模拟高原条件下大鼠爆炸性颅脑创伤伤情特点的研究

目的建立模拟高原条件下大鼠爆炸性颅脑外伤的动物模型，研究其伤情特点。方法用动物低压氧舱模拟高原环境，设计实验用大鼠爆炸性颅脑创伤实验舱，运用8#军用雷管，爆心距离目标18cm，建立大鼠爆炸性颅脑创伤的模型，观察该模型的动物行为学、病理学、脑含水量、血脑屏障开放程度和脑组织氧分压等结果，认识高原开放性颅脑创伤伤情特点。结果本实验制备的爆炸性颅脑创伤动物模型，伤情稳定，可重复性好；高原致伤组与平原致伤组均存在：（1）病理检查发现神经元细胞核、尼氏体和细胞器出现不同程度的损伤及缺血性改变。（2）脑含水量测定提示存在脑水肿。（3）伊文思蓝荧光染料示踪血脑屏障通透性存在不同程度的血脑屏障开放。（4）激光多普勒脑血流及脑组织氧分压监测提示脑组织局部缺血缺氧表现，两组比较，高原致伤组上述结果更严重，持续时间更长。结论本实验制备的动物模型，可以模拟高原环境的爆炸性颅脑创伤，高原致伤组与平原致伤组比较，其损伤程度更严重，持续时间更长。     

颅脑损伤后的血糖变化

目的探讨颅脑损伤与伤后不同时间血糖的变化规律。方法随机选择为轻型、中型、重型颅脑伤，分别在伤后8h、24h、72h、7d、15d，测定血糖含量。结果轻、中、重型颅脑伤组血糖含量均显著升高．在伤后8h内达高峰，此后逐步降低，在72h因脑水肿继发颅内压升高致血糖再次升高。从伤情来看，伤情愈重血糖升高愈显著。结论颅脑伤可导致血糖变化及血糖调节异常。     

探讨垂体前叶细胞缺氧诱导因子-1α(HIF-1α)与脑组织神经生长因子(NGF)的表达水平在颅脑损伤中的临床意义

目的 探讨垂体前叶细胞激素、缺氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)与脑组织神经生长因子(nerve growth factor,NGF)的表达水平在颅脑损伤中的临床意义。方法 选取2015年7月-2017年7月本院收治60例颅脑损伤患者,根据GCS评分分为轻、中和重型组; 收集患者血液和脑脊液并检测垂体前叶激素、HIF-1α和NGF水平。结果 与轻型组比较,中型组和重型组颅脑损伤患者血清内ACTH、GH、HIF-1α和NGF水平显著升高,脑脊液内HIF-1α和NGF水平显著升高,且随着疾病严重程度的加重而逐渐升高(P<0.05),而轻型组、中型组和重型组颅脑损伤患者血清内TSH和LH水平随着疾病严重程度的加重,患者血清内水平并无明显改变。结论 颅脑损伤患者血液和脑脊液内垂体前叶激素、HIF-1α和NGF水平异常升高; 患者血液和脑脊液垂体前叶激素、HIF-1α和NGF水平升高与颅脑损伤的严重程度有一定的关系。     

54例颅脑创伤有关精神障碍的司法鉴定

目的 探讨精神损伤的司法鉴定。方法 对54例与颅脑创伤有关精神障碍司法鉴定进行分析,按精神损伤程度分重伤组与非重伤组统计,卡方检验。结果 54例中,颅脑创伤所致智能障碍38例(70.4％),遗忘综合征1例(1.8％),精神病7例(12.9％),反应性精神病3例(5.6％),诱发精神疾病5例(9.3％),均没有评定损伤或伤残等级。重伤组与非重伤组颅脑外伤等级的差异有显著性(x~2=18.54,P<0.01)。与颅脑创伤有关精神障碍的司法鉴定有增多的趋势。结论 颅脑创伤所致精神障碍的严重程度和颅脑外伤损伤程度有关,制定统一的精神损伤鉴定标准,进一步完善颅脑创伤所致精神障碍的司法鉴定刻不容缓。     

应激性高血糖对急性重型颅脑损伤预后的评估

目的探讨血糖在急性重型颅脑损伤病情评估及预后判断的临床价值。方法对150例既往无糖尿病的急性颅脑损伤患者均于入院时进行GCS评分,根据GCS评分分为轻中度颅脑外伤组(GCS 9~15分)和重度颅脑外伤组(GCS 3~8分),并对患者48h内的血糖变化进行检测,探讨伤后血糖水平与患者伤情、预后的关系。结果重度颅脑损伤组患者的平均血糖水平高于轻中度组(P<0.05),血糖>11.1 mmol/L颅脑损伤患者的病死率明显高于血糖<11.1 mmol/L者(P<0.05),死亡患者的血糖水平明显高于存活患者(P<0.05)。结论重度颅脑外伤患者急性期的血糖浓度是判断颅脑损伤的严重程度及近期预后的参考指标,可作为GCS评分外的辅助指标。     

