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。     

重型颅脑损伤合并骨折的早期处理

颅脑损伤合并骨折的发生有明显的上升,一般来说,应先救治可能危及生命的颅脑损伤,而骨折手术则延期进行,但也有认为早期特别是24h内对主要骨折进行手术内固定,有利于患者的存活,防止肢体畸形、关节僵硬及促进脑功能恢复[1]。一、资料与方法1.一般资料:本组106例患者均为我院自2     

生物型人工硬脑膜在外伤大骨瓣减压术中应用安全性分析

目的 探讨生物型人工硬脑膜在外伤大骨瓣减压术中应用的安全性.方法 通过对试验组(330例)和对照组(222例)患者术后颅内感染、脑脊液漏、癫痫等并发症进行比较,并进行统计学分析,观察两组患者术后并发症的发生率是否具有统计学意义.结果 试验组术后脑脊液漏、颅内感染及癫痫等并发症的发生率均明显低于对照组,而异物反应发生率与对照组比较差异无统计学意义.结论 外伤大骨瓣减压术中应用生物型人工硬脑膜进行减张缝合硬脑膜安全、可行.     

标准外伤大骨瓣开颅术在重型颅脑损伤中的应用

目的 探讨及评价标准大骨瓣开颅术在交通事故性重型颅脑损伤中的应用价值.方法 采用标准大骨瓣开颅术治疗交通事故后46例重型颅脑损伤患者,对其相关的临床资料进行分析总结,3个月后采用GOS评定治疗效果.结果 随访3个月后,患者恢复良好23例,中残5例,重残或植物生存8例,死亡10例.结论 标准外伤大骨瓣手术是治疗交通事故性重型颅脑损伤的有效方法,它具有操作方便、彻底减压的优点,能明显提高治愈率,减轻后遗症,提高患者生存质量.     

The Development of Ego Apparatus and Drive

Recently, a number of people of Chinese descent (first-generation Americans and recent immigrants) have contacted me for psychotherapy. Many complain that they do not know who they are or that they are confused about their professional and personal goals. My attempt to understand their complaints has led me in two directions, each of which is briefly described in this article. First, I have had to learn something about the trauma experienced by some of their parents during the Cultural Revolution and the effects it had on them. For the sake of contrast, I briefly compare this experience with the experience of children of European Holocaust survivors. Second, I have had to learn something about self-development in Asian families as observed, above all, by Alan Roland (1989, 1996, 2005). In an attempt to demonstrate how the interaction of these two factors can result in the confusion my Chinese-descended patients report, I describe a complex case. The article concludes with some comments on my countertransferential feelings and technique.     

Correlates for posttraumatic stress disorder in Gulf War veterans: a retrospective study of main and moderating effects

With a sample of 120 Gulf War veterans, the present study investigated the main effects of childhood and lifetime trauma, combat exposure, and coping strategies on posttraumatic stress disorder (PTSD), as well as combat exposure's moderating effects on the other variables' relationships with PTSD. Logistic regression results indicated correct classification of PTSD diagnosis for 88% of the participants, with combat exposure and avoidant coping making significant contributions to this classification. Multiple regression results indicated that lifetime trauma, combat exposure, and avoidant coping were strongly related to PTSD symptoms. Multiple regression results also revealed that combat exposure moderated the strength and direction of PTSD's relationships with childhood trauma and avoidant coping. Study findings have implications for longitudinal investigation of PTSD development and preventive interventions.     

Penetrating head injury by a stone: Case report and review of the literature

Traumatic intracranial penetration of foreign objects of non-missile intracranial nature rarely occurs. Haemorrhages, major vascular injury and contusions can be causes of death in early stage, epileptic seizures and infections are possible complications in later stages. Complete excision of the foreign body should be performed. Possible dural and vascular injuries should be repaired during surgical treatment. In the present study, we report a rare case of traumatic intracranial stone as a foreign object. A brief review of the literature is presented.     

Addictions and Trauma Recovery: An Integrated Approach

The co-occurence of addiction with trauma-based mental health problems forms a toxic feedback loop, creating assessment and treatment challenges for consumers and their healthcare providers. Traditional separation of addiction and mental health treatment has contributed to a high level of recidivism among clients challenged by trauma and addiction problems. A new treatment model rooted in an understanding of trauma re-enactment, is described. ATRIUM integrates cognitive behavioral and relational treatment through an approach which stresses mind, body, and spiritual health.     

