脑外伤功能障碍的早期康复和护理

地震后脑外伤是自然灾害危及生命、导致残疾的主要原因。在脑外伤患者生命体征稳定后,应尽早介入康复,详细评价外伤后所造成的各种功能障碍,采取积极有效的康复治疗和护理。本文针对脑外伤后常见的功能障碍情况,大体介绍了目前常用的康复和护理措施。     

脑外伤的并发症和继发障碍的康复治疗

脑外伤并发症和继发障碍的康复治疗和护理是脑外伤康复的重要组成部分,了解脑外伤常见并发症和继发障碍的种类、发生机制、预防和康复治疗手段,能有效减少其发生率,缓解脑外伤患者的痛苦,提高患者的日常生活能力和生活质量,提高康复治疗效果,同时也能减少患者家庭和社会的经济负担,促进脑外伤患者早日回归家庭,回归社会。     

Factors Influencing Admission among Children with a Traumatic Brain Injury

OBJECTIVES: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission. METHODS: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics. RESULTS: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital). CONCLUSIONS: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.     

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

The aim of this article is to provide an inventory of the use of contrast‐enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS‐guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best‐evidenced indications for CEUS‐guided interventions are biopsy and ablation of inconspicuous or B‐mode–invisible tumors, intraprocedural ablation control and follow‐up, as well as percutaneous transhepatic cholangiography and drainage procedures.     

Traumatic Brain Injury in Patients Receiving Direct Oral Anticoagulants

BackgroundEmergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients.ObjectiveThis study aims to identify the risk of traumatic hemorrhagic complications in patients with TBI using DOACs.MethodsIn this retrospective study we included patients with TBI. All TBI patients were using DOACs, attended one of the three EDs of our hospital between January 2016 and October 2019, and received a computed tomography (CT) scan of the brain. The primary outcome was any traumatic intracranial hemorrhage on CT. Secondary outcomes were the use of reversal agents, secondary neurological deterioration, a neurosurgical intervention within 30 days after the injury, length of stay (LOS), Glasgow Outcome Scale (GOS) at discharge, and mortality.ResultsOf the included patients (N = 316), 24 patients (7.6%, 95% confidence interval [CI] 4.2–9.8) presented with a traumatic intracranial hematoma (ICH). Seven patients (2.2%, 95% CI 0.6–3.8) received a reversal agent and 1 patient (0.3%, 95% CI ?0.3–0.9) underwent a neurosurgical intervention. Of the 24 patients with a traumatic ICH, progression of the lesion was seen in 6 patients (1.9%, 95% CI 0.4–3.4). The mean LOS was 6.5 days (95% CI 3.0–10.1) and the mean GOS at discharge was 4 (95% CI 3.6–4.6). Death occurred in 1 patient (0.3%, 95% CI ?0.3–0.9) suffering from an ICH.ConclusionBased on the present findings it can be postulated that TBI patients using DOACs have a low risk for ICH. Hematoma progression occurred, however, in a substantial number of patients. Considering the retrospective nature of the present study, future prospective trials are needed to confirm this finding.     

急性颅脑损伤患者血清白介素-8的变化及临床意义

目的:探讨急性颅脑损伤(TBI)后血清中自介素-8(IL-8)的含量变化及其意义.方法:采用ELISA法检测48例TBI患者不同时间血清IL-8含量,按GCS评分分组并与对照组比较,进行统计学分析.结果:TBI患者组IL-8在发病后24 h、3天、5天的血清水平显著高于对照组(P<0.05),发病后血清IL-8水平与入院时Gcs评分呈负相关.结论:IL-8参与了TBI后的病理生理过程,其测定对于评估脑损伤的严重程度和预后有重要的临床意义.     

