重型颅脑损伤后长期意识障碍患者的清醒预测及预后评估

目的探讨影响重型颅脑损伤后长期意识障碍患者清醒的因素及其对预后预测的价值。方法对46例重型颅脑损伤后意识障碍超过2周的患者进行清醒预测,选择6个预后影响因子即年龄、性别、受伤机制、手术与否、体感诱发电位（SEP）表现方式、清醒所需时间等对预后进行分析,清醒结果以患者伤后6个月是否清醒为标准。预后评估以伤后6个月GOS评分为标准进行判别。结果SEP分级与患者清醒及预后有显著相关性（r=-0．749,P〈0．01）,分级越高,清醒的几率越小,预后越差。结论SEP的分级可客观、准确地反映颅脑损伤患者的预后和清醒几率。     

重型颅脑创伤长期意识障碍患者清醒预测的MRI分级研究

目的 探讨MRI对重型颅腩创伤后长期意识障碍患者清醒预测的分级标准.方法 记录66例重型TBI意识障碍超过2周患者的MRI表现,以MRI的表现分为3级:Ⅰ级:仅有大脑半球的损伤;Ⅱ级:丘脑、胼胝体的损伤,伴或不伴有I级的损伤灶,包括:Ⅱa级(单侧丘脑的损伤)和Ⅱb级(胼胝体、双侧丘脑的损伤);Ⅲ级:脑干背外侧的损伤,伴或小伴有Ⅰ级和(或)Ⅱ级的损伤灶.预后以颅脑创伤后6个月患者是否清醒为标准.结果 MRI分级与清醒的概率有显著相关性,Pearson相关系数-0.722(P＜0.05),分级越高,预后越差;Ⅱb级、Ⅲ级作为预后不良的指标,判断的敏感性为85.7%,特异性为87.5%,准确率为86.4%,错误率为13.6%;ROC曲线下面积为0.89,95%可信区间为(0.808,0.978).结论 MRI分级可客观、准确地反映颅脑创伤程度和清醒的概率.     

重型颅脑损伤病人创伤后应激障碍的风险因素分析

目的 探讨重型颅脑损伤病人并发创伤后应激障碍（PTSD）的危险因素。方法 回顾性分析2020年1月至2022年2月收治的110例重型颅脑损伤的临床资料。出院前采用PTSD自评量表（PTSD-SS）评估PTSD情况,总分≥50分表示存在PTSD。结果 110例PTSD-SS评分总分（49.64±7.29）分,其中≥50分52例（47.27%）。多因素logistic回归分析显示,女性、低龄、家庭人均月收入低、非亲属照顾、无经济赔偿、合并颅内感染为重型颅脑损伤并发PTSD的独立影响因素（P<0.05）。根据多因素logistic回归分析结果构建PTSD列线图显示一致性指数为0.886,预测PTSD具有较高的应用价值。结论 重症颅脑损伤病人并发PTSD的风险较高,女性、年轻病人、收入低、非亲属照顾、无经济赔偿、合并颅内感染等因素会增加PTSD发生风险,临床应密切关注,识别PTSD风险因素,并给予有效的防治措施降低PTSD发生率。     

重型颅脑外伤后长期意识障碍患者清醒预测的体感诱发电位分级研究

目的 探讨体感诱发电位(SEP)对重型颅脑外伤(TBI)后长期意识障碍患者清醒预测的分级标准. 方法 记录46例重度TBI后意识障碍超过1周患者的SEP表现,根据SEP中N20-P25是否存在及中枢传导时间(CCT)是否正常,将SEP分为3级:Ⅰ级为双侧N20-P25都存在(Ⅰa:双侧CCT正常且对称,Ⅰb:双侧CCT正常,但不对称);Ⅱ级为一侧N20-P25存在,另一侧消失;Ⅲ级为双侧N20-P25都消失.预后以外伤后6个月患者是否清醒为标准. 结果 SEP分级与清醒的几率存在负相关关系(r=-0.591,P=0.000),分级越高,预后越差. 结论 SEP的分级可客观、准确地反映脑功能损伤程度和清醒的几率.     

