TBI后颅内感染的发生情况和危险因素

目的探讨颅脑损伤(TBI)术后颅内感染的发生率及发生颅内感染的危险因素。方法 2012年1月—2015年12月川北医学院附属医院神经外科收治1 349例TBI患者,道路交通伤542例,高处跌落332例,重物砸伤291例,其他原因184例。其中47例在术后出现颅内感染(感染组),男性31例,女性16例;年龄21~65岁,平均42.0岁;按照年龄、性别进行1∶2匹配的原则选取94例术后未发生颅内感染的TBI患者作为对照组,男性58例,女性36例;年龄20~65岁,平均40.7岁。分析TBI患者发生颅内感染的危险因素。结果 TBI患者手术后并发颅内感染主要与开放性创伤、受伤至手术时间、脑室外引流时间、术后白蛋白水平有关(OR=1.629、95%CI:1.284~4.429,OR=1.531、95%CI:1.227~4.302,OR=1.776、95%CI:1.363~5.728,OR=0.601、95%CI:0.275~0.930,P0.05),与患者入院时的GCS评分关系不显著(OR=0.581、95%CI:0.241~0.836,P0.05)。结论 TBI患者术后容易并发颅内感染,开放性创伤、受伤至手术时间、脑室外引流时间是TBI患者术后并发颅内感染的危险因素,术后白蛋白水平是患者并发颅内感染的保护性因素。     

Factors associated with completing comprehensive traumatic brain injury evaluation

This study examined factors associated with Iraq and Afghanistan Veterans following up with the Department of Veterans Affairs (VA) comprehensive traumatic brain injury (TBI) evaluation after a positive first-level VA TBI screen. Participants included 465 Iraq and Afghanistan Veterans at one VA Medical Center and its five affiliated community-based outpatient clinics, with a positive initial TBI screen between April 1, 2007 and June 1, 2010. We found that 75% of Veterans completed the comprehensive TBI evaluation. Women were three times less likely to complete the comprehensive TBI evaluation than men, and those who endorsed post-traumatic stress disorder avoidance symptoms were nearly two times less likely to complete the comprehensive TBI evaluation. In contrast, headaches, Hispanic ethnicity, and the season of the initial TBI screen (summer vs. winter) were positively associated with completing a comprehensive TBI evaluation. A substantial minority of Veterans who screen positive on the VA initial TBI screen fail to present for the comprehensive TBI evaluation. Addressing specific gender-related issues, avoidance, and the timing of referrals in the context of VA polytrauma programs may increase the likelihood that Veterans receive further assessment, education, and early intervention for TBI or other mental health problems to prevent chronic postdeployment disability.     

急性创伤性脑损伤发生心脏收缩功能障碍的危险因素分析

目的 评估早期急性创伤性脑损伤(TBI)患者是否存在心脏收缩功能障碍,并对相关危险因素进行分析.方法 回顾性分析2018年7月—2019年7月北海市人民医院收治的63例急性创伤性脑损伤(TBI)患者资料,根据有无心脏收缩功能障碍(左室长轴缩短率<25％)分为障碍组(21例)和无障碍组(42例).均因道路交通伤(38例)...     

重度颅脑损伤并发脑积水危险因素的探讨

目的探讨重度颅脑损伤(STBI)后并发脑积水的危险因素。方法回顾性分析收治的336例颅脑损伤患者的临床资料,对颅脑损伤后并发脑积水的相关因素进行Logistic回归分析。结果 336例重型TBI患者中:65例(19.34%)发生脑积水时间在伤后3周～6个月之间;通过Logistic回归分析发现重度TBI患者发生脑积水主要危险因素:年龄(OR=1.070,P=0.020)、去骨瓣(OR=5.530,P=0.032)、弥散性蛛网膜下腔出血(OR=42.512,P=0.001)、硬脑膜缝合(OR=30.276,P=0.035)、腰椎穿刺放血性脑脊液(OR=2.993,P=0.000)。结论高龄患者、开颅去骨瓣减压术、硬脑膜敞开和弥散性蛛网膜下腔出血是创伤后脑积水发生的主要危险因素,硬膜缝合、腰椎穿刺放血性脑脊液可以降低脑积水的发生率。     

创伤性主动脉损伤患者临床特点及危险因素分析

目的 探讨创伤性主动脉损伤(TAI)患者临床特点及危险因素.方法 回顾性分析2015年6月—2020年5月空军军医大学第一附属医院急诊科收治的合并TAI的多发伤患者41例,将其作为合并组.男性33例,女性8例;年龄19～73岁,平均55.3岁;道路交通伤23例,坠落伤7例,其他10例.从同期960例无TAI的多发伤患者...     

