亚低温治疗重型颅脑损伤临床分析

目的研究亚低温对重型颅脑损伤患者颅内压（ICP）及并发症的影响。方法重型颅脑损伤患者68例,随机分为亚低温组（n=38）及常温常规治疗组（n=30）。亚低温组接受32℃～35℃低温治疗,常温常规治疗组除亚低温治疗外,其余治疗同亚低温组。比较两组的ICP、预后和并发症的差异。结果亚低温治疗组伤后ICP显著低于常温常规治疗组（P（0.01）。预后显著好于常温常规治疗组（P〈0.05）。应激性溃疡、肝肾功能异常和外伤性癫痫的发生率显著低于常温常规治疗组（P〈0.01）。结论亚低温对重型颅脑损伤患者ICP升高有明显的治疗作用,可以改善重型颅脑损伤患者的预后,减少全身并发症。     

亚低温治疗重型颅脑损伤患者临床分析

我院于1999年10月～2000年8月共收治重型颅脑损伤患48例(GCS≤8分)，随机分成常规治疗组及常规治疗加亚低温治疗组，结果表明，亚低温组治疗重型颅脑损伤患取得明显效果。     

亚低温治疗重型颅脑损伤的临床体会

目的 探讨亚低温脑保护疗法对救治重型颅脑损伤的疗效。方法 将132例重型颅脑损伤随机平均分为治疗组与对照组，进行对比分析，并且前瞻性分析两组疗效。结果 治疗组66例患者，存活率为77．3％，恢复良好率54．5％（36／66），病死率18．2％（12／66）。疗效明显优于对照组，未发生相关的并发症。结论 亚低温治疗能显著降低重型颅脑损伤患者的死亡率，改善颅脑损伤患者神经功能预后，并具有安全、显著降低病死率及癫痫发生率等优点。     

冬眠亚低温治疗重型颅脑损伤

目的：探讨冬眠亚低温在重型颅脑损伤中的应用及疗效。方法：对本科自2003年10月至2005年10月间收治的重型颅脑损伤患者随机分为常温治疗组32例和亚低温治疗组32例。分别给予常温治疗和亚低温治疗。结果：冬眠亚低温治疗组恢复良好17例（53．1％）,死亡5例05．6％）,常温组恢复良好12例（37．5％）,死亡8例（25％）。两组相比差异显著（P〈0．05）。结论：冬眠亚低温治疗重型颅脑损伤简便,安全有效,能显著降低死残率,提高治愈率。     

亚低温治疗重型颅脑损伤的监护进展

在重型颅脑损伤的治疗中,亚低温能显著减轻脑损伤后神经功能障碍和脑病理形态损害,保护血脑屏障功能,从而明显降低重型颅脑损伤患者的病死率[1],提高存活率和恢复良好率。但低温治疗亦可引起心肺功能、血液凝固系统及免疫机能的障碍,导致并发症的发生,严密观察病情及精心的护理对预防并发症的发生尤为重要。1　治疗机制亚低温治疗的机制尚未完全阐明,但已有实验研究指出可能机制有:1降低氧耗,改善能量代谢,减轻酸中毒;2抑制内源性毒性产物对脑细胞的损害;3减少Ca2+内流,调节Ca2+靶酶活性;4减轻再灌注脑损伤,保护血脑屏障,减轻脑水肿;5保护…     

冬眠亚低温治疗重型颅脑损伤的护理体会

<正> 在重型颅脑损伤的治疗中,亚低温(30℃～35℃)能显著降低脑耗氧量,减轻脑细胞功能破坏,促进脑细胞功能恢复,抑制内源性有害因子的释放,减少钙离子内流,减轻神经损伤,减少脑水肿,从而明显降低颅脑损伤后的残死率,改善预后。现报告我院自1999年1月～2001年1月对28例重型颅脑损伤病人亚低温治疗期间的护理体会。     

早期机械通气联合亚低温治疗重型颅脑损伤效果观察

目的观察早期机械通气联合亚低温治疗重型颅脑损伤的效果。方法选取2016-08—2018-08间西平县人民医院收治的64例重型颅脑损伤患者。将早期机械通气治疗的患者作为对照组,将早期机械通气联合亚低温治疗的患者作为观察组,各32例。比较2组治疗后的血气指标及GOS评分。结果治疗后观察组的Pa O2、Pa CO2、Sa O2及GOS评分均优于对照组,差异有统计学意义(P0.05)。结论早期机械通气联合亚低温治疗重型颅脑损伤,能迅速改善患者的血气指标和预后。     