定量脑电图对重型颅脑创伤长期意识障碍患者的清醒评估

目的 探讨定量脑电图在重型颅脑创伤后长期意识障碍患者预后中的应用.方法 收集我院重型颅脑创伤意识障碍超过2周的患者41例,分成清醒组(19例)和未清醒组(22例),均于入院后2周行脑电图检查获取原始脑电图资料,采样后借助计算机软件行快速傅里叶转换进行功率谱分析,功率谱按频率分为δ(1.0～4.0 Hz)、θ(4.1～8.0 Hz)、α1(8.1～10.0 Hz)、α2(10.1～13 Hz)、β1(13.1～17.5 Hz)、β2(17.6～35.0 Hz)6个频带,计算出各个频带的绝对功率值及δ+θ/α+β值并以δ+θ/α+β值作为患者顸后评判指标,进行两个病例组之间的关系研究,以颅脑创伤后6个月患者是否清醒为标准.结果 清醒组的6+θ/α+β值((-x)±s)为5.432±3.277,未清醒组的δ+θ/α+β值((-x)±s)为8.724±5.641.清醒组和末清醒组行两独立样本t检验,两组病例间差异有统计学意义,t=2.237(P=0.030).清醒患者的GCS评分和δ+θ/α+β值行Pearson相关分析,得出r=-0.622,P=0.004,两者呈负相关.结论 定量脑电图作为一种廉价、客观、快速的脑功能评价手段,可准确地反映颅脑创伤程度和预后.

Abstract：

Objective To explore the quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening.Method All cases were divided into two groups( the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of unconsciousness ≥2 weeks.The sampled data did make fast Fourier transform to obtain the power spectrum analysis with the computer software.The power spectrum was divided into 6 bandwidth by frequency: δ( 1.0～4.0 Hz)、θ(4.1 ～8.0 Hz) 、α1(8.1 ～10.0 Hz) 、α2(10.1 ～13 Hz) 、β1 (13.1 ～17.5 Hz) 、β2(17.6 ～35.0 Hz).Calculate the absolute power value in each band and δ + θ/β + β value and research the correlation of the both group.The awakening after the sixth months from injury was used as the criterion.Results The score of δ + θ/α + β was 5.432 ± 3.277 in the awake group,yet in the unfavourable prognosis group was 8.724 ± 5.641.Using the two independent sample t test, both groups had significant difference, t =2.237 ( P = 0.030 ).Using Pearson correlation analysis, r = - 0.622, P = 0.004, both Glasgow coma score and δ + θ/α + β value had negative correlation.Conclusions As an inexpensive,objective and rapid means of the evaluation of brain function,the QEEG can accurately reflect the degree of brain dysfunction and assess the prognosis of patients.     

颅脑损伤术后癫痫发作20例临床分析

我院外科近5年来施行各种颅脑外伤手术146例,术后继发癫痫20例。现就本组20例术后癫痫发生原因、防治等问题进行探讨。     

应用MRI分级预测颅脑损伤长期意识障碍患者的清醒时间及预后

目的 探讨颅脑损伤长期意识障碍患者MRI分级与清醒时间及预后的关系.方法 收集珠江医院神经外科自2003年至2008年收治的66例重型颅脑损伤后意识障碍超过2周的患者,记录患者颅脑MRI表现并进行分级;记录所有清醒患者损伤后清醒时间;预后以患者伤后6个月时GOS评分进行判别.结果 患者预后(GOS评分)与MRI分级存在联系,分级越高者,预后越差;MRI对预后的预测准确率为83.33%.MRI分级为Ⅰ级和Ⅱa级的清醒患者的平均清醒时间为(8.00±4.10)周,MRI分级为Ⅱb级和Ⅲ级的清醒患者的平均清醒时间为(22.67±23.66)周.结论 颅脑损伤长期意识障碍患者的头颅MRI分级与患者的清醒时间及预后有关,应用MRI分级可客观、准确的预测患者的预后.     

体感诱发电位在重型颅脑损伤长期意识障碍患者清醒预测中的作用

目的探讨重型颅脑损伤(traumatic brain injury,TBI)后长期意识障碍成人患者清醒的影响因素及清醒预测。方法收集47例重度颅脑损伤后(Glasgow coma scale,GCS8)意识障碍超过2周的患者的病例资料,选择5个预后因子:年龄、性别、受伤机制、去骨瓣减压手术、体感诱发电位(somatosensory evoked potentials,SEP)表现方式等分析与清醒结果的关系,将体感诱发电位分为3个等级:Ⅰ级,双侧N20-P25都存在,①双侧CCT正常且对称,N20-P25波幅正常;②至少一侧CCT延长低于其正常均值一倍且N20-P25波幅0.8μV。Ⅱ级,至少有一项达到下列指标,①双侧CCT延长超过其正常均值一倍;②双侧N20-P25波幅0.8μV;③一侧N20-P25消失,另一侧存在。Ⅲ级,双侧N20-P25消失。结果判定以外伤后6个月患者是否清醒为标准。结果 SEP分级与重型颅脑损伤长期意识障碍患者清醒的机率有显著相关性(P=0.002),其对清醒的预测准确率可达87.2%。结论 SEP分级可客观、准确地评估患者的预后及预测患者的清醒机率。     