标准大骨瓣开颅减压术在治疗重型颅脑损伤并发脑疝中的应用

目的讨标准大骨瓣开颅减压术治疗重型颅脑损伤并发脑疝的疗效。方法将33例符合手术治疗的重型颅脑损伤并发脑疝的患者行标准大骨瓣开颅减压术,术后随访6~10个月。采用GOS评判预后。结果 33例重型颅脑损伤并发脑疝病人,行标准大骨瓣开颅减压术后,经随访恢复良好15例(45.5%),中残6例(18.2%),重残3例(9.1%),植物生存2例(6.1%),死亡7例(21.2%)。结论标准外伤大骨瓣开颅减压术,具有暴露广泛,颅骨减压窗大,压力容易分散,最大限度地增加有效容积,减压充分,脑疝易复位,能明显降低脑疝病人的死亡率和病残率。     

6 690例颅脑损伤病例流行病学研究

目的探讨颅脑损伤的发生规律和临床特点,为制定预防和干预措施提供科学依据。方法对6690例颅脑损伤病人的年龄、性别、职业、受伤时间、伤因、伤情、治疗方法和效果等临床资料进行回顾性分析。结果病人男性多于女性,男女之比为3.57∶1;31￣40岁年龄段发病率最高,占23.03%;12月份发病人数最多占13.36%;受伤地点以街道、公路为主,车祸伤最常见,占52.26%。损伤类型中以中型颅脑损伤多见,占41.61%;其次为重、轻型,分别占38.30%、20.09%,重型颅脑损伤的死亡率为21.31%。结论颅脑损伤的发生,在年龄、职业、时间、地点的分布上存在一定的规律性,根据不同人群和职业特点,因地制宜的采取预防和干预措施,可有效降低发病率。     

胰岛素与颅脑损伤

胰岛素是人体正常生理状态不可缺少的激素,在生理状态下由血液中代谢底物水平的升高刺激胰腺胰岛β细胞分泌,参与单糖、脂肪酸和氨基酸的摄取并转化为糖原、甘油三酯和蛋白质.随着其在颅脑损伤中作用及机理的不断研究,临床应用也逐渐受到重视.     

Interrelationship of childhood trauma, neuroticism, and depressive phenotype

Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P=.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P=.019), and physical neglect predicted the Anxiety symptom dimension (P=.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions.     

颅脑损伤后凝血紊乱研究的新进展

自1972年Druskin等首次报告1例颅脑火器伤引起弥散性血管内凝血(DIC)后,脑外伤所致凝血紊乱(或称凝血病,coagulopathy)得到了学者们的普遍重视。现已明确,凝血紊乱是脑外伤常见并发症,是二次脑损伤的主要原因之一。颅脑损伤激活凝血系统造成高凝状态及其随后发生的纤溶亢进可加重脑损害,影响预后。颅脑损伤严重程度与凝血紊乱、迟发性颅内血肿之间以及凝血紊乱与不良预后之间是密切相关的一、颅脑损伤后凝血紊乱的概述     

早期大剂量纳络酮治疗重型颅脑损伤的临床观察

目的观察早期大剂量应用纳络酮治疗重型颅脑损伤的临床效果。方法将100例重型颅脑损伤患者分为治疗组及对照组,治疗组又分为伤后3h内用药组(A组)和3h后用药组(B组)。治疗组均在常规治疗的基础上采用大剂量持续给予纳络酮,对照组按照常规治疗方法进行治疗,观察病人生命体征、颅内压、头颅CT征变化和远期疗效等,并对数据进行统计学处理。结果纳络酮治疗组的A组和B组近、远期疗效均较对照组有显著改善(P<0.05),同时A组在清醒时间方面优于B组,呼吸异常的发生率低于B组(P<0.05)。结论早期大剂量应用纳络酮可以降低重型颅脑外伤病人颅内压的升高幅度,缩短昏迷时间,降低伤残率,促进病人神经功能恢复。     

颅脑创伤后脑红蛋白表达变化的实验研究

目的 研究弥漫性颅脑创伤后大鼠脑组织中脑红蛋白的表达变化情况,探究脑红蛋白与颅脑创伤的关系.方法 选择Marmarou自由落体打击装置复制颅脑创伤模型,分别采用实时定量PCR技术及免疫组化技术检测伤后不同时间脑组织中脑红蛋白的核酸、蛋白表达情况,并对所得数据进行统计学分析.结果 (1)核酸表达:在伤后0.5 h,脑组织中脑红蛋白核酸表达出现首个高峰,此后逐渐下降,至6 h恢复至正常水平;伤后12 h再次升高,于伤后48 h达高峰,此后下降,至伤后120 h仍高于正常水平;(2)蛋白表达:致伤区皮层神经元脑红蛋白表达分别于伤后2 h、72 h呈现出两次高峰表达.结论 弥漫性颅脑创伤后脑组织中脑红蛋白表达呈"双峰",提示脑红蛋白可能与创伤后神经元保护相关.     

颅脑外伤后继发性脑损害发病机制的研究进展

颅脑外伤(TBI)对脑组织造成的损伤包括原发性和继发性的，后者存很大程度上决定了TBI的最终结果，继发性脑损害的机制尚未完全明了，最近的研究发现颅脑外伤后的继发性脑损害最值得继续关注的病理机制有：(1)兴奋性氨基酸(EAAs)大量释放引起Ca^2 通道开放；(2)自由基生成和脂质过氧化；(3)炎性介质释放；(4)细胞凋亡等，这些机制既同时发生作用又互相关联构成连锁反应，最终导致神经细胞的死亡。针对上述损伤机制的脑保护措施仍有待于进一步研究。     

颅脑损伤后免疫状态的改变

重型颅脑损伤后,患者的全身及脑组织局部免疫状况均会发生一系列改变.免疫功能下降导致临床上各型感染几率增加,而免疫功能不适当的激活又可导致全身炎症反应综合征及神经元继发性损伤.