Effects of Cocaine in an Experimental Model of Traumatic Brain Injury

Background: Cocaine intoxication is found in a significant subset of emergency department (ED) patients presenting with traumatic brain injury (TBI). Objectives: To investigate the effects of acute cocaine intoxication on physiologic and metabolic parameters in a model of experimental TBI. Methods: Under inhalational anesthesia, swine were instrumented and subjected to fluid percussion TBI of 3 atm. Two groups were studied: TBI and cocaine (n= 7) and TBI only (n= 7). Two sequential doses of cocaine hydrochloride were administered intravenously to the animals receiving cocaine: 4 mg/kg 10 minutes prior to injury and 2 mg/kg 1 minute prior to injury. Control animals received normal saline. Cardiorespiratory and cerebral physiologic data were monitored for 180 minutes following injury. Cerebral blood flow (CBF) was measured using dye‐labeled microspheres. Serum cocaine levels were measured by gas chromatography/mass spectrometry. Results: Mean (±SD) cocaine levels at the time of injury were 1,771 (±403) ng/mL. All animals survived the 180‐minute observation period. There was a trend toward higher intracranial pressure (ICP) in the control (15.4 ± 8.2) vs. cocaine‐treated (11.1 ± 5.8) animals, although this did not reach statistical significance (p = 0.18). Cerebral venous lactate (CVL) levels also trended higher in the control (1.14 ± 0.22) vs. cocaine‐treated (0.91 ± 0.19) groups (p = 0.06). Cerebral perfusion pressures (CPPs), however, did not differ between groups. The CBF values decreased significantly from baseline in both groups but were not different between groups. Conclusions: Cocaine‐intoxicated animals subjected to TBI showed no significant difference in primary outcome measures of CPP or CBF, although a nonsignificant trend toward lower ICP was noted. Overall, acute cocaine intoxication did not adversely affect the physiologic parameters examined in this TBI model.     

Novel Contrast‐Enhanced Ultrasound Evaluation in Neonatal Hypoxic Ischemic Injury: Clinical Application and Future Directions

Sensitive, specific, and safe bedside evaluation of brain perfusion is key to the early diagnosis, treatment, and improved survival of neonates with hypoxic ischemic injury. Contrast‐enhanced ultrasound (US) imaging is a novel imaging technique in which intravenously injected gas‐filled microbubbles generate enhanced US echoes from an acoustic impedance mismatch. This article describes contrast‐enhanced US imaging in 2 neonates with hypoxic ischemic injury and future directions on developing quantitative contrast‐enhanced US techniques for improved characterization of perfusion abnormalities. The importance of studying the temporal evolution of brain perfusion in neonatal hypoxic ischemic injury is also highlighted.     

Corticosteroids in Pediatric Traumatic Brain Injury: A Principle-Based Concept Analysis

Over 7,400 children in the United States die from severe traumatic brain injury annually. Therefore, evidence-based clinical practice recommendations, such as the use of corticosteroids to reduce cerebral edema, are necessary to guide clinical practice to improve outcomes. However, a clearer analysis of their use in pediatrics is needed to validate its true impact on neurologic outcomes. A principle-based concept analysis revealed that the type of corticosteroid, indication for use, population, and outcome measurement are not consistent within the literature, thereby making clinical practice recommendations problematic. Further research in the pediatric population is necessary before clinical practice recommendations can be made.     

颅脑损伤患者的吞咽障碍

近年来颅脑损伤后吞咽困难的相关研究越来越多,既往研究显示颅脑损伤后吞咽障碍发生率高,口腔期及咽期障碍均可出现,并且一些相关因素有助于评估患者的吞咽功能。本文从流行病学、评估方法、障碍特点、相关因素、治疗方法、临床转归等方面对颅脑损伤患者吞咽障碍的研究进行综述。     

Application of High-Intensity Focused Ultrasound to the Study of Mild Traumatic Brain Injury

Though intrinsically of much higher frequency than open-field blast overpressures, high-intensity focused ultrasound (HIFU) pulse trains can be frequency modulated to produce a radiation pressure having a similar form. In this study, 1.5-MHz HIFU pulse trains of 1-ms duration were applied to intact skulls of mice in vivo and resulted in blood-brain barrier disruption and immune responses (astrocyte reactivity and microglial activation). Analyses of variance indicated that 24 h after HIFU exposure, staining density for glial fibrillary acidic protein was elevated in the parietal and temporal regions of the cerebral cortex, corpus callosum and hippocampus, and staining density for the microglial marker, ionized calcium binding adaptor molecule, was elevated 2 and 24 h after exposure in the corpus callosum and hippocampus (all statistical test results, p < 0.05). HIFU shows promise for the study of some bio-effect aspects of blast-related, non-impact mild traumatic brain injuries in animals.