多层螺旋CT扫描技术在脊柱外伤诊断中的临床价值分析

目的:探究多层螺旋CT扫描技术在脊柱外伤诊断中的临床价值.方法:选取接受诊治的80例脊柱外伤患者为观察对象,使用多层螺旋CT扫描技术对其病情进行诊断分析.观察多层螺旋CT扫描技术诊断的定性准确率和定位准确率,并对诊断结果进行分析.结果:80例中漏诊1例,误诊1例,多层螺旋CT诊断脊柱外伤的定性准确率和定位准确率分别为97.5％(78/80)和95.00％(76/80),征象显示单纯屈曲压缩外伤32例,爆裂型外伤28例,骨折脱位型18例.结论:多层螺旋CT扫描技术在脊柱外伤诊断中的临床价值较高,能对患者病情快速成像,有利于分析病情,并迅速对患者的病灶发展情况有准确了解,具有较高的诊断价值,可以在临床推广应用.     

76例硬膜外血肿术后脑水肿临床分析

目的研究硬膜外血肿患者术后发生脑水肿的相关因素,为指导临床救治提供参考。方法回顾性分析76例硬膜外血肿术后患者资料,对患者性别、术前GCS评分、瞳孔大小、脑中线移位程度、术中血肿清除量、伤后开始手术的时间、是否有基础疾病、高热、原发昏迷、术前血压是否升高进行分析,探讨其与发生脑水肿的相关性。结果硬膜外血肿术后脑水肿组患者在术前GCS评分、术前瞳孔散大、手术清除的血肿量、脑中线移位、外伤后开始手术时间、高热、术前低血压等临床表现等指标上与对照组存在显著性差异（P〈0.05）。患者脑水肿发生与术前瞳孔大小、术中血肿清除量、手术拖延时间呈正相关,与前者术前GCS评分值、术前血压呈负相关。结论硬膜外血肿患者术后极易发生脑水肿,临床救治中应仔细观察患者有无血压升高、瞳孔散大等临床症状和体征,并在外伤后尽早对患者实施手术,最大限度地减轻或避免术后脑水肿发生,有效改善患者预后。     

CT诊断肾外伤临床价值分析

目的：分析和观察CT在肾外伤诊断中的临床应用价值。方法选择60例肾外伤患者，给予CT进行诊断，并观察其CT表现。结果患者经过CT平扫与CT增强诊断后，肾外伤定位定性均准确，确诊率达到100%。结论 CT诊断肾外伤就有极高的确诊率，相对于其他诊断方法具有操作简单、诊断效果好的优势，同时其增强扫描则能够为肾外伤诊疗提供更多的信息，建议临床疾病诊断继续推广使用。分型与诊断中具有显著性的应用价值。     

一种观察脑水肿的新方法:脑电阻抗地形图--原理和临床研究

目前,脑水肿和脑梗塞的病人主要是通过CT等方法进行检查的,虽可准确判断瞬时脑水肿的范围和程度,但由于它们不适合用于临床监护,为病情的检查带来不便。科学研究表明,脑电阻抗的变化与脑水肿、脑梗塞有极大的关系,脑电阻抗是脑水肿灵敏的检测指标,该文研究了将电脑阻抗方法应用于脑水肿监护的原理和测量装置。研究小组进行了双道头颅电阻抗的理论和临床研究,在动物和人体头皮上以接触方式实现了颅内电阻抗的测量方法,验证脑电阻抗与脑水肿的关系。在此基础上首次提出了电脑阻抗地形图的概念,应用自行设计的脑电阻抗地形图检测系统,对临床脑水肿患者进行了初步检测。结果发现,该系统可比较敏感地反映脑梗死后的缺血性水肿,且阻抗地形图显示阻抗值升高的范围与CT显示的水肿范围基本一致,提示通过脑电阻抗地形图检测,能反映脑缺血后缺血区组织水肿的严重程度,同时还能反映水肿的部位及范围。该方法的进一步研究有可能为脑水肿检测提供一种无创、床旁使用、能连续监护的方法和设备。     

MRI扫描对高血压脑病的早期诊断价值

目的：探讨MRI扫描高血压脑病的影像学表现及其对高血压脑病早期诊断的价值。方法回顾性分析2008年1月-2014年3月我院收治的11例高血压脑病患者MRI影像学资料，总结其影像学特点。结果11例患者MRI检查均有影像学改变，顶叶及枕叶脑回对称性水肿为主要形态改变，MRI信号异常部位以顶枕为主，部分病变累及颞叶及脑干，信号异常累及皮层及皮层下白质，病变部位T1WI低信号， T2WI稍高信号， FLAIR较高信号,DWI病变呈等及稍高信号。结论高血压脑病患者MRI扫描多伴有明显信号异常，多表现为脑水肿及脑实质局灶性缺血等损伤征象，能够为高血压脑病的早期临床诊断提供参考。     

