高渗盐水治疗儿童颅脑损伤的研究进展

儿童外伤性颅脑损伤处理中缓解脑水肿及降低颅内压是主要治疗措施之一.甘露醇是临床脱水治疗的一线药物,但它作用时间短,反复使用作用减弱.高渗盐水除渗透性作用,还具有改善组织灌注,调节血管活性、神经递质及免疫等特性,能有效治疗脑水肿,降低颅内压,在治疗儿童外伤性颅脑损伤合并失血性休克方面优于甘露醇,但目前仍需要进一步研究高渗盐水使用的最佳浓度及给药方式等,该文作一简单综述.     

儿童颅脑损伤心律失常探讨

目的　探讨儿童颅脑损伤与心律失常的关系。方法　将 6 2例颅脑损伤患儿分轻型 36例和中重型2 6例 ,伤后连续监测心电图、电解质、心肌酶学和血氧饱和度。结果　 16例发生心律失常 ,轻型 7例 ,中重型 9例 ;其中心肌酶学异常 9例 ,电解质紊乱 7例 ,血氧饱和度降低 4例。结论　儿童颅脑损伤发生心律失常与多种因素有关 ,损伤越重发生率越高 ,但预后较好     

儿童颅脑损伤的临床特点

目的　探讨儿童颅脑损伤的特点。方法　对儿童颅脑损伤患儿 98例临床表现及预后进行分析 ,并与成人颅脑损伤比较。结果　儿童颅脑损伤后腹痛、脑梗死、癫发生率均高于成人组 (P <0 .0 5 ) ,两组预后存在差异 (P <0 .0 5 )。结论　儿童颅脑损伤后临床表现较重 ,但预后较成人好     

TINS评分在婴幼儿颅脑损伤中的应用

目的介绍和评价一种新的颅脑损伤评分方法——TINS评分。方法回顾性分析28例婴幼儿颅脑损伤的TINS评分及其与患儿治疗效果、预后之间的关系，并与GCS评分方法相比较。结果与GCS评分方法相比，TINS评分与婴幼儿的临床表现、治疗效果有较好的相关性。结论TINS评分是一种较为可靠、客观的评分方法，建议在婴幼儿颅脑损伤中常规应用。     

聚乙二醇4000对重型颅脑损伤便秘患儿的疗效

目的　通过检测重型颅脑损伤便秘患儿结肠传输时间 ,评价聚乙二醇 4 0 0 0 (PEG 4 0 0 0 )对此类患儿的疗效。方法　符合便秘诊断标准的重型颅脑损伤患儿 ,男 11例 ,女 7例 ;年龄 3～ 14岁。应用简化不透X线标志物法 ,测定其治疗前后结肠传输时间 (CTT)和分段CTT ,包括右半结肠传输时间 (RCTT)、左半结肠传输时间 (LCTT)和直肠乙状结肠传输时间 (RSTT)。研究对象早晚 2次口服PEG 4 0 0 0 (0 .2 5～ 0 .5 ) /kg ,2次 /d ,治疗3周 ,记录排便次数和大便性状 ,停药 1周后复查CTT ,比较服药前后CTT的变化。结果　该组患儿治疗前后CTT、RCTT、LCTT和RSTT分别为 (76 .5± 10 .2 )hvs (17.8± 5 .1)h ,(31.4± 5 .3)hvs (9.3± 4 .3)h ,(16 .8± 6 .1)hvs (3.8± 3.4 )h ,(2 8.3± 6 .4 )hvs (4 .7± 3.1)h (P均 <0 .0 0 1)。排便次数由 (1.5± 0 .5 )次 /周 ,增加至 (7.3± 0 .8)次 /周 (P <0 .0 1)。 83.3%患儿大便性状恢复正常 ,总有效率为 94 .4 % ,不良反应发生率为5 .5 %。结论　CTT对诊断便秘和选择治疗方案有重要意义。PEG 4 0 0 0治疗重型颅脑损伤便秘患儿安全、有效 ,是治疗儿童便秘的第一选择     

亚低温辅助治疗重型颅脑损伤临床效果的Meta分析

目的 总结国内外亚低温辅助治疗重型颅脑损伤的研究结果，采用Meta分析方法综合评价亚低温辅助治疗重型颅脑损伤的临床效果，探讨应用亚低温治疗重型颅脑损伤的可行性。方法 制定原始文献的纳入标准、排除标准及检索策略，检索PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库等，获得亚低温辅助治疗重型颅脑损伤的临床文献。使用国际Cochrane中心推荐的方法进行质量评价后，采用Review Manager4.22软件对满足条件的有关亚低温治疗重型颅脑损伤效果随机对照研究的病例进行Meta分析。选取颅内压（ICP）和预后作为观察指标，得出合并后疗效的优势比（OR）、95%的可信区间（CI）进行定性、定量综合评估。结果 共检索出1028篇文献，符合纳入标准的9篇进入Meta分析，所有研究均为随机对照试验，未采用盲法，漏斗图检验未发现发表偏倚。Meta分析结果显示，治疗后24h亚低温组（n=479）颅内压下降程度高于对照组（n=473）（5项对照研究，WMD=-4.78，95%CI：-5.24~ -4.33， P<0.00001）；治疗后72h亚低温组（n=479）颅内压下降程度高于对照组（n=473）（5项对照研究，WMD=-5.13，95%CI：-6.53~ -3.73，P<0.00001）；治疗后7d亚低温组（n=479）颅内压下降程度高于对照组（n=473）（5项对照研究，WMD=-6.48，95%CI：-7.56~ -5.40，P<0.00001）；有6项研究结果报道了亚低温组（n=454）和对照组（n=455）随访6个月至6年后的患者预后情况，Meta分析结果显示，亚低温组治疗后患者的预后明显优于对照组（OR=2.04，95%CI：1.56~2.67，P<0.00001）。结论 在重型颅脑损伤常规治疗的基础上，采用亚低温治疗可减轻患者颅内高压，改善患者预后。     