大鼠颅脑损伤早期血清IL-6和CRP的动态变化及意义

目的 探讨大鼠颅脑损伤早期血清IL-6和CRP的变化及与颅脑损伤程度的关系.方法 用双抗体夹心酶标免疫分析法测定颅脑损伤大鼠血清IL-6和CRP的水平.结果 轻中重度颅脑损伤大鼠血清IL-6和CRP水平均有升高,其水平与颅脑损伤的严重程度显著相关(P＜0.01),并且颅脑损伤大鼠血清IL-6和CRP含量之间呈正相关(P＜0.05).结论 血清IL-6和CRP是评价颅脑损伤早期炎症损伤程度的重要生化指标,其含量变化与伤情严重程度密切相关,通过对其动态观察可及时判断颅脑损伤的严重程度及预后.     

不同程度颅脑损伤后血清TNF-α、IL-6、IL-8变化及其临床意义

目的 探讨不同程度颅脑损伤病人血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-8水平变化及其临床意义。方法 收集我院2005年4-11月神经外科住院急性颅脑损伤患者41例及对照组25例，对照组清晨空腹抽取静脉血，急性颅脑损伤病人分别在伤后第1、3、7天取外周静脉血3mL。采用放射免疫法检测TNF-α、IL-6、IL-8，分析急性颅脑损伤分级与血清中TNF-α、IL-6、IL-8含量之间的关系及其变化趋势。结果 IL-6、IL-8早期即有升高，伤后3、7d升高显著，且有继续上升趋势；TNF-α于伤后第3天达高峰，第7天有所下降，但仍显著高于对照组。重型颅脑损伤组在病程第1、3、7天三个时间点的血清TNF-α、IL-6、IL-8的水平较轻、中型组显著升高（P〈0．05）。结论 血清中TNF-α、IL-6、IL-8参与了急性颅脑损伤的病理生理过程，其水平在重型颅脑损伤中显著增高，与颅脑损伤程度呈正相关，并可能在继发性脑损害中起重要作用。其测定对于早期评估颅脑损伤的严重程度和预后有重要的临床意义。     

颅脑损伤后氨基末端脑利钠肽前体的应用价值研究

目的探讨血浆氨基末端脑利钠肽前体(NT-pro-BNP)在评估颅脑创伤(TBI)严重程度及颅内压(ICP)增高中的应用价值。方法选择2009年1月到2009年12月收入我院神经外科的63例颅脑创伤患者作为研究对象。收集的资料包括患者的性别、年龄、入院时GCS评分、受伤机制、颅内压数值、总住院天数、重症监护病房(ICU)住院天数。按照患者入院时最初的GCS评分将其分为轻度颅脑创伤组(GCS 13-15,n=14),中度颅脑创伤组(GCS 9-12,n=24),重度颅脑创伤组(GCS 3-8,n=25)三组。应用电化学发光免疫分析技术测定血浆NT-pro-BNP浓度。结果重度颅脑创伤组血浆NT-pro-BNP水平显著高于轻度颅脑创伤组及中度颅脑创伤组(F=12.590,P<0.01)。同ICP控制组(n=15)249.3 pg/ml±103.8 pg/ml及未行ICP监测组(n=40)221.9 pg/ml±142.7 pg/ml相比,ICP增高组(n=5)NT-pro-BNP血浆浓度520.2 pg/ml±153.5 pg/ml可出现显著增高(P<0.01)。血浆NT-pro-BNP水平与GCS评分及ICU住院天数存在相关性。结论颅脑创伤早期血浆NT-pro-BNP水平越高,其伤后颅内压控制难度越大。血浆NT-pro-BNP水平可作为判断颅脑创伤严重程度及颅内压增高程度的一个潜在评估指标,有助于及早预判颅内压增高并及时地对其进行干预。     

