微创颅内血肿清除术对高血压性脑出血患者血肿周围水肿及血清炎性因子的影响

目的:探讨微创颅内血肿清除术对高血压性脑出血患者血肿周围水肿及血清炎性因子的影响。方法:将69例急性高血压性脑出血患者随机分为微创组35例和对照组34例,2组患者均给予常规治疗,微创组还进行微创颅内血肿清除术,检测2组治疗前及治疗后7、14d血清炎性因子的变化,同时行头颅CT检查,观察并计算血肿及周围水肿体积,并进行神经功能缺损评分。结果:治疗后7、14d,微创组的血肿及周围水肿体积,血清hs-CRP、IL-6、TNF-α含量组,神经功能缺损评分均明显低于对照组(P<0.05)。结论:微创颅内血肿清除术可有效降低高血压性脑出血患者急性期炎性因子水平,减轻血肿周围水肿。     

微创穿刺术治疗高血压性脑出血28例临床观察

目的：观察微创颅内血肿清除术在治疗高血压性脑出血的治疗效果。方法：63例高血压性脑出血患者随机分成2组，对照组35例给予常规治疗。治疗组28例给予常规治疗＋微创颅内血肿清除术，于术后1、7、14、21d进行神经功能缺损评分．并与对照组相比较。结果：微创治疗组患者的痊愈率、显效率、神经功能缺损评分的下降均显著高于对照组（P＜0．01）。结论：颅内血肿微创清除术是治疗高血压性脑出血的一种较好的方法。     

脑出血颅内微创手术治疗与常规保守治疗的神经功能转归时程的研究

目的研究急性脑出血颅内微创手术治疗与常规保守治疗的神经功能转归时程。方法41例急性脑出血患者分为：脑出血内科保守治疗组18例,颅内微创血肿清除术组23例,在发病24h内进行手术。对两组患者的一般情况、住院时间、临床神经功能缺损时程变化和继发脑水肿时程变化进行统计分析。结果在患者颅内微创血肿清除术后第7d和14d时,颅内微创血肿清除术组较内科保守治疗组明显改善（P〈0．01）,表明中．重度脑出血患者采用颅内微创血肿清除术的治疗方法可明显改善患者神经功能。同时缩短了患者的住院时间（P〈0．01）。颅内微创血肿清除术能够显著减轻脑出血患者所继发的脑水肿（P〈0．01）。结论CT指导下的颅内微创血肿清除术能够明显减轻患者继发脑水肿和改善患者临床神经功能缺损程度,缩短了患者住院时间。     

软通道颅内血肿清除术对高血压脑出血的影响

目的：探究给予高血压脑出血患者软通道颅内血肿清除术治疗对患者氧化应激及神经损伤等指标的影响。方法：选取2019年5月至2022年5月收治的78例高血压脑出血患者为研究对象,根据手术通道类型不同将其分为硬通道组和软通道组各39例。其中硬通道组行硬通道微创颅内血肿清除术,软通道组行软通道颅内血肿清除术,对比两组临床疗效、围手术期指标、氧化应激指标、神经损伤指标及手术并发症发生率。结果：两组患者临床疗效对比,差异无统计学意义（P>0.05）;软通道组手术时间、术中出血量、住院时间、术后3 d血肿残余量及术后7 d血肿残余量均少于硬通道组（P<0.05）;手术后,软通道组血清8-羟基脱氧鸟苷酸（8-OHdG）、丙二醛（MDA）水平均低于硬通道组,谷胱甘肽过氧化物酶（GSH-Px）水平高于硬通道组（P<0.05）;软通道组神经元特异性烯醇化酶（NSE）、神经肽（NPY）水平低于硬通道组,脑源性神经营养因子（BDNF）水平高于硬通道组（P<0.05）。结论：软通道颅内血肿清除术与硬通道颅内血肿清除术临床效果及术后并发症发生率相近,但软通道颅内血肿清除术可以改善患者的围手术指...     

