特重型颅脑损伤的围手术期处理

颅脑创伤的致伤机理比较复杂,常伤情严重,合并伤多,处理棘手,给麻醉手术带来诸多困难,急症围术期迅速有效的处理可赢得抢救机会,减少死亡率.本组总结了近年来我院138例特重型颅脑损伤患者,男113例、女25例;年龄2～76岁,平均34.7岁.全组患者均行急症手术.其中昏迷85例、嗜睡15例、瞳孔散大63例.入院时格拉斯哥昏迷指数(GCS)8分以下者85例,其中5分以下者17例,合并明显休克34例,血气胸16例,肝脾破裂6例,四肢骨折14例,恶心呕吐发生误吸83例.麻醉过程:本组患者于诱导前30 min肌注杜非     

重视和加强颅脑创伤合并伤的诊断和治疗

随着颅脑创伤规范化处理原则的推广应用,国内颅脑创伤的救治水平不断提高.但颅脑创伤合并伤的诊治由于涉及多个学科,在确定救治顺序、现场指挥协调、手术人员安排、用药选择等多个环节上存在一定难度,不同层次医院的救治水平还存在较大差距.创伤专家提出了加强对创伤评分系统的应用和对创伤外科理念的认识,建议从整体上诊治颅脑创伤及其合并伤[1,2].因此,颅脑创伤合并伤的诊治已经成为创伤研究的一个十分重要的问题.     

把握重型颅脑创伤救治中的关键点

把握救治中的关键点对于提高重型颅脑创伤的救治率甚为重要。本文重点阐述了重型颅脑创伤救治中的一些关键点,如伤情的判断、手术时机和方法的选择,脑水肿治疗及颅内外并发症的防治。     

颅脑创伤后脑梗塞的临床诊治

目的探讨影响颅脑创伤后并发脑梗塞的相关因素及治疗方法。方法对44例颅脑创伤后脑梗塞患者临床资料结合文献进行分析。结果出院时按GOS评价：良好27例，中残6例，重残3例，植物生存3例，死亡5例。结论正确认识颅脑创伤后脑梗塞的发生原因及时手术、术后正确地治疗，可有效的减少和减轻脑梗塞的发生，提高生存质量。     

术前急诊钻颅引流对重型脑损伤脑疝患者颅内压及其预后的影响

重型颅脑创伤合并脑疝后继发脑干损伤，临床预后极差。我科自2002年1月以来对89例重型颅脑创伤合并脑疝患者在开颅术前采用急诊钻颅引流的方法降低颅内压，解除脑疝，缩短了脑疝时限，提高了手术疗效。报告如下。     

高原地区颅脑创伤手术的麻醉处理与术后并发症的预防

青藏高原地区颅脑创伤患者术后常并发脑水肿、高血糖、肾功能衰竭等.为有效预防术后并发症的发生,现将我院2000-2007年手术治疗的63例颅脑创伤患者的麻醉处理及术后并发症的预防处理总结如下.     

异丙酚对急性颅脑外伤手术脑保护作用的临床研究

目的研究急性颅脑外伤患者手术前和手术期间血清神经冗特异性烯醇化酶（NSE）和S100蛋白（S100B）的变化及静脉麻醉剂异丙酚对这一变化的影响,评价异丙酚的脑保护作用。方法10例无颅脑损伤的泌尿系统手术患者为正常对照组。急症颅脑外伤手术患者30例,随机分为异丙酚组（A组,n=15）和异氟醚组（B组,n=15）。两组患者分别于手术前,手术开始2h,手术结束时测定血清NSE和S100B含量。正常对照组只在术前测定血清NSE和S100B含量。对急症颅脑外伤手术患者进行格拉斯哥评分并记录。结果急性脑外伤患者手术前NSE和S100B显著高于正常对照组（P〈0．01）,格拉斯哥评分越低的口才1术前NSE和S100B也越高。手术结束时异丙酚组NSE和S100B显著低于异氟醚组（P〈0．05）,开颅手术2h和手术结束时两组NSE和S100B均较术前升高。结论急性颅脑外伤手术患者血清NSE和S100B含量升高,开颅手术期间持续静脉泵注临床麻醉剂量的异丙酚可降低血清NSE和S100B水平,减轻继发性脑损害,具有脑保护作用,是颅脑手术麻醉的理想药物。     

西维来司钠对高原颅脑损伤大鼠中性粒细胞弹性蛋白酶的影响及神经损伤的保护作用

目的探讨中性粒细胞弹性蛋白酶(NE)对大鼠高原颅脑损伤的影响及NE抑制剂西维来司钠对高原颅脑损伤的神经保护作用。方法取雄性SD大鼠48只,随机分为6组。即平原对照组,平原颅脑创伤组,平原颅脑创伤+西维来司钠治疗组,高原对照组,高原颅脑创伤组,高原颅脑创伤+西维来司钠治疗组。创伤组按Feeney自由落体撞击法制作大鼠高原与平原颅脑损伤模型,对比观察高原与平原颅脑创伤前后以及给予西维来司钠治疗后血清NE浓度变化,并通过病理学观察西维来司钠治疗对高原颅脑损伤的神经保护作用。结果大鼠高原颅脑创伤前后NE浓度均明显高于平原颅脑创伤前后(P0.05),脑组织病理形态结果显示,高原大鼠颅脑创伤后立即给予NE抑制剂西维来司钠治疗,颅脑损伤程度较未治疗组明显减轻。结论NE是加重大鼠高原颅脑损伤后神经组织损伤的重要因素,西维来司钠治疗对高原颅脑损伤的神经组织具有明显的保护作用。     

手术治疗颅脑创伤合并面神经损伤13例

目的探讨颅脑创伤合并面神经损伤的诊断方法与手术为主综合治疗的临床意义。方法回顾分析本科以手术治疗为主综合治疗的13例颅脑创伤合并面神经损伤患者的临床特点、诊断与治疗方法。结果13例患者中术后随访时间6个月～3年,依据House-Brack-mann[1]面神经功能恢复评分标准评定,完全恢复6例,Ⅱ级恢复3例,Ⅲ级恢复2例,Ⅳ级恢复1例,Ⅴ级恢复1例,其中完全恢复与Ⅱ级恢复者占随访人数69.2%。结论对颅脑创伤合并面神经损伤患者,明确诊断后,应尽早开展手术为主的综合治疗,面神经减压术是一种简便、有效的术式。     

颅脑火器性盲管伤4例

颅脑火器盲管伤病死率高，并发症多，致残率高，诊断和处理都有其特殊性。1999～2002年，我院收治重型颅脑火器盲管伤4例，经一期手术彻底清创伤道，二期手术再取除颅内弹片。无死亡。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.