亚低温治疗重型颅脑损伤的观察及护理

亚低温是轻度低温（３３℃～３５℃）和中度低温（２９℃～３２℃）的合称。国内临床研究大都选择３３℃～３５℃轻度低温治疗重型颅脑损伤，疗效显著犤１犦。本院颅脑外科在１９９９年１０月至２００２年２月，对４８例重型颅脑损伤患者施行亚低温疗法，取得一定疗效。现将观察方法及护理体会报告如下。临床资料１．一般资料：本组４８例，男３８例，女１０例；年龄１９～６８岁，平均４１岁。病人均经CT扫描和临床表现诊断为重型颅脑损伤，GCS评分３～８分。２．方法：本组病人均于入院４～６小时内开始亚低温治疗。降温采用Medi－Ther…     

亚低温治疗重型颅脑损伤临床研究

目的观察亚低温治疗重型颅脑损伤的疗效。方法将43例重型颅脑损伤(格拉斯哥昏迷评分<8分)病人分为两组:亚低温组(22例)采用全身冰毯降温,使体温降至32~35℃5d,同时使用冬眠合剂;对照组(21例)给予常规治疗。结果亚低温组病人预后良好率60%(13/22),病死率26%(5/22);对照组预后良好率29%(6/22),病死率48%(10/21),两组病人疗效比较差异有统计学意义(P均<0.05)。结论亚低温治疗重型颅脑损伤疗效明显优于常温治疗重型颅脑损伤的疗效。     

亚低温治疗重型颅脑损伤的护理配合

本院自2001年6月至2003年5月,采用亚低温治疗重型颅脑损伤68例,效果良好.现报告如下.     

Spectrum of traumatic brain injury from mild to severe

Traumatic brain injury (TBI) involves significant damage of the brain parenchyma, and is the leading cause of morbidity and mortality after trauma. It is thus essential for all physicians involved in acute care medicine and surgery to have a thorough understanding of TBI. Management of the patient with TBI is a rapidly advancing field, characterized by an improved understanding of intracranial pathophysiology and decreasing overall mortality largely because of improved neurocritical and surgical care. This article summarizes the classification system, management approaches, and recent controversies in the care of mild, moderate, and severe TBI.     

标准大骨瓣减压术治疗重型颅脑损伤的应用体会

<正>重型颅脑损伤由于伤情严重,病情变化迅速,常合并严重的急性颅内压增高,致残率及死亡率高。早期手术救治及去骨瓣减压是缓解颅内高压及降低死亡率的重要方法。本院于2003年1月至2007年12月期间,对收治的重型颅脑损伤且需行去骨瓣减压术的83例病人,进行了标准外伤大骨瓣开颅减压术治疗。效果满意,现报告如下。     

Unusually rapid and severe cognitive deterioration after mild traumatic brain injury

A 56-year-old man (AB) presented with dramatic cognitive deterioration following a mild traumatic brain injury. There was no indication of severe brain injury or significant anoxic encephalopathy. Detailed history indicated no significant pre-morbid cognitive deficits. His pre-injury psychosocial and occupational functioning was intact. Cognition functioning was impaired immediately post-injury and remained impaired. Neuropsychological examination at 8 months post-injury showed severe cognitive deficits. The cognitive profile was consistent with Alzheimer's disease. MRI at 1-year post-injury showed minor ischaemic changes not consistent with hypoxic injury and insufficient to explain his cognitive problems. Early SPECT was consistent with a diagnosis of Alzheimer's disease and a repeat SPECT showed a significant deterioration in an Alzheimer pattern. AB was seen for detailed serial neuropsychological examination over a 3-year period, which revealed clear evidence of cognitive deterioration consistent with Alzheimer's disease. AB is presented as an unusual case of rapid progressive AD following a mild head injury.     

Neuropsychological rehabilitation of mild traumatic brain injury

A significant minority of patients who have sustained a mild traumatic brain injury (MTBI) may exhibit persistent disability. There have been few attempts to describe and evaluate the effectiveness of neurorehabilitation for these patients. We conducted a retrospective analysis of the results of a neuropsychological rehabilitation programme for 20 patients with MTBI. Based upon the ability to resume productive functioning after treatment, 10 patients were determined to exhibit a good outcome and 10 patients were considered to exhibit a poor outcome. Patients with good outcome exhibited significant pre-post-treatment improvements on both neuropsychological measures of cognitive functioning and self-reported post-concussive symptoms. Patients with poor outcome demonstrated little improvement in either area, and in some cases showed a decline in functioning. The results are consistent with the view that there may be significant variability in recovery and response to treatment after MTBI. There is a continued need to identify which patients may benefit from neurorehabilitation, develop specially tailored interventions, and conduct controlled, prospective studies in this area.     

Management of severe traumatic brain injury

Severe brain injuries, most often occurring in young subjects, are a major source of lost work years. These injuries are medical and surgical emergencies. Prehospital management of severe brain injuries requires intubation and mechanical ventilation aimed at normal arterial carbon dioxide pressure. Signs of transtentorial herniation: Uni- or bilateral mydriasis requires immediate perfusion of 20% mannitol or hypertonic sodium chloride. Neurological disorders after head injury justify emergency cerebral computed tomography. The presence of a mass syndrome or signs of transtentorial herniation are in principle indications for surgery. Specialized hospital management is essential. In the case of refractory intracranial hypertension, the cerebral perfusion pressure and osmotherapy should be adapted to the volume of the cerebral contusion. The use of deep hypothermia and barbiturates should be minimized as much as possible. Magnetic resonance imaging makes it possible to identify the cerebral lesions.     