血糖变化对急性严重颅脑损伤程度及预后评估的价值

目的探讨急性严重颅脑损伤患者血糖变化与预后的关系,为颅脑损伤患者伤情及预后判断提供理论依据。方法根据发病与否分为颅脑创伤组和对照组;以入院时GCS评分判定病情分成3~4分组(10例),5~6分组(15例),7~8分组(23例);按照预后分为存活和死亡2组。结果急性颅脑创伤患者的血糖含量明显高于对照组(P<0.01);GCS评分3组间血糖值有显著性差异(P<0.01);血糖水平与GCS评分呈显著负相关(r=-0.721,P<0.01);死亡组的血糖含量明显高于非死亡组(P<0.01)。结论颅脑损伤后血糖值可作为判断伤情的指标,应重视颅脑损伤患者血糖监测,努力控制高血糖,提高急性严重颅脑创伤患者的治愈率。     

尼莫地平对实验性脑损伤的治疗作用

目的研究钙拮抗剂尼莫地平对实验性颅脑创伤的治疗作用及其机制.方法采用家兔落体致伤闭合性颅脑创伤模型,致伤后静脉给予尼莫地平治疗,于电子显微镜下观察脑组织超微结构变化;以干湿法测定脑组织含水量;荧光标记法测定神经细胞胞浆内游离Ca2+水平;经颅多普勒超声仪观察大脑中动脉血流速度变化;并结合颅内压监测综合评定尼莫地平对实验性颅脑创伤的治疗作用.结果尼莫地平治疗组家兔神经细胞胞浆内的游离Ca2+水平显著下降,脑组织毒性损害表现减轻,大脑中动脉痉挛得到改善,脑水肿程度减轻,但颅内压变化与未用药组相比差异无显著性意义(P＞0.05).结论尼莫地平可阻断脑损伤后神经细胞"钙超载"引起的一系列病理过程,解除脑血管痉挛,改善脑血流量,具有保护脑组织的作用.     

Measurement of global cerebral circulation time using power duplex echo-contrast bolus tracking

Ultrasound assessment of global cerebral circulation time (CCT) using echo-contrast bolus tracking is a new approach to characterise the perfusion status of the human brain. We present the analysis of global CCT in 36 healthy volunteers and one patient with a cerebral arteriovenous malformation (AVM), measured by extracranial power duplex. CCT was defined as the time interval between bolus arrival in the internal carotid artery and internal jugular vein. CCT in the volunteer group was 7.5 +/- 1.1 s (mean +/- SD). Values did not correlate with age, gender, blood pressure or blood flow velocity. Measurement in the AVM patient revealed a CCT of 1.5 s. Ultrasonographic CCT analysis is a promising new tool for the evaluation of cerebral hemodynamics.     

Evaluation of the intelligence level in patients following craniocerebral injuries

The purpose of the study was to find out whether persistent depression of intellectual functions after craniocerebral injuries occurs also outside the group of very severe traumas and what is the role played by the degree of injury, the age of the patient and the length of time after trauma. Using Wechsler's test for adults 150 men were tested who had had from 1 to 10 years earlier craniocerebral injuries. The sustained injuries were classified according to the severity and permanent neurological sequelae. A control group of 50 individuals was tested similarly. The study showed that craniocerebral injuries caused permanent depression of intellectual functions also in the cases of less severe injuries, and that the degree of trauma severity was not always correlated significantly with the degree of intellectual impairment. It was shown that in the subjects with skull trauma sustained at the age above 40 years intellectual impairment caused by trauma was greater (significance level p less than 0.002) than in younger subjects.     

大鼠颅脑外伤致多器官功能障碍综合征模型的建立

目的建立符合临床实际、简便易行的颅脑外伤致多器官功能障碍综合征（MODS）模型。方法采用改进自由落体法建立颅脑外伤致MODS模型,48只Wistar大鼠随机分为正常对照组、假手术组、颅脑外伤不同时间后6个亚组（4,12,24,36,48,72h组）,记录各时相点大鼠颅脑外伤后的症状、体征,检测外周血WBC、肝肾功能、心肌酶学改变。光镜下观察肺、小肠、肝和肾组织病理变化,依据全身炎症反应综合征（SIRS）和MODS的诊断标准判断SIRS和MODS的发生率。结果（1）假手术组与正常对照组相比,其呼吸、心率、体温及外周血WBC、ALT、AST、BUN、Cr、CK的差异无显著意义（P〉0.05）;颅脑外伤组的上述各项指标均高于正常对照组、假手术组（P〈0.01）,并且在24～36h变化最明显;（2）大鼠颅脑外伤后各时相点各脏器组织均有不同程度的炎性损害,颅脑外伤组在24～36h时相点的脏器病理变化最显著,在48h稍有减轻,72h时相点仍可见炎性损害;（3）颅脑外伤组SIRS的发生率为100%;MODS发生率为69.4%,病死率为38.9%。结论（1）采用大鼠改良自由落体法可成功建立颅脑外伤致MODS的实验动物模型;（2）颅脑外伤后存在重要脏器的炎性改变及SIRS,提示SIRS是颅脑外伤致MODS的病理学基础。     