微创清除术联合丹参注射液治疗高血压脑出血的临床研究

目的观察微创清除术联合丹参注射液对高血压脑出血患者病灶周围水肿体积及神经功能缺损程度的影响。方法将89例高血压脑出血患者随机分为治疗组（45例）和对照组（44例）。两组均行颅内血肿清除术及脱水、止血、抗炎、控制血压等治疗，治疗组同时加用丹参注射液。于治疗前及术后7、14和21d行CT检查以测量病灶周围水肿体积；并于治疗前及术后14d和30d以美国国立卫生研究院卒中量表（NIHSS）评定神经功能缺损程度评分（NDS），同时观察病死率及再出血情况。结果两组术后7、14和21d血肿周围水肿体积逐渐缩小，且均明显小于治疗前，治疗组术后14d和21d血肿周围水肿体积缩小程度明显大于对照组同时间点，差异均有统计学意义（P〈0．05或P〈0．01）；两组术后NDS逐渐降低，治疗组术后14d和30dNDS评分降低程度明显大于对照组（P均〈0．01）。两组病死率比较差异无统计学意义，治疗组无持续出血。结论丹参注射液能有效减轻微创清除术后高血压脑出血的水肿，促进神经功能的恢复。     

急性脑出血患者血清炎性因子和CRP的动态变化及其意义

【目的】探讨急性脑出血患者血清炎症因子、C 反应蛋白（CRP）水平的动态变化及其意义。【方法】选取本院2013年2月至2014年12月神经内科收治的100例高血压急性脑出血患者作为研究对象（脑出血组）、选取同期50例年龄、性别基本匹配的健康体检正常者作为对照组,对比两组的血清炎症因子水平,分析炎症因子水平与患者格拉斯哥昏迷评分（GCS）、脑水肿程度的相关性。【结果】脑出血组患者在起病后6 h 、24 h 、72 h 、7 d 和14 d 的白细胞介素6（IL‐6）、IL‐8、IL‐10、肿瘤坏死因子‐α（TNF‐α）、CRP 水平均显著的高于对照组（ P ＜0．05）;且IL‐6在起病后72 h 达到最高值,后逐渐降低;其 IL‐8、IL‐10、TNF‐α、CRP 水平在起病后7 d 达到最高值,之后逐渐降低;d14,脑出血患者 GCS 评分基本恢复正常水平,脑水肿量较起病12 h 时显著降低（ P ＜0．05）。脑出血组患者的 IL‐6水平与 GCS 评分、脑水肿量的相关性不具有统计学意义（ P ＞0．05）,脑出血患者的血清 IL‐8、IL‐10、TNF‐α和 CRP 与 GCS 评分、脑水肿量均呈显著的正相关关系（ P ＜0．05）。【结论】外周血炎症因子 IL‐8、IL‐10、TNF‐α和 CRP 与 GCS 评分、脑水肿量具有一定的关系,这对于诊治高血压脑出血患者具有一定的指导价值。     

脑内血肿微创清除术的临床应用

目的对脑内血肿微创清除术的三种治疗方法进行回顾性比较，观察微创清除术对脑出血治疗的临床效果。方法应用微创清除术治疗的脑内血肿患者83例，根据选用微创清除术的方法分为3组，分别对治疗前及治疗后24h内，第7、14及21d的神经功能缺损评分及血肿残余量进行比较，观察3种微创清除术的治疗效果。结果与治疗前比较，3组治疗后神经功能缺损评分均有不同程度的改善（P〈0．05或P〈0．01）；治疗后24h内及第7、14、21天神经功能缺损评分比较，微侵袭神经内窥镜组均明显低于其他2组（均为P〈0．01）。微侵袭神经内窥镜组首次血肿清除量最大，与其他2组比较差异均有显著性（均为P〈0．01）。颅内钻孔置管引流组与YL-Ⅰ型穿刺组血肿清除量至术后14d才明显提高（均为P〈0．05），至术后21d差异更显著性（均为P〈0．01）。结论颅内血肿微创清除术的应用可有效改善脑出血的治疗效果，微侵袭神经内窥镜优于颅骨钻孔置管血肿引流及YL-Ⅰ型血肿粉碎穿刺针。     

