严重颅脑损伤合并腹腔脏器损伤

一、对象与方法1.一般资料:本组病例中男性7例,女性3例,年龄12~56岁,平均年龄31.5岁;受伤原因:坠落伤3例,车祸伤6例,打击伤1例;均以颅脑损伤首诊于神经外科。2.临床表现:10例患者均有不同程度的意识障碍,其中神志恍惚1例,浅昏迷5例,中度昏迷4例,GCS 12~6分,血压90~200/55~105 m     

脊髓损伤大鼠损伤早期电位变化与损伤程度的关系

To investigate characteristics of injury potentials after different degrees of spinal cord injury in rats,the present study established models of spinal cord contusion with severe,moderate,and mild degrees of injury.Injury potential was measured in vivo using a direct current voltage amplification system.Results revealed that in the first 4 hours after acute spinal cord injury,initial amplitude of injury potential was greatest after severe injury,followed by moderate and mild injuries.Amplitude of injury potential decreased gradually with injury time,and the recession curve was logarithmic.Under the same degree of injuries,amplitude of rostral injury potential was generally less than caudal injury potential.Results suggested that injury potential reflected injury severity,because large initial amplitude of injury potential during the early injury stage implied severe injury.     

颅脑损伤合并颈椎损伤的诊治

目的总结对颅脑损伤合并颈椎损伤病人的诊治经验。方法回顾性分析46例颅脑损伤合并颈椎损伤病人的临床资料。结果术后生存42例，死亡4例。颈椎损伤病人早期漏诊5例，因未及时行颈椎X-线平片或CT检查，致死亡1例。截瘫1例。颅骨牵引继发硬膜外血肿或原血肿加大者4例，新增血肿多在颅骨骨折处，而颅骨骨折多因入院未行CT骨窗扫描漏诊或被忽略，致死亡1例。吸取上述经验后，对5例颅颈复合伤病人一经确诊即与骨科同台早期手术。结论对颅颈复合伤病人，早期行颈椎CT、X-线平片检查及头颅CT骨窗扫描可减少颈椎损伤及颅骨骨折漏诊率。早期脑外科与骨科同台手术，可减少并发症。     

重型颅脑损伤合并胸部损伤临床救治

目的 探讨重型颅脑损伤合并胸部损伤的临床救治要点.方法 回顾GCS≤8分的重型颅脑损伤合并胸部损伤患者29例,对其治疗方法 及治疗结果 进行总结分析.结果 本组病人29例,根据GCS预后评分法,恢复良好14例,中残4例,重残4例,死亡7例,病死率为24.1%.结论 快速准确诊断是病人生存的关键,紧紧围绕呼吸、循环和脑受压三个环节展开救治,正确的综合治疗和护理能提高救治成功率及生存质量,降低病死率     

运用损伤控制性手术治疗重型颅脑损伤

目的探讨运用损伤控制性手术救治重型颅脑损伤的临床疗效。方法2004年2月至2011年12月对538例重型颅脑损伤患者运用损伤控制手术治疗。结果出院时按GOS评分评估预后,恢复良好348例,重残80,植物生存19例,死亡91例。总死亡率16．9％。结论颅脑损伤早期行损伤控制手术能及时缓解增高的颅内压,降低脑疝发生率,提高危重患者的存活率。     

颅脑损伤合并颈椎损伤的诊治体会

目的探讨颅脑损伤合并颈椎损伤的诊断和治疗。方法回顾性分析12例的颅脑损伤合并颈椎损伤的诊疗经过。结果12例的颅脑损伤合并颈椎损伤无1例漏诊。其中,颅脑损伤合并单纯性颈椎损伤7例,GOSⅤ级6例,GOSⅢ级1例;颅脑损伤合并颈髓损伤5例,GOSⅤ级1例,GOSⅢ级2例,GOSⅠ级2例（死于肺部感染）。结论对颅脑损伤患者进行细致地神经系统检查和颈椎CT检查有助于发现是否合并颈椎损伤。颅脑损伤合并单纯性颈椎损伤,预后取决于颅脑伤情,颅脑损伤合并有颈髓损伤预后则较差。     

电损伤合并脑神经损伤的临床分析

目的了解电损伤合并脑神经损伤的发病率,发病原因及治疗。方法通过对308例电损伤中合并132例脑神经损伤患者的回顾调查,总结出合并中枢神经损伤的情况的诊断与治疗情况进行分析。结果本组电损伤合并脑神经损伤的发病率(42.86%),致病原因分为直接电损伤与继发损伤,治疗及预后较好。结论对电损伤病人要认真检查并合理估计中枢神经电损伤的伤情,早期治疗。     

腹部闭合性损伤合并颅脑损伤诊治体会

目的探讨腹部闭合性损伤合并颅脑损伤的早期诊断和治疗。方法分析2004-06～2010-04 60例闭合性腹部损伤合并颅脑伤患者的临床资料、腹部症状及体征表现、休克情况。结果 55例手术治疗患者痊愈41例,轻残9例,重残2例,植物生存状态1例,死亡2例。结论治疗腹部闭合性损伤合并颅脑损伤患者的关键之处在于早期明确的诊断和最及时的救治,是降低腹部闭合性损伤合并颅脑损伤的并发症和病死率的关键。     