颅脑损伤患者血浆凝血酶敏感蛋白-1、血浆组织因子水平与迟发性颅内血肿的相关性

目的 分析颅脑损伤患者血浆凝血酶敏感蛋白-1(TSP-1)、血浆组织因子(TF)水平,探讨二者与迟发性颅内血肿的关系.方法 回顾性分析2017年8月至2019年8月本院收治的行开颅手术治疗的重型颅脑损伤患者115例,根据术后颅脑CT复查是否发生迟发性颅内血肿分为非迟发性颅内血肿组85例,迟发性颅内血肿组30例.收集比较...     

颅脑损伤程度对大鼠脑血流及氧代谢的影响

目的 对颅脑损伤影响脑血流及氧代谢进行前瞻性研究。方法 30只Wistar大白鼠分成3组：颅脑损伤1组（TBI1）、2组（TBI2）及3组（TBI3）各10只,分别为轻、中、重型颅脑损伤。用脑阻抗（REG）测定脑血流量,颈内静脉血氧饱和度（SjVO2)反映全脑氧代谢情况。结果 TBI、TBI2及TBI3组影响脑血流和氧代谢程度依次为TBI3＞TBI2＞TBI1,健侧脑组织含水量各组无明显差异,伤侧脑组织含水量TBI3组最多,其次为TBI2,明显高于TBI1组（P＜0．01）。结论 颅脑损伤后脑血流和氧代谢变化取决于损伤程度,脑血流和氧代谢各参数的监测对正确认识脑组织病理生理变化,指导临床治疗,判断预后有重要价值。     

Ultrasonographic measurement of cerebral blood flow,cerebral circulation time and cerebral blood volume in vascular and Alzheimer’s dementia

Vascular dementia (VD) and Alzheimer’s dementia (AD) are the most common differential diagnoses in patients with cognitive impairment. Although of different etiology, small vessel disease is postulated to be present in both conditions. We investigated global cerebral blood flow (CBF), global cerebral circulation time (CCT) and global cerebral blood volume (CBV) in VD and AD patients using a multimodal ultrasound (US) approach. 20 VD and 20 AD patients were included and compared with 12 age–matched controls. Duplex US of both internal carotid and vertebral arteries was performed to measure CBF. CCT was defined as the time delay of an echo–contrast bolus arrival between the internal carotid artery and internal jugular vein using extracranial Doppler. CBV was calculated as the product of CBF and CCT. CBF was significantly lower (VD: 570 ± 61; AD: 578 ± 77; controls: 733 ± 54ml/min) and CCT significantly longer (8.8 ± 2.6; 8.2 ± 1.4; 6.4 ± 0.8 s) in both patient groups compared with controls (p < 0.003). No difference in CBF and CCT was found between the two patient groups. CBV was similar in all three groups (82 ± 20; 79 ± 19; 78 ± 9 ml). The equally reduced CBF and prolonged CCT in VD and AD support the hypothesis, that small vessel disease is a relevant factor in both types of dementia. The presented multimodal US approach helps to assess the extent of changes in the global cerebral hemodynamics in patients with dementia but does not allow a differentiation between VD and AD. Drs. Schreiber and Doepp contributed equally to their work.     

重型颅脑损伤急性期血浆纤维蛋白原和D-二聚体动态改变的临床意义

目的 观察重型颅脑损伤患者不同时间、不同部位血标本中血浆纤维蛋白原(Fbg)和D-二聚体(D-dimer)的变化及其与预后的关系.方法 本组共33例单纯性颅脑损伤患者,在颅脑损伤后4h、8 h、16h、24h、36h、48h分别检测患者动脉、外周静脉、颈静脉三处血标本中Fbg和D-dimer水平并进行统计学分析.结果 颅脑损伤后4 h时Fbg值高于正常水平,此后出现降低,16h降至低于正常值.24h后Fbg水平出现回升.但颈静脉血标本比外周静脉和动脉血标本回升慢,差异有统计学意义(P<0.05);D-dimer伤后4 h即出现升高,随着时间推移逐渐下降.在48 h内仍保持高于正常水平.预后不良与预后良好患者在相同时间点的Fbg和D-dimer值比较,差异有统计学意义(P<0.05).结论 颅脑损伤后急性期出现凝血功能异常,表现为Fbg含量的降低,其降解产物D-dimer含量的显著升高,反映了脑内出现高凝状态和继发性纤溶亢进.提示凝血功能的变化可作为评价患者伤情和影响患者预后的一个因素.     