改良软通道微创颅内血肿清除术在高血压脑出血治疗中应用

目的:探讨急诊床边行改良-立体定向软通道微创颅内血肿清除术在高血压脑出血中的临床疗效。方法:选取我院35例高血压脑出血患者作为研究对象,在与患者家属沟通并获同意后,随机分成软通微创组15例、硬通微创组10例、开颅减压组10例。治疗判定采用美国国立卫生研究院卒中量表(NIHSS)评分并结合血肿的清除情况,比较3组患者的临床疗效。结果:软通微创组总有效率为93.4%,硬通微创组总有效率为60%,开颅减压组总有效率为50%,统计显示软通微创组的总有效率明显高于硬通微创组和开颅减压组(P0.05);术后神经功能评分比较,在治疗后第7和14天,软通微创组明显小于硬通微创组和开颅减压组(P0.05)。结论:急诊床边行改良-立体定向软通微创颅内血肿清除术在高血压脑出血中的治疗具有疗效高、致残率低等优势,值得临床应用与推广。     

CT立体定位引导微创穿刺颅内血肿清除术与开颅手术治疗高血压脑出血的疗效观察

目的：探讨采用CT立体定位引导微创穿刺颅内血肿清除术与开颅血肿清除术治疗高血压脑出血（HICH）患者的疗效。方法：选取住院治疗的182例高血压脑出血患者,随机分为CT立体定位引导微创穿刺颅内血肿清除术组（微创穿刺组）与开颅手术组,每组91例,分别采用CT立体定位引导微创穿刺颅内血肿清除术和开颅手术治疗,对两组术后神经功能恢复情况、有效率、平均住院日及平均住院费用进行比较。结果：CT立体定位引导微创穿刺颅内血肿清除术术后格拉斯哥昏迷评分（GCS）、神经功能缺损评分、治疗总有效率及神经功能缺损恢复时间优于开颅手术组,差异有统计学意义（P〈0．05）,CT立体定位引导微创穿刺颅内血肿清除术平均住院日较开颅手术组短（P〈0．05）,平均住院费用少于开颅手术组（P〈0．05）。结论：CT立体定位引导微创穿刺颅内血肿清除术治疗高血压脑出血安全有效。     

软、硬通道微创穿刺引流术治疗高血压脑出血的效果比较

目的 探讨软、硬通道微创穿刺引流术治疗高血压脑出血的效果和适应证.方法 选择我院采用微创穿刺引流术治疗的高血压脑出血216例,其中112例经软通道治疗(软通道组),104例经硬通道治疗(硬通道组),观察比较两组治疗效果和并发症发生情况等.结果 两组总病死率15.3％,软通道组病死率13.4％,硬通道组病死率17.3％,两组比较差异无统计学意义(P＞0.05);手术操作时间软通道组平均7.6 min,硬通道组平均3.8 min,两组比较差异有统计学意义(P＜0.05).脑实质内血肿引流时间软通道组平均4.6d,硬通道组平均4.9d,两组比较差异无统计学意义(P＞0.05);脑室内血肿引流时间软通道组平均4.8d,硬通道组平均5.9d,两组比较差异有统计学意义(P＜0.05).两组肺炎、应激性溃疡发生率比较差异无统计学意义(P＞0.05),颅内碎骨片残留率、颅内感染发生率及穿刺针道出血率比较差异有统计学意义(P＜0.05).结论 软、硬通道微创穿刺引流术治疗高血压脑出血均有良好效果,但其适应证不同,临床工作中应区别对待.     