腹腔镜阑尾切除术在学龄前儿童中的应用探讨

目的探讨腹腔镜阑尾切除术(Laparoscopic Appendectomy,LA)在学龄前儿童中的运用。方法对2011年1月至2015年12月笔者收治的239例行阑尾切除术的儿童病例进行回顾性分析,其中学龄前儿童55例,学龄儿童184例;采取腹腔镜阑尾切除术116例,开腹阑尾切除术123例。比较采取腹腔镜阑尾切除术的学龄前儿童与其他手术儿童在手术时间、住院时间、切口感染率、腹腔脓肿发生率的差别。结果采用腹腔镜阑尾切除术的学龄前儿童与采用相同手术方式的学龄儿童在手术时间、住院时间、切口感染及腹腔脓肿的发生率上比较,差异无统计学意义(P>0.05)。在病理类型为单纯性阑尾炎的学龄前儿童中,采用腹腔镜手术方式的患儿住院时间明显短于采用开腹手术方式的患儿(P<0.05),手术时间、切口感染及腹腔脓肿的发生率比较,差异无统计学意义(P>0.05)。在病理类型为复杂性阑尾炎的学龄前儿童中,不同手术方式在手术时间、住院时间、切口感染及腹腔脓肿的发生率上比较,差异无统计学意义(P>0.05)。结论腹腔镜阑尾切除术在学龄前儿童中的应用是安全、可行的,与学龄儿童相比较并不会提高切口感染及腹腔脓肿的发生率。与传统开腹手术比较有一定的临床优势,值得推广。     

自体颅骨点状植骨在小儿颅脑损伤手术中的应用

近１５年来我们采用自体颅骨点状植骨治疗小儿颅脑损伤,去骨瓣减压术后所致颅骨缺损２８例,疗效满意,报道如下。临床资料：２８例中男２２例,女６例,年龄１～５岁７例,～１０岁１３例,～１５岁８例。颅骨缺损面积：４０ｃｍｘ４（ｃｍ～５ｃｍｘ５ｃｍ１５例,５ｃ...     

单臂外固定器在儿童骨盆骨折并发多损伤治疗中的应用

目的 探讨单臂外固定器在儿童骨盆骨折并发多损伤治疗中的应用价值。方法 自1994年始收治儿童骨盆骨折并发多损伤患儿8例，其中男6例，女2例，平均年龄8.5岁（6－14岁）。致伤原因：车祸5例，挤压伤2例，坠落伤1例。8例骨盆骨折均为不稳定型，均有耻骨联合分离，所有病例均在伤后24h内生命体征平稳后手术。对儿童骨盆骨折并发多损伤的患儿我们采用单臂外固定器迅速固定骨盆，并对其进行随访和疗效分析。结果 8例患儿骨盆骨折均愈合，经随访无跛行及骨盆畸形。结论 单臂外固定器可迅速地完成骨盆骨折的固定，有效控制骨折端出血和疼痛，保持骨盆环完整和稳定。对伤员全身状况及严重创伤的抢救无不良影响，有利于患儿救治。单臂外固定器治疗儿童骨盆骨折是一种简单、安全、有效、微创的治疗方法。     

腹膜透析治疗小儿重症颅脑损伤并严重高钠血症的临床研究

目的：观察腹膜透析对小儿重症颅脑损伤合并严重高钠血症的治疗效果。方法对47例重症颅脑损伤合并严重高钠血症患儿,观察腹膜透析前后血钠浓度变化及其规律,并经有创颅内压监测颅内压变化,评估腹膜透析对颅内压的影响,测定血浆晶体渗透压、血肌酐和血气分析、血压、心率等的变化,评估腹膜透析治疗的效果与安全性。结果与治疗前相比,血钠每天均下降,以第1天下降幅度大,速度快（187．49±2．91 vs 202．48±9．31,P＜0.05）,其后降钠速度减慢。持续颅内压监测颅内压逐渐下降,第1天下降明显（164．58±5．98 vs 177．83±7．47,P＜0.05）。腹膜透析期间,血浆晶体渗透压下降,酸中毒纠正,生命体征稳定。结论腹膜透析可有效治疗重型颅脑损伤后高钠血症,与其弥散、降低颅内压等因素有关,临床安全有效。     