Modified experimental mild traumatic brain injury model

BACKGROUND: Experimental models of traumatic brain injury (TBI), using a variety of techniques and species, have been devised with the aim of producing repeatable lesions resembling those found in head injuries. There are various TBI models mentioned in the literature. In experimental head trauma models, emphasis has been placed on the severe head injuries. There are only a few models developed to study mild traumatic brain injury (MTBI). In fact, MTBI is as important a problem as severe head injuries for neurosurgeons. METHODS: Fifty-six male Sprague-Dawley rats were subjected to MTBI with a weight-drop device, which was described by Marmarou et al. The said model was used in its original form as well as in modified forms by employing different weights dropped from the same height. Animals were divided into four groups of 14 rats as follows: Group I (n=14), head injury was induced using 450 g-1 m weight-height impact; Group II (n=14), head injury was induced using 350 g-l m weight-height impact; Group III (n=14), head injury was induced using 300 g-1 m weight-height impact; Group IV (n=14), control group, no injury was applied. Animals were evaluated neurologically, physiologically, electrophysiologically, and histopathologically. RESULTS: Group I and II animals (450 and 350 g-1m weight-height impact, respectively) showed the symptoms of severe head injury, whereas Group III animals (300 g-l m) showed more MTBI symptoms. CONCLUSION: We recommend the application of the modified MTBI model used for group III (300 g-l m weight-height impact) as the most appropriate and the simplest model for future MTBI studies.     

S100 in mild traumatic brain injury

Primary objectives: To examine the diagnostic value of S100 in mild traumatic brain injury (MTBI).

Research design: Prospective cohort study.

Methods and procedures: S100B, S100A1B and S100BB concentrations were examined in sera from patients with MTBI with an arrival Glasgow Coma Scale score of 15 or 14, patients with orthopaedic injuries and non-injured subjects.

Main outcome and results: Mean values and proportions of subjects above cut-off limits for S100B and S100A1B were significantly higher in each trauma group than in non-injured controls, but only for S100A1B when patients with MTBI were compared with controls with orthopaedic injuries. Using a 97.5 percentile cut-off limit, the sensitivity of S100A1B for MTBI vs orthopaedic injury was 61% (95% confidence interval (CI) 49-73%), specificity 77% (95% CI 62-93%). The area under the ROC curve did not approach 0.9 for any cut off limit.

Conclusions: Diagnostic validity of S100 in acute MTBI was not demonstrated. S100A1B has merits for long-term prognostic studies.     

Olfactory function after mild traumatic brain injury

Objective: The aim of this study was to determine the incidence of olfactory dysfunction after mild traumatic brain injury (MTBI). Damage to the olfactory bulbs or frontal cortex has been reported in MTBI, but olfactory dysfunction after MTBI has not been studied in a prospective way before.

Design: Patients with first-time MTBI were included. Patients' olfactory threshold values (Hyposmia Utility Kit by Olfacto-Labs®) were measured 2 weeks after the trauma. Associations between olfactory threshold values and individual symptoms and S-100B and NSE concentrations were examined, using multiple linear regression analysis, adjusting for the influence of age.

Results: Twenty-two per cent of 111 included patients had hyposmia and 4% had anosmia. Thresholds at 2 weeks showed no significant associations with the presence of symptoms at the ER, nor with early concentrations of S-100B or NSE.

Conclusions: Although a high prevalence of olfactory dysfunction was found, no correlation was found between olfactory dysfunction and acute parameters of MTBI.     

Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury

Objective： To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury （STBI） using clinical microdialysis. Methods：Thirty-one patients with STBI （ GCS ≤ 8 ） were randomly divided into hypothermic group （Group A ） and control group（ Group B）. Microdialysis catheters were inserted into the cerebral cortex of perilesional and normal brain tissue. All samples were analyzed using CMA mlcrodialysis analyzer. Results. In comparison with the control group, lactate/glucose ratio （ L/G ）, lactate/pyruvate ratio （ L/P ） and glycerol（Gly） in perilensional tissue were significantly decreased; L/P in normal brain tissue was significantly decreased. In control group, L/G, L/P and Gly in perilensional tissue were higher than that in normal brain tissue. In the hypothermic group, L/P in perileusional tissue was higher than that in relative normal brain. Conclusions： Mild hypothermia protects brain tissues by decreasing L/G, L/P and Gly in perilensional tissue and L/P in ＂ normal brain＂ tissues. The energy crisis and membrane phospholipid degradation in perilensional tissue are easier to happen after traumatic brain injury, and mild hypothermia protects brain better in perilensional tissue than in normal brain tissue.