神经节苷脂治疗鼻咽癌患者放射性脑损伤25例疗效观察

【目的】观察神经节苷脂治疗放射性脑损伤的临床疗效。【方法】选择本院鼻咽癌放疗后放射性脑损伤患者50例,将患者分为神经节苷脂联合常规治疗（激素加高压氧）组与单纯常规治疗组,每组各25例。治疗前及治疗后2个月均予以疗效评价,采用LENT／SOMA放射性脑损伤量表评定临床症状与体征,简易智能精神状态量表（MMSE）评定认知功能,改良巴氏指数（MBI）评价日常生活能力（ADL）。【结果】①任务完成能力障碍比较,常规组：显效1例,有效6例,无效16例,恶化2例,总有效率为28％（7／25）;联合组：显效4例,有效16例,无效5例,总有效率为80％（20／25）;②神经功能障碍比较,常规组：显效2例,有效5例,无效17例,恶化1例,总有效率为28％（7／25）;联合组：显效5例,有效15例,无效5例,总有效率为80％（20／25）;联合组总有效率均明显高于常规组,且两组相比较差异有显著性（ P＜0．05）。联合组相对常规治疗组能显著提高 MMSE及MBI评分,且两组相比较差异有显著性（ P＜0．01）。【结论】与传统常规治疗放射性脑损伤的治疗方法对比,神经节苷脂联合常规治疗可明显改善患者神经功能障碍,提高其任务完成能力及提高 MMSE及MBI评分。     

Poster 10: Activity-related quality of life: activities and personal feelings about them in the first year after traumatic brain injury

Objective: To investigate relationships between community activities and feelings about specific activities, desires to change them, and global life satisfaction. Design: Observational study with follow-up 1 month after rehabilitation discharge and 12 months postinjury. Setting: Community. Participants: 144 adult survivors of serious traumatic brain injury. Interventions: Not applicable. Main Outcome Measures: Community Integration Questionnaire-2, augmented by individuals’ ratings of satisfaction and dissatisfaction, desire to change each activity, and the Diener Life Satisfaction Scale. Results: Although significant correlations were found for some items, most correlations between objective activities and subjective ratings of quality of life (QOL) were low and nonsignificant. Subjects generally reported that they were satisfied with their activities, but there were exceptions (eg, work situation). Correlations between activity-specific satisfaction and general life satisfaction were also weak and generally nonsignificant. Activity-specific satisfaction correlated robustly with subjects’ desires to change them, but general life satisfaction did not. Conclusions: The lack of association between objective activities and subjective appraisals of them is a challenge to outcomes measurement and has implications for the targeting of rehabilitative interventions and evaluation of their worth. More research is needed to understand how individualizing functional objectives and gains might maximize likely effects on the QOL of persons served.     

"To care for him who shall have borne the battle and for his widow and his orphan" (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care

Sigford BJ. “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): the Department of Veterans Affairs Polytrauma System of Care.The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA). Service members injured in combat most often sustain multiple injuries (polytrauma) and require a unique service delivery model to meet their needs. The VA recognized this need and responded with the development of the Polytrauma System of Care (PSC). This national system of care balances access and expertise to provide specialized life-long care to the combat injured. The PSC is comprised of: 4 specialized regional rehabilitation centers that are accredited in brain injury by the Commission on Accreditation of Rehabilitation Facilities; 21 specialized outpatient and subacute rehabilitation programs; designated polytrauma teams at smaller, more remote VA facilities; and a point of contact at all other VA facilities. In addition, the PSC has developed a proactive case-management model, a specialized telehealth network, guidelines for long-term follow-up, and services for those individuals who are unable to return home. The following commentary and articles provide additional detail on this new and unique system of care.     