可逆性后部脑病综合征临床与CT特点(附CT表现7例)

目的 探讨可逆性后部脑病综合征(PRES)临床与影像学特点.方法 对7例经临床和颅脑CT扫描确诊的可逆性后部脑病综合征进行回顾性分析.7例均为CT平扫,其中5例进行了第2次CT平扫复查.结果 CT显示病灶双侧性4例,单侧性3例,5例位于顶、枕叶皮层下,1例位于额叶皮层下.病变均为低密度影呈手指状深入皮下.5例CT平扫复查显示明显吸收好转或基本吸收.结论 可逆性后部脑病综合征CT平扫主要表现皮层下弥漫性或局灶性脑水肿,顶、枕叶多见.治疗及时者预后良好.     

脑出血后脑水肿扩大的相关危险因素分析

目的探讨脑出血后脑水肿扩大的危险因素,为脑出血后脑水肿扩大的预防和治疗提供参考。方法对60例脑出血后脑水肿患者的临床资料进行回顾性分析,对脑出血后脑水肿扩大的相关危险因素进行Logistic回归分析,筛选脑出血后脑水肿扩大的相关危险因素。结果单因素分析结果显示,发病至首次CT时间、入院时GCS评分、血肿形态、入院后24h内使用降压药与脑出血后脑水肿扩大有关,而脑出血后脑水肿扩大与性别、年龄、高血压史、糖尿病史、高脂血症、卒中史、吸烟史、饮酒史、首次血肿体积、血肿破入脑室、入院后24h内使用脱水剂等因素无明显相关性（P〉0.05）;多因素Logistic回归法分析表明,发病至首次CT时间和血肿形态是脑出血后脑水肿扩大的危险因素。结论发病至首次CT时间和血肿形态是脑出血后脑水肿扩大的危险因素,对这些危险因素加以重点评估和合理控制,可以控制脑出血后脑水肿扩大的发生。     

高压氧在颅脑外伤康复中的应用及护理

我院自1997年至2001年12月,对131例颅脑外伤康复期病人进行高压氧治疗,采取了恰当的护理措施,疗效满意,现报道如下。 1 临床资料 1.1 本组131例,男81例,女50例,年龄7岁～72岁,平均年龄39岁,均有明显外伤史,损伤部位:脑干损伤13例,颅内血肿85例(其中手术治疗58例),脑挫裂伤33例。伤后头颅CT扫描检结果示均有不同程度异常,康复期表现,精神异常48例,剧烈头痛77例,中度头痛9例,伴语言障碍11     

胸部外伤的CT诊断价值

目的 探讨CT检查在胸部外伤的应用价值.方法 搜集我院10年来94例胸部外伤后早期普通胸片及CT扫描二项检查的病人的影像诊断资料,并进行对比,以层厚10 mm、层距10 mm进行平扫,部分兴趣区以层厚5mm扫描.结果 CT扫描可以及时诊断平片不能发现的轻微肺挫伤、少量气胸、纵隔少量积气、少量胸腔积液(血)、隐匿性肋骨骨折(包括肋软骨骨折)、心包少量积血(液)及被掩盖的病变.结论 CT在胸部外伤的诊断中对损伤程度的判断有重要的实用价值,可为临床正确、及时处理及判断预后提供可靠而必需的资料.     

外伤性迟发性颅内血肿的观察与护理

外伤性迟发性颅内血肿（traumatic delay in—tracranial hematoma，TDICH）系指患者头部外伤后头颅CT未发现血肿，一段时间以后再次CT扫描发现了血肿，或清除颅内血肿一段时间以后又在颅内不同的部位发现了血肿。在临床上较为常见。通过对外伤性迟发性颅内血肿患者的病情观察，总结其发生发展规律，以指导临床治疗和护理。     

Correlation between Radiological Images and Histopathological Type of Meningioma: A Cohort Study

BackgroundHistologically affirmed meningiomas represent 37.6% of all essential central nervous system tumors and half of all types of critical central nervous system tumors. This study compares computed tomography (CT) scans of the head with histological findings to establish the characteristics of different types of meningiomas observed in eastern Indonesia.MethodsThis prospective study evaluated 224 patients by examining the correlation between histological and CT data collected from January to December 2020 at Wahidin Sudirohusodo Hospital, Makassar, Indonesia. We assessed data including the location of pre- and post-contrast CT scans, number of tumors, margin, density, contrast enhancement, bony reaction, calcification, and perifocal edema. Patients underwent biopsies followed by an examination of the anatomical pathology tissue.ResultsThe female-to-male ratio of participants was 4.2 to 1, and the highest incidence was observed in participants of both genders aged 40–60 years. The most common meningioma subtype was meningothelial, while the most commonly observed locations involved the convexity and sphenoid regions. Most meningiomas had well-defined margins on CT imaging: 54.5% of patients exhibited isodense lesions on pre-contrast scans, and 64.7% exhibited high-contrast enhancement. Bone destruction developed in 4.1% of patients, while hyperostosis was observed in 17.4%, and calcification was present in 10.3% of the participants. Edema was identified in 65.2% of cases, of which moderate edema was the most common manifestation.ConclusionMeningioma should be highly suspected in female patients aged 40–60 with isodense lesions on pre-contrast CT scans and high-contrast enhancement on post-contrast CT scans. Meningiomas were primarily classified as convexity meningiomas with well-defined margins. The presence of hyperostosis, calcification, and brain edema supported the meningioma diagnosis.     