弥漫性轴索损伤

弥漫性轴索损伤(DAI)属于闭合性原发弥漫性脑损伤。是由于头部成角、加(减)速运动或旋转性暴力出现弥漫性轴索扭曲、肿胀、断裂及皮髓质交界区穿行血管中断所致。好发于皮髓质交界区、胼胝体、尾状核、丘脑、内囊及中脑被盖的背外侧。其病理变化包括:(1)广泛性轴索损害,累及大脑、脑干和小脑的白质和大脑深部核质,包括中线旁皮质下白质、胼胝体、穹窿柱、内囊、基底节及丘脑、齿状核背侧小脑叶、皮质脊髓束、内侧丘脑系、内侧纵束等。(2)胼胝体局限性出血灶。(3)上脑干背外     

外伤性颈内动脉损伤

外伤性颈内动脉损伤如不及时处理可导致严重的致残或死亡。由于颈内动脉的解剖学特征而使其在头颈部外伤时易于合并损伤,常见类型包括:血栓形成、海绵窦瘘、壁间剥离和动脉瘤。本文就外伤性颈内动脉损伤的及时诊断和治疗进行综述。     

Mild traumatic brain injury

Traumatic brain injury (TBI) is one among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100–300/100 000. Intracranial complications of mild traumatic brain injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but potentially life threatening (case fatality rate 0.1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life‐threatening complication in a large number of individual patients. The 2002 EFNS guideline used the best evidence approach based on the literature until 2001 to guide initial management with respect to indications for computed tomography (CT), hospital admission, observation and follow‐up of MTBI patients. This updated EFNS guideline for initial management in MTBI proposes a more selective strategy for CT when major [dangerous mechanism, Glasgow Coma Scale (GCS) < 15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post‐traumatic seizure] or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition, clinical decision rules for CT now exist for children as well. Since 2001, recommendations, although with a lower level of evidence, have been published for clinical observation in hospitals to prevent and treat other potential threats to the patient including behavioural disturbances (amnesia, confusion and agitation) and infection.     

拳击运动伤的诊治

目的 拳击运动职业化已过百年,由于反复用力击打头部,拳击运动所带来颅脑创伤引起国内外神经外科医生重视,本文旨在对拳击运动伤的诊治和机制进行回顾性研究.方法 总结笔者经治的拳击运动伤54例,通过对其治疗效果进行总结分析,并检索国内外文献进行研究.结果 54例患者4例因CT示明确的颅内病变入院治疗后好转,余急症和门诊患者经对症治疗后症状多数消失或缓解,仅4例好转不明显.结论 拳击运动伤的损伤情况与拳手承受击打的力度和从业时间有直接的关系,特别是慢性损伤近似于Alzheimer病,应该引起重视,进一步研究其相互关系.     

Temporal and spatial characterization of neuronal injury following lateral fluid-percussion brain injury in the rat

The pattern of neuronal injury following lateral fluid-percussion (FP) brain injury in the rat was systematically characterized at sequential time points to identify selectively vulnerable regions and to determine the temporal contribution of primary and delayed neuropathological events. Male Sprague-Dawley rats (n = 28) were killed 10 min, 2 h, 12 h, 24 h, 4 days, and 7 days following a lateral FP brain injury of moderate severity (2.2 atm), or 24 h after a sham injury. Brain sections were stained and analyzed using Nissl, acid fuchsin, and silver staining methods to identify regions with injured neurons or with visible lesions. Extensive numbers of acid fuchsin or silver-stained neurons were observed as early as 10 min after the FP brain injury in regions extending from the caudate/putamen to the pons. The frequency of injured neurons was greatest in the ipsilateral cortex, hippocampus, and thalamus, and a visible loss of Nissl-stained neurons was observed in these regions beginning at 12 h after the FP brain injury. Acid fuchsin-stained neurons were restricted to the same brain regions for all of the survival periods and gradually decreased in numbers between 24 h and 7 days after injury. These findings suggest that lateral FP brain injury in the rat produces a combination of focal cortical contusion and diffuse subcortical neuronal injury, which is present within minutes of the impact, progresses to a loss of neurons by 12 h, and does not markedly expand into other brain regions with survival periods up to 7 days. Furthermore, the acute onset and rapid evolution of the neuronal injury process may have important implications when considering a window of opportunity for pharmacological intervention. Received: 23 May 1995 / Revised, accepted: 15 September 1995     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.     

小胶质细胞和放射性脑损伤

放射治疗是有效的肿瘤治疗手段,尤其在神经系统肿瘤,由于其部位的限制和血脑屏障的存在,手术和化学治疗的效果常不理想,而有的肿瘤如生殖细胞瘤、脑干胶质瘤等,放疗可能是唯一的治疗选择.