鼠脑射频损伤区神经修复的实验研究

目的：研究鼠脑射频性损伤后神经胶质纤维酸性蛋白（GFAP）、增生细胞核抗原（PCNA）的变化规律,进一步探讨脑外伤后神经修复的机制,为进一步治疗颅脑外伤作前期探索。方法：建立鼠脑射频损伤动物模型,分别研究损伤后的不同时段GFAP阳性、PCNA阳性、及二者均阳性的细胞。结果：总结GFAP阳性、PCNA阳性细胞的特点;GFAP阳性细胞、PCNA阳性的分布范围;GFAP阳性细胞的峰值远远大于PCNA阳性细胞的峰值;且二者均阳性的细胞数量极少。结论：颅脑损伤后修复主要依靠GFAP阳性细胞为主的胶质细胞肥大来完成。     

1例创伤性窒息并发急性缺氧性脑病患者的护理

总结1例颈胸部严重挤压伤致急性缺氧性脑病患者的护理经验。护理要点包括：保持呼吸道通畅、充分供氧;做好镇静镇痛治疗与护理;应用冰帽进行头部亚低温治疗;患肢的观察与护理;高压氧治疗的护理;做好院内转运的配合与护理;加强心理护理。经过8d的积极抢救与护理,患者意识恢复,患肢感觉及运动功能得到一定程度恢复,予以出院并转至专科医院对受损神经进一步康复治疗。     

无创颅内压监测对治疗创伤性急性弥漫性脑肿胀的临床价值

[目的]探讨无创颅内压(ICP)监测对治疗创伤性急性弥漫性脑肿胀(PADBS)的临床指导作用.[方法]回顾性分析2009年1月至2014年12月长沙市解放军第163医院神经外科收治的69例PADBS患者的临床资料,均于伤后2~24 h内在ICU病房予以无创颅内压监护仪(MICP-1A闪光视觉诱发电位无创颅内压检测分析仪)进行监护.根据患者入院时无创ICP值分为轻、中、重度颅内高压三种类型, 根据患者临床症状、头颅CT及无创颅内压监测值予以对症治疗,比较不同类型患者的格拉斯哥预后评分(GOS)评估预后情况.[结果]本组病例预后良好率为43.5% (30/69),预后不良率56.5% (39/69),病死率31.8%(22/69).轻度颅内高压患者预后良好率为90.1% (10/11), 中度颅内高压预后良好率为65.22% (15/23),重度颅内高压预后良好率为14.29% (5/35), 轻度颅内高压患者预后良好率显著高于中、重度颅内高压预后良好者,差异具有统计学意义(均P<0.05).重度颅内高压患者死亡所占比例显著高于轻、中度颅内高压患者,差异具有统计学意义(均P<0.05).[结论]根据持续无创ICP监测结果给予对症治疗,对创伤性急性大脑弥漫性脑肿胀的治疗有重要的指导作用.     

降钙素原在重度脑外伤细菌感染治疗中的诊断价值

【目的】探讨降钙素原（PCT）在重度脑外伤细菌感染中的诊断价值。【方法】将44例重度脑外伤患者分成非细菌感染组（A组）和细菌感染组（B组）,检测入院后d1、d3、d5、d7血清PCT水平,比较两组d1最高体温、白细胞（WBC）计数、C反应蛋白（CRP）及PCT水平。【结果】B组各时段血清PCT均显著高于A组,差异有统计学意义（P＜0．05）;两组在d1最高体温、WBC计数、CRP比较无统计学意义（P＞0．05）;以PCT≥1ng／mL为界值,PCT判定细菌性感染的敏感度为83．3％（20／24）,特异度为85．0％（17／20）。【结论】血清PCT水平及其变化可作为判断重度脑外伤后细菌感染及预后的有效指标,PCT≥1ng／mL可作为重度脑外伤患者细菌感染的参考值。     

Coping With Chronic Pain After Traumatic Brain Injury: Role of Race/Ethnicity and Effect on Participation Outcomes in a TBI Model Systems Sample