颅脑创伤后颅内感染的危险因素分析

目的：探讨颅脑创伤（ TBI）后颅内感染的发生情况和危险因素,从而提高临床预见性和治疗效果。方法回顾性分析我科2011年1月～2013年12月收治的520例颅脑创伤患者的临床资料,其中男性308例,女性212例;年龄14～85岁,平均（40.22±8.46）岁。分析颅内感染的相关危险因素。结果32例（6.15％）出现颅内感染。颅内感染好发于损伤后4～10d。单因素分析显示脑脊液漏、外引流、多次开颅手术（≥2次）与颅内感染的发生密切相关; Logistic回归分析提示脑脊液漏（P＝0.0091,OR＝2.071）、外引流（P＝0.0165,OR＝1.923）为其独立危险因素。结论颅内感染是颅脑创伤的严重并发症之一,脑脊液漏或外引流患者更易出现颅内感染,临床上应予以足够重视,争取患者获得最佳的治疗效果。     

急性颅脑创伤后进展性颅内出血发生的

目的 分析急性颅脑创伤后进展性颅内出血(progressive intracranial hemorrhage,PIH)发生的危险因素及临床意义.方法 通过比较颅脑创伤患者连续头颅CT扫描的表现,确定是否发生PIH.分析PIH与非PIH患者在年龄、性别、受伤机制、入院时GCS、受伤至首次CT检查时间、首次CT检查表现、伤后早期血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、血小板(PLT)、D-二聚体(D-D)的含量等方面的差异,并采用Logistic回归分析PIH发生的危险因素.结果 共纳入498例患者,其中139例(27.9%)发生PIH.116例(83.5%)PIH在伤后2 h内行CT扫描.PIH组与非PIH组在年龄、入院时GCS、受伤至首次CT扫描时间、伤后首次CT表现为骨折、蛛网膜下腔出血(SAH)、挫裂伤、初发血肿、血浆PT、Fg、D-D含量差异有统计学意义(P＜0.01).Logistic多元回归分析显示,PIH组与非PIH组在伤后CT表现为SAH、挫裂伤、初发血肿以及D-D与PIH的发生密切相关(P＜0.01).结论 对于受伤后早期(2 h内)即行首次头颅CT检查的患者,如果首次CT表现为SAH、挫裂伤、初发血肿合并D-D含量升高,应进行更早的连续CT扫描以期早期发现PIH.     

急性严重型颅脑损伤早期死亡的预测因素

目的 探讨急性严重型颅脑损伤患者早期死亡的预测因素.方法 回顾性分析2017年6月—2019年12月雅安市人民医院神经外科收治的128例重度颅脑损伤患者,男性81例,女性47例;年龄14～76岁,平均47.5岁.道路交通伤68例,高空坠落伤18例,跌打伤22例,重物砸伤12例,殴打伤8例.观察患者的年龄、性别、入院时的...     

急性颅脑创伤后进展性颅内出血发生的

Objective To investigate the risk factors related to progressive intracranial hemorrhage (PIH) in patients with acute traumatic brain injury (TBI) and analyze their clinical significance.Methods PIH was validated by comparing the initial and repeated CT scans. Data including gender,age, injury causes, Glasgow Coma Score (GCS) on admission, time interval from injury to the first CT scan, initial CT scan manifestations, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), platelet (PLT) and D-dimer (D-D) in both groups were compared with Logistic regression analysis to observe the risk factors related to PIH. Results The study involved 498 patients with acute TBI, of which 139 (27.91%) patients suffered from PIH. There were 116 patients (83.45%) with PIH who received the initial CT scan within two hours post injury.There was statistical difference in aspects of age, GCS on admission, time interval from injury to the first CT scan, initial CT scan manifestations ( including fractures, subarachnoid hematoma, contusion and onset hematoma), PT, Fg and D-D values in both groups (P ＜0.01 ). Logistic regression analysis showed that CT scans (subarachnoid hemorrhage, brain contusion and primary hematoma) and plasma D-D values were predictors of PIH ( P ＜ 0.01 ). Conclusions For patients with the initial CT scan manifestations including subarachnoid hemorrhage, brain contusion, primary hematoma together with D-D value increase within two hours post injury, a continuous CT scan should be performed promptly to detect PIH early.     