Unilateral decompressive craniectomy for children with severe brain injury. Report of seven cases and review of the relevant literature

Severe head injuries in children (under 15 years of age) have many features that differentiate them from head injuries in adults. In such cases, non-surgical treatment cannot always prevent fatal herniation. We report on seven cases of children with severe head injury, presenting with decorticate posturing and treated by unilateral decompressive craniectomy. The aim of the unilateral decompressive craniectomy was to decompress the midbrain and the brainstem. Post-operatively, all patients showed good recovery within 5 weeks (Glasgow Coma Scale score 15). The alternative treatment modalities are discussed critically in an attempt to determine the value of the unilateral decompressive craniectomy procedure and to define the clinical parameters that might identify those children most likely to benefit from this technique. CONCLUSION: the unilateral decompressive craniectomy has an advantage over non-surgical treatment of children with severe brain injury and should be considered in their management.     

儿童颅脑外伤的诊治原则

创伤性颅脑损伤严重危害人类的生活和健康,易引起残疾和死亡。特别是小儿颅脑损伤,临床表现复杂,病情变化快,早期各种并发症发生率高,但处理及时得当及病情稳定后有效的康复治疗使恢复空间大。     

Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury

The purpose of this study is to determine whether serial computed tomography (CT) scans of the head lead to operative intervention in pediatric patients with severe traumatic brain injury (TBI). Serial CT scans are those done in addition to the initial CT scan and one follow up CT scan in the first 24–48 h. This study is a retrospective review from January 1990 to December 2003. The hospital course was reviewed for 942 pediatric patients with traumatic brain injuries. Of these, 40 patients were identified who met the following criteria: age less than 18, admission, Glasgow Coma Scale (GCS) ≤8, intra-cranial pressure (ICP) monitoring during hospitalization, no craniotomy at admission, and at least one serial CT scan after the first 48 h. One hundred fifteen serial CT scans were ordered. Eighty-seven were ordered for routine follow up, 24 were ordered for increased ICP, and 4 were ordered for neurologic change. One craniotomy and one burr hole were performed based on serial CT scans ordered for increased ICP. Serial CT scans, beyond the initial and follow-up scans, have a limited role in children with severe TBI. In this series, only serial CT scans ordered for increased ICP (21%) and neurologic deterioration (3%) led to operative interventions. Serial scans ordered for routine follow-up (76%) resulted in no operative interventions.     

Management of severe traumatic brain injury

Traumatic brain injury (TBI) causes significant morbidity and mortality in children. Physiological insults worsen morbidity and mortality and are particularly common in the pre-hospital setting. Management of severe TBI in the ICU is largely focused on the management of raised intracranial pressure and preservation of cerebral perfusion. Few randomised controlled trials have been undertaken in children with TBI.     

持续颅内压监测在创伤性脑损伤患儿中的应用

颅内压监测已经成为了创伤性脑损伤患儿监护的基本技术.随着医疗水平的发展,有关颅内压监测的研究已成为近年来神经重症监护的重要研究课题.该文就颅内压监测在创伤性脑损伤患儿中的应用作一综述.     

Mild traumatic brain injury in children

Head injury occurs frequently in childhood and results in approximately 500,000 emergency department visits and over $1 billion in costs annually. Nearly 75% of these children are ultimately diagnosed with mild traumatic brain injury (MTBI), a misnomer because many will have radiographically identified intracranial injuries and long-term consequences. Identification of the brain at risk and prevention of secondary injury is associated with the largest reduction in head trauma morbidity and mortality. This article reviews the current literature to discuss the initial evaluation, management, and long-term outcomes in children sustaining MTBI.     

Incidence and mortality of moderate and severe traumatic brain injury in children: A ten year population-based cohort study in Norway

ObjectiveIn this study we wanted to estimate population-based rates of incidence and mortality of moderate and severe traumatic brain injury (TBI) in children in one specific region in Norway.MethodsIn the region there are seven acute care hospitals (ACHs) in addition to a Level 1 trauma centre. Of 702 869 inhabitants (2014), 145 395 were children aged 0–16 years. Data were collected during ten years (2004–2014). All children aged 0–16 years with moderate (Glasgow Coma Scale [GCS] score 9–13) or severe (GCS score ≤ 8) TBI admitted to the Level 1 trauma centre were prospectively included. Children treated outside the Level 1 trauma centre were retrospectively included from the ACHs. Children who died from TBI prehospitally were included from the National Cause of Death Registry. Poisson regression was used to estimate incidence rate ratios (with a 95% confidence interval) comparing age, sex, and time periods.ResultsA total of 71 children with moderate or severe TBI were identified. Crude incidence rates were 2·4 (95% CI 1·7–3·3) for moderate and 2·5 (95% CI 1·8–3·4) for severe TBI per 100 000 person-years (py). Mortality rate from TBI was 1·2 (95% CI 0·7–1·9) per 100 000 py, and 88% were prehospital deaths.ConclusionThe incidence rates and mortality of moderate and severe TBI were low compared to international reports. Most likely explained by successful national prevention of TBI.