大鼠脑损伤后脑水肿与精氨酸加压素含量的相关性研究

目的探讨颅脑损伤后血浆中精氨酸加压素（AVP）的动态变化与继发性脑水肿的关系。方法以自由落体硬膜外撞击方法制作轻度和重度大鼠脑损伤模型，应用放射免疫法检测大鼠脑伤后24h、48h、72h和5d血浆中AVP的含量，干湿重法测定脑组织含水量。结果颅脑损伤早期血浆AVP含量与脑水肿严重程度呈正相关。颅脑损伤越严重，AVP升高越明显，脑水肿程度越重（P〈0．05）。结论颅脑损伤后血浆中AVP的含量与继发性脑水肿密切相关，AVP是参与颅脑损伤后继发性脑水肿形成的重要因素之一。     

The effects of alcohol on head injury in the motor vehicle crash victim

The objective of this study was to determine if alcohol potentiates the severity of traumatic brain injury (TBI) in motor vehicle crash (MVC) victims, controlling for crash severity characteristics. Prior studies evaluating effects of alcohol on TBI have not accounted for severity of crash. We evaluated severity of head injury by Marshall score [a classification scale of intracranial pathology on head computed axial tomogram (CT)], and blood-alcohol concentration (BAC), while controlling for crash characteristics [traffic accident deformity score (TAD) and belt use]. Marshall scores were determined from initial CT or autopsy reports, by a neurosurgeon, and were categorized into less severe injury (<3) and more severe (> or =3). Logistic regression using this variable as the outcome parameter and crash characteristics, age and BAC as predictors was done, and the odds ratio (OR) and 0.95 confidence interval (0.95 CI) calculated. Fifty-eight patients were analysed: 41% were BAC positive, 30% had a modified Marshall score of > or =3. Patients with positive BAC were 2.1-fold more likely to have a more severe head injury as measured on CT scan by the Marshall scores. We suggest that alcohol potentiates severity of TBI as determined from head CT among MVC victims. Further research will be needed to substantiate this finding as well as to determine its long-term effect on clinical outcome.     

Preliminary experience with controlled lumbar drainage in medically refractory intracranial hypertension

INTRODUCTION: The contribution of brain edema to brain swelling in cases of traumatic brain injury remains a critical problem. In head injury, the swelling and eventual rise in intracranial pressure is a frequent cause of death, and in survivors the poor prognosis with sustained elevation of ICP has been well documented. OBJECTIVE: The objective this study was to evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension following severe brain injury. METHOD: The study involved 10 head injured patients (GCS < or = 8) with medically refractory intracranial hypertension. Aggressive treatment included the repeated steps of the Brain Trauma Foundation's guidelines, barbiturate coma and in many cases decompressive craniectomy as well. After institution of a lumbar drain, cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and neurological status. ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. RESULTS: All patients demonstrated an immediate decrease of ICP (from 30.6 +/- 4.7 mm Hg to 11.5 +/- 3.9 mm Hg, mean +/- SD) and a concomitant increase of cerebral perfusion pressure. In seven patients the decrease of ICP was long lasting and 5 of them had a favourable outcome. Two patients survived with a severe permanent neurologic deficit and only three patients died because of the progressive brain edema, which developed despite of the maximum therapy. CONCLUSION: In conclusion we may consider, that controlled lumbar cerebrospinal fluid drainage is a potentially useful treatment in cases of severe traumatic brain injury when maximal medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high intracranial hypertension. The danger of herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.     