急性颅脑创伤后进展性颅内出血发生的

Objective To investigate the risk factors related to progressive intracranial hemorrhage (PIH) in patients with acute traumatic brain injury (TBI) and analyze their clinical significance.Methods PIH was validated by comparing the initial and repeated CT scans. Data including gender,age, injury causes, Glasgow Coma Score (GCS) on admission, time interval from injury to the first CT scan, initial CT scan manifestations, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), platelet (PLT) and D-dimer (D-D) in both groups were compared with Logistic regression analysis to observe the risk factors related to PIH. Results The study involved 498 patients with acute TBI, of which 139 (27.91%) patients suffered from PIH. There were 116 patients (83.45%) with PIH who received the initial CT scan within two hours post injury.There was statistical difference in aspects of age, GCS on admission, time interval from injury to the first CT scan, initial CT scan manifestations ( including fractures, subarachnoid hematoma, contusion and onset hematoma), PT, Fg and D-D values in both groups (P ＜0.01 ). Logistic regression analysis showed that CT scans (subarachnoid hemorrhage, brain contusion and primary hematoma) and plasma D-D values were predictors of PIH ( P ＜ 0.01 ). Conclusions For patients with the initial CT scan manifestations including subarachnoid hemorrhage, brain contusion, primary hematoma together with D-D value increase within two hours post injury, a continuous CT scan should be performed promptly to detect PIH early.     

1026例颅脑交通伤合并多发伤患者的预后因素分析

目的 分析颅脑交通伤合并多发伤患者损伤部位及其损伤程度的分布特点,探讨不同损伤部位及程度对此类患者预后的影响. 方法 回顾性分析2007年8月-2010年8月收治入院的1 026例颅脑交通伤合并多发伤患者的临床资料. 结果 患者以中青年居多(78.07％),且以男性为主(男女之比为3.62:1),合并伤以胸部损伤为主(46.69％).相关性分析表明GCS、年龄、颌面部损伤、胸腹损伤与GOS有相关性(P＜0.05),Logistic回归分析显示年龄、GCS、肺损伤是GOS的独立危险因素. 结论 低GCS评分、高龄、严重肺挫伤预示高死亡率和致残率,而四肢、骨盆等部位的损伤则对预后没有显著影响.     

脑损伤患者糖皮质激素及其相关指标的变化

目的 探索颅脑创伤(traumatic brain injury,TBI)导致血皮质醇激素异常分泌的规律及其临床意义. 方法 收集55例TBI患者和13例正常人血清标本,应用酶放大化学发光法、放射免疫法分别测定血清总皮质醇、促肾上腺皮质激素、类固醇结合球蛋白水平,并运用Coolen公式计算游离皮质醇水平和游离皮质醇指数.结果 TBI后患者的类固醇结合球蛋白较稳定,而皮质醇及其他相关激素水平均明显升高,且随伤情加重有升高趋势.手术可部分解除应激反应,不导致激素异常分泌.升高的激素越快降至正常,患者预后越好.如果皮质醇激素过低,预后也较差. 结论 TBI会导致血皮质醇及其他相关激素升高,皮质醇持续过高或过低者预后不佳,TBI早期大量补充激素治疗须慎重.     

The Trauma Symptom Inventory: factors associated with invalid profiles in a sample of combat veterans with post-traumatic stress disorder

The assessment of combat-related post-traumatic stress disorder (PTSD) relies upon self-reported symptoms and the need for indicators of valid reporting is critical. The Trauma Symptom Inventory (TSI) is a testing instrument specific to PTSD which includes validity scales. In a pilot study examining the use of the TSI with combat veterans, 50 male veterans diagnosed with PTSD were administered the TSI. Nineteen percent of the profiles were invalid, all but one based on the Atypical Response Scale. Differences between veterans with valid and invalid TSI profiles are examined in terms of demographic and historical factors, TSI profiles, and individual scale items. The model best able to predict invalid profiles included high scores on subscales measuring dissociative experiences and tension reduction behaviors. Implications for the interpretation of TSI validity scales in assessing combat-related PTSD are discussed.     