犬颅脑爆震伤后脑组织中NO、ET变化实验研究

目的建立不同伤情颅脑爆震伤动物模型,探讨颅脑爆震伤后脑组织中细胞因子一氧化氮(NO)、内毒素(ET)的变化。方法杂种雄性犬30只,随机分为:轻伤I组(13 mm,n=10),中度伤II组(9 mm,n=10)及重伤III组(5 mm,n=10),用1 g TNT当量的球型爆炸源置于距右颞顶部不同距离(13 mm、9 mm、5 mm)对犬的颅脑部引爆致伤,制作轻、中、重型颅脑爆震伤动物模型,伤后1 h、3h、6 h、12 h检测脑组织中NO、ET含量。结果犬爆震伤后,各组脑组织中NO含量与伤前比较明显升高(P<0.01),6 h达到峰值。在相同的时间点轻、中、重型伤NO含量之间有显著性差异(P<0.05)。各组脑组织ET含量与受伤前相比显著升高(P<0.01),随时间延长逐渐升高,在相同的时间点III组ET含量均较I组有显著性差异(P<0.05)。结论颅脑爆震伤后脑组织中NO、ET有不同程度的升高,伤情越重,数值指标越高,提示NO和ET可能在颅脑创伤早期的疾病演进中发挥作用。     

Morphological changes of platelets in disturbed cerebral microcirculation--a clinical study using a scanning electron microscope (author's transl)

Many factors are known that contribute to the pathogenesis of the cerebral microcirculatory disturbances, but, there are few reports investigating the roles of the intravascular components directly. The present study was undertaken to evaluate morphological changes of platelets in patients with cerebral damage, in relation to neurological signs, especially consciousness levels. Morphological changes of platelets were observed in 72 patients with intracranial organic lesions. These lesions included subarachnoid hemorrhages, hypertensive cerebral hemorrhages, cerebral infarctions, brain tumors, chronic subdural hematomas, and acute epidural hematomas. Two blood samples were taken, one from the internal jugular vein (the blood after cerebral perfusion), the other from the cubital vein (systemic blood). After fixative procedures with 1% glutaraldehyde, the differences in the three-dimensional structures of platelets were compared, using a scanning electron microscope. In general, remarkably activated forms of platelets were found in the blood after cerebral perfusion in cases with severely impaired consciousness in the acute stage. But, in cases without severe neurological deficits, such changes of platelet forms were rarely seen. A close relationship was suggested between the degree of neurological damage (especially consciousness levels) and that of platelet activation in the acute stage. In the chronic stage, these changes of platelets in the cerebral blood disappeared. Changes of platelet forms were not found in the systemic blood from the cubital vein, even in the acute stage. It is clinically suggested that morphological changes of platelets play an important role in the pathogenesis of the disturbed cerebral microcirculation. Obstruction of cerebral microvasculature may be caused, mechanically by the activated platelets themselves, and/or chemically by vasoconstrictive substances released from these platelets. Therefore, in the treatment of these intracranial organic lesions, it is concluded that the possible roles of activated platelets should be taken into consideration.     

高压氧治疗重型颅脑损伤的疗效分析

目的观察高压氧对重型颅脑损伤的治疗效果,并分析其作用机制。方法80例重型颅脑损伤患者随机分为高压氧治疗组(n=40)和对照组(n=40),观察两组患者的清醒人数,清醒时间,GCS评分的变化,治疗3个月后GOS评分、病死和植物状态比例,并分析两组的临床疗效,同时监测治疗前后脑动脉血流速度变化。结果治疗组的清醒人数的比例明显高于对照组(P<0.05),觉醒平均时间较对照组明显缩短(P<0.05),3疗程后GCS评分和3个月后的GOS评分明显高于对照组(P<0.05)、植物状态及死亡率较对照组低(P<0.05)、治愈率及总有效率明显高于对照组(P<0.01);治疗组2个疗程后血流速度较对照组下降明显(P<0.05)。结论早期行高压氧治疗对重型颅脑损伤具有明显疗效,可能与高压氧能有效提高血氧含量、扩大血氧弥散半径、促进血管生成和侧枝循环建立、有效缓解脑血管痉挛状态、清除自由基、减少缺血区脑细胞凋亡等作用有关。