闭合性颅脑损伤患者发生颅内进展性出血的危险因素分析

目的探讨闭合性颅脑损伤发生颅内进展性出血患者的临床特征,并分析其相关危险因素。方法选取2013年6月-2015年2月我院未行急诊手术治疗的闭合性颅脑损伤101例,根据颅内有无发生进展性脑出血分为进展型脑出血组(48例)和非进展型脑出血组(53例),分析2组相关指标的差异,并进行logistic回归分析。结果患者相对年龄大、纤维蛋白降解产物和D-二聚体、血小板水平高、入院时格拉斯哥昏迷评分高是颅脑损伤发生颅内进展性出血的危险因素(P0.05)。外伤到行第1次头颅CT时间短和第2次CT复查血肿量多可能是发生颅内进展性出血的影响因素(P0.05)。结论临床应对颅脑损伤发生颅内进展性出血的危险因素进行评估,提前做好预防和治疗准备,有利于改善患者的预后。     

脑苷肌肽联合醒脑静治疗急性颅脑损伤的疗效观察

目的探讨脑苷肌肽联合醒脑静治疗急性颅脑损伤的临床疗效。方法将104例急性颅脑损伤患者随机分两组,治疗组(n=54)在常规治疗基础上给予脑苷肌肽联合醒脑静,对照组(n=50)仅给予常规治疗,采用CT检查评估两组患者治疗前、治疗7 d后、治疗14 d后脑水肿体积的变化,同时采用格拉斯哥昏迷评分(GCS)系统及3个月后Glasgow颅脑损伤转归分级(GOS)比较两组患者的预后。结果治疗至第7天,患者脑水肿达高峰期,治疗前和治疗7天后两组患者脑水肿体积无明显统计学差异(P>0.05),但治疗14天后,治疗组患者脑水肿体积明显减少至(2.63±1.02)cm3,与对照组比较差异有统计学意义(P<0.05)。治疗后患者意识转清醒率(46.3%)显著高于对照组(P<0.05)。随访3个月,恢复良好率(42.6%)明显高于对照组(P<0.05),重残及死亡率(20.4%)明显少于对照组(P<0.05)。结论醒脑静联合脑苷肌肽能减轻神经元的损害和脑水肿,改善急性颅脑损伤病人预后,提高生存质量,降低死亡及重残率。     

Effectiveness of CT for clinical stratification of occupational lung edema

We treated two occupational lung diseases in different situations during military training. The purpose of this study is to investigate the availability of CT scanning for the evaluation of inhalation pulmonary edema. Two soldiers suffered severe lung edema after using a spray for the daily maintenance of their firearms. Four soldiers suffered severe dyspnea after undertaking drills in a narrow zone where numerous smoke bombs had been used. We evaluated these patients from several aspects. CT scans of the chest of spray-induced patients revealed bilateral infiltration predominantly in the upper lung fields. The patients received steroid pulse treatment and gradually recovered. CT scans of the chest of smoke-induced patients revealed bilateral ground-glass attenuation with peripheral lung sparing. The patients gradually recovered with steroid therapy. In accordance with previous studies, CT scans of the chest in our patients demonstrated that the periphery of the lungs remained normal, except in cases of serious injury. When differential diagnosis is required, we consider that CT scans of the chest are particularly useful; CT findings are useful in determining the severity of lung injury as well as the diagnosis of inhalation pulmonary edema.     

Incidence of traumatic head or brain injuries in catchment area of Academic Hospital Maastricht in 1997

OBJECTIVE: To measure the incidence of traumatic head or brain injury in the catchment area of the Academic Hospital Maastricht (AZM), the Netherlands. DESIGN: Retrospective. METHOD: Data were collected about head injury patients who visited the emergency room of the AZM in 1997 by separate forms that were filled out for each patient who came to the emergency room. Data were added from admission records and radiology records. The AZM had a catchment area of approximately 231,000 people. RESULTS: The emergency room was attended by 1933 patients with traumatic head or brain injury. Head trauma without signs of brain injury was diagnosed in 1440 patients (74%) mild brain injury in 467 (24%) and moderate or severe brain injury in 26 (1%). The mean age was 30 years (range: 0-97) and 29% of all patients were below the age of 15. Two-thirds (67%) of patients were male. An X-ray of the skull was performed in 15% of the cases. In 7% of these X-rays a relevant abnormality was found. Eleven per cent of patients were admitted for observation. The incidence rate of traumatic head or brain injury in 1997 was 836/100,000 and the incidence of admission 88/100,000. The causes were a fall (43%), traffic accident (22%), violence (15%), sports injuries (7%), accidents during work (4%), or other/unknown (9%). CONCLUSION: Most patients with head or brain injury had mild injuries (99%, sole head injury or mild brain injury). Compared with other studies, the annual frequency of hospital admissions was low.     

神经节苷脂治疗急性颅脑外伤临床观察

目的观察神经节苷脂对急性颅脑损伤患者的疗效。方法将急性脑外伤患者随机分为神经节苷脂组（60例）和胞磷胆碱治疗组（60例）,观察患者治疗后GOS的变化。结果与胞磷胆碱治疗相比,神经节苷脂对中、重型颅脑损伤、硬膜下血肿和脑内血肿的治疗效果更好,均显著高于对照组（P〈0.05）。结论神经节苷脂应用于急性颅脑损伤患者时能减轻脑水肿,促进脑功能恢复,降低死亡率,改善预后。