神经电刺激治疗颅脑损伤后意识障碍的研究进展

<正>意识障碍是中、重型颅脑损伤(traumatic braininjury,TBI)的严重并发症。近十年来,随着神经多模态监测技术、大骨瓣减压术等手术理念的推广以及神经危重症医学技术的进步,重型TBI的病死率明显下降,但伤后意识障碍的发生率也在持续增加^[1],临床治疗面临巨大的压力和挑战^[2]。     

Risk of Stroke with Temporary Arterial Occlusion in Patients Undergoing Craniotomy for Cerebral Aneurysm

Objective

This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms.

Methods

Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke.

Results

In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011).

Conclusion

Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient''s age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.     

Comparison of Conscious Sedation and Asleep-Awake-Asleep Techniques for Awake Craniotomy

Since awake craniotomy (AC) has become a standard of care for supratentorial tumour resection, especially in the motor and language cortex, determining the most appropriate anaesthetic protocol is very important. The aim of this retrospective study is to compare the effectiveness of conscious sedation (CS) to “awake-asleep-awake” (AAA) techniques for supratentorial tumour resection. Forty-two patients undergoing CS and 22 patients undergoing AAA were included in the study. The primary endpoint was to compare the CS and AAA techniques with respect to intraoperative pain and agitation in patients undergoing supratentorial tumour resection. The secondary endpoint was comparison of the other intraoperative complications. This study results show that the incidence of intraoperative agitation and seizure were lower in the AAA group than in the CS group. Intraoperative blood pressures were significantly higher in the CS group than in the AAA group during the pinning and incision, but the level of blood pressures did not need antihypertensive treatment. Otherwise, blood pressures were significantly higher in the AAA group than in the CS group during the neurological examination and the severity of hypertension needed statistically significant more antihypertensive treatment in the AAA group. As a result of hypertension, the amount of intraoperative bleeding was higher in the AAA group than in the CS group. In conclusion, the AAA technique may provide better results with respect to agitation and seizure, but intraoperative hypertension needed a vigilant follow-up especially in the wake-up period.     

Critically Ill Cancer Patients are not Consistently Hypercoagulable after Craniotomy

Introduction  

Recent reports using thrombelastography have suggested that neurosurgical patients develop a hypercoagulable state in the postoperative period. Since venous thromboembolism is a potentially life threatening complication in these patients, we studied a similar population in our institution.     

开颅手术后颅内感染相关危险因素的Logistic回归分析

目的探讨开颅手术后颅内感染相关的危险因素，为预防和控制颅内感染提供依据。方法检索1994年至2004年在国内杂志发表的有关颅内感染的相关文献，收集描述其相关危险因素的文献进行荟萃分析，对开颅术后颅内感染的相关危险因素进行二分类Logistic回归统计。结果共有46篇论文进入荟萃分析，其中有18篇文献探讨了颅内感染危险因素构成比，12篇可提取6种主要相关危险因素的可比较资料。开颅术后发生颅内感染构成比最高的是手术时间〉4h，占54．81％，其它依次为颅内置管引流、后颅窝手术、开放性颅脑损伤、急诊手术和脑脊液漏。二分类Logistic回归统计结果显示，脑脊液漏（OR=11．587）、开放性颅脑损伤（OR=3．024）和后颅窝手术（OR=2．737）是构成颅内感染密切关联危险因素（P〈0．05，OR〉1）。结论分析结果证实了开颅手术后脑脊液漏、开放性颅脑损伤和后颅窝手术是术后颅内感染的主要危险因素。     

