颅脑创伤康复期应用计算机通讯促进恢复的研究进展

电子邮件通讯技术已经广泛被应用于颅脑创伤多中心医师之间、医师对患者及其家属问卷调查等研究之中,诸如利用电子邮件调查工具进行颅脑创伤患者输血指征调杳、康复治疗期间颅脑创伤深静脉血栓形成、肺栓塞形成的筛查、预防、治疗的多中心研究.     

西维来司钠对高原颅脑损伤大鼠中性粒细胞弹性蛋白酶的影响及神经损伤的保护作用

目的探讨中性粒细胞弹性蛋白酶(NE)对大鼠高原颅脑损伤的影响及NE抑制剂西维来司钠对高原颅脑损伤的神经保护作用。方法取雄性SD大鼠48只,随机分为6组。即平原对照组,平原颅脑创伤组,平原颅脑创伤+西维来司钠治疗组,高原对照组,高原颅脑创伤组,高原颅脑创伤+西维来司钠治疗组。创伤组按Feeney自由落体撞击法制作大鼠高原与平原颅脑损伤模型,对比观察高原与平原颅脑创伤前后以及给予西维来司钠治疗后血清NE浓度变化,并通过病理学观察西维来司钠治疗对高原颅脑损伤的神经保护作用。结果大鼠高原颅脑创伤前后NE浓度均明显高于平原颅脑创伤前后(P0.05),脑组织病理形态结果显示,高原大鼠颅脑创伤后立即给予NE抑制剂西维来司钠治疗,颅脑损伤程度较未治疗组明显减轻。结论NE是加重大鼠高原颅脑损伤后神经组织损伤的重要因素,西维来司钠治疗对高原颅脑损伤的神经组织具有明显的保护作用。     

多次颅脑创伤患者的临床特点及诊治

目的回顾性分析多次颅脑创伤患者的致伤原因、病程演变、头颅CT特点以及治疗方法和效果,提高对此类损伤的认识。方法以我院神经外科治疗的颅脑创伤患者为研究对象,统计既往有颅脑创伤史的53例患者的临床资料。结果多次颅脑创伤患者中有9例(17%)发生脑内血肿或脑室内出血,预后差;轻、中型患者后遗症发生率达74%。结论多次颅脑创伤是相对特殊的创伤类型,更为严重地危害患者的健康。     

特重型颅脑损伤术后高压氧治疗阶段并发症的特点及处理

高压氧综合治疗是颅脑创伤术后的主要治疗手段，但由于特重型颅脑创伤多同时有颅脑、胸腹部、四肢等多发伤，以及气管切开、肺部感染、胃肠道出血等并发症，治疗极为困难。面对危重复杂的病情，如何在保证病情稳定的前提下，及早安全有效进行高压氧治疗是迫切需要解决的问题。现对我院2001年1月至2005年12月间住院进行高压氧综合治疗的特重症颅脑损伤患者情况及严重并发症的处理进行分析和总结，报告如下。     

高原地区颅脑创伤手术的麻醉处理与术后并发症的预防

青藏高原地区颅脑创伤患者术后常并发脑水肿、高血糖、肾功能衰竭等.为有效预防术后并发症的发生,现将我院2000-2007年手术治疗的63例颅脑创伤患者的麻醉处理及术后并发症的预防处理总结如下.     

分子生物学治疗方法及其在颅脑创伤中的应用

随着对颅脑创伤后病理生理变化的深入研究 ,对颅脑创伤的认识水平已进入分子水平 ,应用分子生物学方法治疗颅脑创伤是未来的发展方向。1　常用的分子生物学治疗方法简介分子生物学治疗方法是在蛋白质水平或者核酸水平影响细胞的病理生理变化 ,达到治疗的目的。1 1　蛋白质水平　以蛋白质或多肽链作为治疗因子 ,影响细胞的病理生理变化。早期多以质粒、噬菌体等为载体将神经营养因子基因转入大肠杆菌 ,使之表达 ,获得体外重组的神经营养因子 ,再将各种不同的神经营养因子通过静脉注射、脑池内注射等方法提供给脑组织 ,神经营养因子再与靶细…     

颅脑创伤并发应激性溃疡中Ghrelin保护作用的研究进展

颅脑创伤(TBI)是一种严重而又复杂的创伤,不仅中枢神经系统发生原发性损伤,机体内环境紊乱引发的全身脏器功能障碍也是影响患者预后的重要因素。应激性溃疡的发生是颅脑创伤后常见的并发症之一,胃肠道黏膜破坏时肠内细菌和毒素发生移位,诱发机体发生严重的全身炎症反应,严重者可导致全身炎症反应综合征,最终发生多脏器功能衰竭。因此,对于颅脑创伤患者的治疗,不仅要控制神经系统原发性损伤,还要关注并发症的防治。Ghrelin是一种具有多种生物学功能的脑肠肽,不仅能在颅脑创伤后保护神经,还可以缓解颅脑创伤诱发的胃肠道功能障碍。因此Ghrelin有可能是未来临床治疗颅脑创伤的重要方法之一。     

重视和加强颅脑创伤合并伤的诊断和治疗

随着颅脑创伤规范化处理原则的推广应用,国内颅脑创伤的救治水平不断提高.但颅脑创伤合并伤的诊治由于涉及多个学科,在确定救治顺序、现场指挥协调、手术人员安排、用药选择等多个环节上存在一定难度,不同层次医院的救治水平还存在较大差距.创伤专家提出了加强对创伤评分系统的应用和对创伤外科理念的认识,建议从整体上诊治颅脑创伤及其合并伤[1,2].因此,颅脑创伤合并伤的诊治已经成为创伤研究的一个十分重要的问题.     

创伤性脑水肿的发生机制及治疗研究进展

颅脑创伤作为一种严重的创伤类型,无论平时还是战时均有较高的发生率,严重威胁人类生命安全。颅脑创伤后,均有不同程度的脑水肿的发生和存在,对脑水肿的治疗效果直接关系到疾病的预后。本文就创伤性脑水肿的分类、发生机制及治疗进展作了全面综述。     

早期外固定术在重型颅脑创伤合并四肢骨折中的应用

目的 探讨早期(<48 h)骨折外固定术在重型颅脑创伤(GCS≤8)合并四肢骨折患者中的临床应用效果.方法 统计重型颅脑创伤合并四肢骨折年龄、性别、颅脑创伤情况、骨折部位分布及其他全身情况等差异均无统计学意义的患者,根据骨折的早期(＜48 h)治疗方法不同,将重型颅脑创伤患者分为两组.A组:早期骨折外固定组(40例);B组:早期骨牵引、石膏固定等保守治疗组(57例).对比分析两组患者褥疮、肺炎、下肢静脉血栓形成等并发症发生情况,ICU时间、住院时间、骨折愈合时间、病死率等指标.结果 A组在感染率、褥疮、肺炎、下肢静脉血栓发生率方面明显低于B组(P＜0.05).A组的ICU时间、住院时间、骨折愈合时间短于B组(P＜0.05).A组的病死率低于B组,差异有统计学意义(P＜0.05).结论 针对重型颅脑创伤合并四肢骨折的患者,开展早期骨折外固定法与原有早期骨牵引、石膏固定等保守治疗方法相比,减少了并发症,缩短了恢复时间,降低了病死率.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.