白藜芦醇对大鼠脑创伤后血清炎性因子影响的实验研究

目的：检测白藜芦醇治疗前后大鼠血清炎性因子TNF-α和IL-1β的浓度变化,以探讨白藜芦醇的脑保护作用。方法：SD大鼠75只,随机分为创伤组、对照组和治疗组,每组分伤后3、12、24、48、72 h共5个时间点,各时间点每组动物5只,Feeney法自由落体致伤动物,治疗组给予白藜芦醇（50 mg/kg体重）腹腔注射治疗,伤前一天治疗一次,伤后每天治疗一次,直至采血时间点;对照组同法给予等量生理盐水治疗;创伤组不予治疗,正常喂食水。分别于伤后各时间点股静脉取血,静置分层后离心,取血清低温保存,放射免疫法检测血清TNF-α和IL-1β浓度。结果：伤后治疗组TNF-α和IL-1β浓度比对照组明显降低（P〈0.05）,TNF-α和IL-1β在创伤组与对照组无明显差异（P〉0.05）。结论：白藜芦醇可以减少伤后血清TNF-α和IL-1β浓度,减轻炎症反应,对脑创伤有保护作用。     

神经血管单元与创伤性脑损伤

创伤性脑损伤(traumatic brain injury,TBI)已成为一个非常严重的社会医学问题.在美国,每年超过140万人发生TBI[1];我国每年因脑外伤致死者约10万人,伤数百万人,占全身各部位损伤的第2位,且随着社会的发展而逐渐增加;重型颅脑外伤的病死率和致残率居高不下,总病死率一直保持在30%～50%左右[2],居第1位.     

重型颅脑损伤后并发脑积水的多因素分析

目的探讨重型颅脑创伤后并发脑积水的危险因素。方法回顾性分析2009年1月~2014年5月收治的248例重型颅脑损伤患者的临床资料,其中男性180例,女性68例;年龄18~74岁,平均51.2岁。致伤原因:道路交通伤200例,高处坠落伤23例,殴打伤8例,硬物砸伤10例,其他伤7例。根据伤后是否并发脑积水分为脑积水组(50例)和无脑积水组(198例)。对颅脑损伤后并发脑积水的相关因素,如患者的年龄、入院时格拉斯哥昏迷评分(GCS)、去骨瓣、硬脑膜有无缝合、蛛网膜下腔出血(SAH)情况、血肿位置及腰椎穿刺有无引流脑脊液等,进行Logistic回归分析。结果 248例颅脑损伤患者中,50例(20.2%)发生脑积水;通过Logistic回归分析发现重型颅脑损伤患者发生脑积水主要危险因素为年龄(OR=1.823,P=0.031)、去骨瓣(OR=1.136,P=0.000)、弥散性SAH(OR=2.288,P=0.018)、硬脑膜缝合(OR=1.711,P=0.037)、腰椎穿刺放血性脑脊液(OR=0.449,P=0.002)。结论高龄患者、去骨瓣减压、硬脑膜开放以及弥散性SAH是重型颅脑损伤后并发脑积水的危险因素,采取硬脑膜缝合、腰椎穿刺引流血性脑脊液可降低脑积水的发生率。     

Minor traumatic brain injury in sports

Mild traumatic brain injury (MTBI) is an all-too-frequent occurrence among amateur and professional athletes alike. The increased attention it has received in recent literature may suggest that incidence of this injury has risen. The frequency of MTBI in general may be rising with the increased interest in so-called noncontact sports such as soccer, snowboarding, skateboarding, and motocross. Despite significant improvements made in the quality of protective equipment, head injury remains common in football, soccer, and amateur boxing. The management of athletes who suffer traumatic head injury remains problematic for coaches, trainers, team physicians, primary care physicians, and neurologic specialists. This article addresses guidelines, and diagnostic and treatment protocols to help with the management of athletes with concussion and traumatic head injuries.