤并发急性呼吸衰竭且继发肺部感染是造成患者死亡的重要原因。30例患者经过综合治疗和护理,情况良好16例,占据53．33％,中残5例,占16．67％,重残2例,站6．67％,死亡23．33％。结论通过术前精心准备,抓住手术时机,观察术后病情,强化护理等措施能有效降低患者死亡率。     

醉酒后颅脑损伤救治分析

目的分析醉酒后颅脑损伤的诊治特点。方法对醉酒后颅脑损伤的53例患者，从外伤因素、患者结构、诊断与治疗及预后情况进行回顾性分析。结果其中格拉斯哥昏迷评分（GCS）3-7分31例，治疗后恢复良好13例（41.9％），中、重残者7例（22.6％），植物状态生存1例（3.2％），死亡10例（32.3％）：8-12分22例，治疗后恢复良好17例（77.3％），中残4例（18.2％），死亡1例（4.5％）。总病死率达20.8％（11／53）。结论醉酒后易掩盖颅脑损伤的典型症状，增加了误诊率和病死率，而及时行头部CT检查，采用早诊早治、防治并发症、重视康复治疗等措施，可降低醉酒后颅脑损伤患者的死残率，改善预后。     

推拿治疗颅脑损伤后偏瘫的临床分析

目的 探讨推拿治疗颅脑损伤后偏瘫的临床疗效。方法把200例颅脑损伤后偏瘫的患者随机分成治疗组与对照组，两组均进行常规治疗，治疗组施加中医推拿治疗3个月。结果治疗组治愈52例，占52％，显效25例，占25％，有效14例，占14％，无效9例，占9％，总有效率91％；对照组治愈28例，占28％，显效23例，占23％，有效16例，占16％，无效33例，占33％，总有效率67％。两组比较，P〈0．05，差异有显著性。结论推拿治疗颅脑损伤后偏瘫疗效确切，减少了后遗症的发生，降低了致残率，经济便捷，值得临床推广。     

重症颅脑损伤并发肺部感染原因分析及早期物理治疗效果观察

目的 分析重症颅脑损伤并发肺部感染,观察早期物理治疗效果.方法 选择颅脑损伤并发肺部感染患者作为研究对象,进行细菌学分析,并随机分为观察组和对照组；观察治疗效果、呼吸功能和神经功能.结果 共检出病原体45株,其中细菌35株占77.78％,支原体属6株占13.33％,病毒4株占8.89％；观察组治疗总有效率94.29％、血氧饱和度(96.3±10.32)％、动脉血氧分压(94.18±10.38)mm Hg,明显高于对照组,呼吸恢复平稳时间(1.89±0.24)d、X线征象消失时间(6.92±0.82)h、肺部啰音消失时间(5.23±0.62)d明显低于对照组.结论 重症颅脑损伤合并多种病原菌同时感染,早期物理治疗能够促进呼吸功能和神经功能的恢复,对于颅脑损伤并发肺部感染具有积极的临床价值.     

Agricultural injury

BACKGROUND: Agriculture is one of the most hazardous industries in the US. METHODS: We reviewed MEDLINE and NIOSHTIC to identify English-language studies addressing occupational injury among agricultural populations, focusing on North America. Additional references were identified from the reference lists of identified studies and from contacts with experts in the field. RESULTS: U.S. data indicate up to approximately 780 deaths and 140,000 cases of nonfatal disabling injuries in 1998. Risk of agricultural injuries is approximately 5-10/100 persons per year, but is higher in certain risk groups, such as males and cattle workers. Falls, machinery, and animals are among the most common causes. Unique features of the agricultural workplace and exposed population combine to increase risk and hinder accurate measurement. These features include a wide range of activities, hazards, and dispersed work places in agriculture; a seasonal hired work force that often has brief tenure, poor English skills, and a distrust of officialdom; and a history of exemption regarding occupational health and safety regulations. CONCLUSIONS: Research in agricultural injury should include epidemiologic study of risk factors and evaluation of interventions. Although only limited data are available documenting efficacy of specific preventive approaches, prevention should focus on engineering controls, regulatory approaches, and education.     

Arterial injury

Urban violence, collision of high-speed vehicles, acts of terrorism and military conflict continue to present difficult arterial injuries. The immediate threat of exsanguination, combined often with multiple trauma, and the challenge of limb salvage makes speedy effective management essential to improve the outcome for victims, who are frequently young adults.     

Local injury information,community participation and injury reduction

Abstract: Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community-focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three-year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a ‘community information’ strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident-related hospital admissions of children (not statistically significant) have been observed over the course of the four-year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury-reduction strategy.     

Occupational liver injury

Summary Epidemiological studies have mapped the occurrence of hepatitis B among health personnel with the use of specific serologic markers and thereby made rational preventive precautions possible. Follow-up studies have demonstrated the effect of this prevention, and the newly developed hepatitis B vaccine has further improved the possibilities for effective prophylaxis against occupational hepatitis B. On the other hand, there is the chemically induced occupational liver damage. Only a few of the thousands of industrially used chemicals have been sufficiently investigated for hepatotoxicity and the list of suspected and confirmed hepatotoxic agents is still growing. The worrisome example of vinylchloride-induced serious liver disease among PVC-workers, revealed after 42 years of industrial use by alert clinicians, calls for intensified activities in the field of occupational hepatotoxicity. However, the clinical, biochemical, and morphological features of liver disease are often vague and unspecific. A non-invasive, convenient quantitative liver function test is needed. Circumstantial evidence and a few epidemiological studies suggest that part of the so-called cryptogenic liver diseases, such as liver cirrhosis, may be caused by occupational exposure to chemicals. This should be further studied. Animal experiments have shown that one chemical agent may potentiate the hepatotoxic effect of another chemical agent. This should be the subject of investigations in the work environment, where exposure to various chemicals is the rule rather than the exception. Alcohol consumption may also interfere with the hepatotoxicity of occupationally used chemicals.     

Hospitalizations for injury in New Zealand: prior injury as a risk factor for assaultive injury.

OBJECTIVES. This study sought to determine the degree to which injury hospitalization, especially for assaultive injury, is a risk for subsequent hospitalization due to assault. METHODS. A New Zealand hospitalization database was used to perform a retrospective cohort study. Exposure was defined as an injury hospitalization, stratified into assaultive and nonassaultive mechanisms. Hospitalizations for an assault during a 12-month follow-up period were measured. RESULTS. Individuals with a prior nonassaultive injury were 3.2 times more likely to be admitted for an assault than those with no injury admission (95% confidence interval [CI] = 2.7, 3.9). The relative risk associated with a prior assault was 39.5 (95% CI = 35.8, 43.5), and the subsequent admission rate did not vary significantly by sex, race, or marital or employment status. Among those readmitted for an assault, 70% were readmitted within 30 days of the initial hospitalization. CONCLUSIONS. Prior injury is a risk for serious assault, and the risk is even greater if the injury is due to assault. Risk of readmission for assault is largely independent of demographic factors and greatest within 30 days of the initial assault.