ObjectiveTo investigate catastrophizing and self-efficacy for managing pain among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics with chronic pain after traumatic brain injury (TBI), and whether coping interacts with race/ethnicity to predict participation outcomes.SettingCommunity after discharge from inpatient rehabilitation.Participants621 individuals with moderate to severe TBI and chronic pain, who completed follow-up as part of a national longitudinal study of TBI and also participated in a collaborative study on chronic pain.DesignMulticenter, cross-sectional, survey study.Main MeasuresCatastrophizing subscale from the Coping With Pain Scale; Pain Self-Efficacy Questionnaire; Participation Assessment With Recombined Tools-Objective.ResultsAfter controlling for relevant sociodemographic variables, a significant interaction was observed between race/ethnicity and insurance status, such that Blacks who had public health insurance reported greater catastrophizing in response to pain compared with Whites. Race/ethnicity and self-efficacy for managing pain were unrelated. Greater catastrophizing was associated with lower participation but did not interact with race/ethnicity. Blacks reported lower participation relative to Whites, independent of catastrophizing.ConclusionsBlack individuals who have TBI and chronic pain, and who have public insurance, may be vulnerable to difficulties managing pain. They are more likely to cope by catastrophizing, and catastrophizing is related to worse participation outcomes. The results suggest that access to care may affect response to chronic pain after TBI.     

Poster 23: Loss to follow-up and potential systematic bias in survivors of traumatic brain injury 60 months postinjury

Objectives: To predict which survivors of traumatic brain injury (TBI) are more likely to be lost to follow-up and to examine the possibility of systematic bias in TBI research. Design: Characteristics of participants found for a 12-month follow-up were compared with those lost and found for a 60-month follow-up using logistic regression. Setting: A prospective, longitudinal database. Participants: 588 adult survivors of TBI. Interventions: Not applicable. Main Outcome Measures: Lost participants were those with no 60-month follow-up interview, excluding the deceased. Results: Follow-up was attempted with 558 survivors of TBI identified 12 months postinjury. At the 60-month follow-up, 34 had died (6.1%), 220 were lost to follow-up (39.4%), and 304 (54.5%) were located and interviewed. Deceased study participants were excluded from analysis. Inpatient rehabilitation was associated with a slight increase in probability of being available for follow-up at 60 months (OR=.56; 95% CI, .32-.98). Injury severity was also associated with loss to follow-up, with the critically injured more likely to be found at 60 months than the moderately injured (OR=4.1; 95% CI,1.13-19.6). Age was a significant predictor of follow-up status (OR=.86; 95% CI, .77−.95). Conclusions: The likelihood of being located at follow-up increased by 92% for every 5-year increase in age.     

Common data elements for traumatic brain injury: recommendations from the biospecimens and biomarkers working group

Manley GT, Diaz-Arrastia R, Brophy M, Engel D, Goodman C, Gwinn K, Veenstra TD, Ling G, Ottens AK, Tortella F, Hayes RL. Common data elements for traumatic brain injury: recommendations from the Biospecimens and Biomarkers Working Group.Recent advances in genomics, proteomics, and biotechnology have provided unprecedented opportunities for translational research and personalized medicine. Human biospecimens and biofluids represent an important resource from which molecular data can be generated to detect and classify injury and to identify molecular mechanisms and therapeutic targets. To date, there has been considerable variability in biospecimen and biofluid collection, storage, and processing in traumatic brain injury (TBI) studies. To realize the full potential of this important resource, standardization and adoption of best practice guidelines are required to insure the quality and consistency of these specimens. The aim of the Biospecimens and Biomarkers Working Group was to provide recommendations for core data elements for TBI research and develop best practice guidelines to standardize the quality and accessibility of these specimens. Consensus recommendations were developed through interactions with focus groups and input from stakeholders participating in the interagency workshop on Standardization of Data Collection in TBI and Psychological Health held in Washington, DC, in March 2009. With the adoption of these standards and best practices, future investigators will be able to obtain data across multiple studies with reduced costs and effort and accelerate the progress of genomic, proteomic, and metabolomic research in TBI.