体感诱发电位N20评价意识障碍患者预后的研究

目的：探讨体感诱发电位参数N20评价意识障碍患者预后的价值。方法：回顾性分析110例因各种因素（外伤、心肺复苏术后、缺血缺氧、脑血管病等）导致意识障碍患者的病史、病程和体感诱发电位N20的数据;并进行1年的随访,观察患者预后转归。采用描述性分析,独立样本t检验、ROC曲线及Kaplan-Meier分析等方法进行统计学分析。结果：110例意识障碍患者随访中死亡2例予以剔除,共纳入分析病例108例。根据意识恢复情况分为：意识恢复组（52例）;意识未恢复组（56例）。N20潜伏期判断患者预后有着较好的评判价值（ROC曲线下面积分别为C3-’N20：77.6%,C4-’N20：79.3%）,意识恢复组双侧N20潜伏期均较意识未恢复组短,但两组患者的波幅差异均无统计学意义。C4-’N20潜伏期界定为20.05 ms时及C3-’N20潜伏期界定为19.95 ms时有着较好的敏感度和特异度（C4-’N20：70.8%,75.0%,C3-’N20：75.0%,72.0%）;Kaplan-Meier分析结果显示C3-’N20潜伏期〈19.95 ms及C4-’N20潜伏期〈20.05 ms的患者1年内能够恢复的概率最大,恢复时间最短。结论：体感诱发电位N20潜伏期能够较好评价意识障碍患者预后,其中以C4-’N20潜伏期20.05 ms及C3-’N20潜伏期19.95 ms为较好的界定值。     

开颅术后颅内感染的危险因素及防治措施

目的探讨颅脑手术后颅内感染的危险因素及防治方法。方法对我院1952例颅脑手术后66例发生颅内感染患者的临床资料进行了回顾性分析。结果66例开颅术后颅内感染者,61例颅内感染得到控制,4例死亡,1例自动出院。结论急症、后颅窝手术、脑脊液漏、脑室外引流及手术时间过长为术后发生颅内感染的高危因素,严格的无菌操作、开展微创手术、围手术期使用有效抗生素以及针对不同的危险因素采取相应的预防措施可减少术后颅内感染的发生,正确用药对控制颅内感染效果较好。     

Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy

Objective Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy. Methods Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point. Results Patients’ diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R²=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R²=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R²=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R²=0.278, p=0.014). Conclusion Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.     

经额开颅术后额窦炎的治疗（附8例报告）

目的分析经额开颅术后出现额窦炎的原因,探讨其防治措施。方法经额开颅术后急性或慢性额窦炎患者8例,其中经1次或2次清创手术治疗6例,理疗2例。结果8例病人全部治愈。结论针对不同时期、不同程度的开颅术后额窦炎,采用不同的治疗措施,是处理该类病人的合理方式。     

脑胶质瘤致癫痫因素临床分析

目的探讨脑胶质瘤致癫痫因素。方法回顾性分析我院2002年3月至2006年6月收治的137例脑胶质瘤患者的临床资料。结果在137例脑胶质瘤中51例(37.23%)伴发癫痫。肿瘤主体位于额叶、颞叶部位者癫痫发病率高,具有钙化、肿瘤累及皮层和没有明显占位效应的胶质瘤容易引发癫痫,低级别胶质瘤患者癫痫发病率明显高于高级别胶质瘤患者(P<0.05)。结论胶质瘤伴发癫痫与其病理类型、肿瘤生长部位及特征有关;癫痫发作类型与肿瘤所在部位密切相关。     

颅脑术后颅内葡萄球菌感染的临床分析

目的 分析颅脑术后颅内葡萄球菌感染的临床表现、危险因素、细菌耐药性特点,探讨预防措施及治疗方法.方法 回顾性收集1999年9月至2007年9月山东大学齐鲁医院神经外科颅脑手术术后脑脊液培养证实葡萄球菌生长患者的资料,并进行统计学分析.结果 本组共30例,男16例、女14例,年龄2～72岁,平均39.5岁.检出金黄色葡萄球菌1例,表皮葡萄球菌27例,溶血葡萄球菌4例,腐生葡萄球菌1例.合并两种以上细菌感染9例,其中7例为革兰氏阴性菌.颅内肿瘤术后感染11例.脑外伤5例,颅内置管性手术(脑室体外引流和脑脊液分流,其中2例为脑肿瘤患者)11例,颅内其他手术5例,其发生率分别为0.24%、0.64%、1.90%、0.69%,置管性手术组与肿瘤组及其他手术组相比有明显差异(P＜0.05).耐甲氧西林葡萄球菌总体检出率为69.7%,未有耐万古霉素菌株出现.结论 颅脑术后葡萄球菌脑膜炎以表皮葡萄球菌感染为主,好发于颅内置管性手术.耐甲氧西林菌株检出率呈逐年增高趋势,但万古霉素治疗效果仍可靠.