颅脑火器伤的判断与救治

分析总结颅脑火器伤的临床特点。方法。对３１年内收治的２０１例颅脑火器伤病例进行分析。结果：男１７９例，妇女２例；盲管伤１１９例，贯通伤７０例，浅线伤７例，颅面联伤５例；早期合并症主要有：脑挫裂伤８８．６％，颅内血肿１９．４％，感染２１．０％。     

颅脑火器伤的研究进展

本文对目前颅脑火器伤的主要研究进展作一综述 ,其致伤机理复杂 ,多种因素参与其中。诊治时应重视辅助检查和神经合并伤的治疗 ,加强多科协作。     

护理程序在重型颅脑损伤急救护理中的运用

由A、B、C3名护士组成急救小组，运用护理程序对370例重型颅脑损伤患者进行护理。结果106例经急诊抢救后送ICU进一步治疗；139例经抢救后病情稳定．术前准备后送手术室进行手术；100例经CT常规检查后送脑外科继续治疗；死亡25例。抢救成功率93．2％。提示及时、正确、有效的救护是抢救成功的保证。     

护理程序在重型颅脑损伤急救护理中的运用

由A、B、C 3名护士组成急救小组,运用护理程序对370例重型颅脑损伤患者进行护理。结果106 例经急诊抢救后送ICU进一步治疗;139例经抢救后病情稳定,术前准备后送手术室进行手术;100 例经CT常规检查后送脑外科继续治疗;死亡25例。抢救成功率93.2%。提示及时、正确、有效的救护是抢救成功的保证。     

重症颅脑损伤病人的护理急救统筹

为使重症颅脑损伤病得到及时有效的护理急救处置，将重症颅脑损伤病人护理急救处置按Ⅰ级急救、Ⅱ级急救设计为程序，实施统筹、分工合作、主动护理，结果Ⅰ级急救病人从入院到入手术室只需15－20min完成急救处置；Ⅱ级急救处置30min，提示护理急救统筹能缩短重症颅脑损伤病人抢救时间，提高危重病人抢救成功率。     

重型颅脑损伤的急救护理

颅脑损伤现已成为当今最威胁人类生命的疾患之一,尤其是重型颅脑损伤,在临床上有突变、易变、多变的特点,死亡率高.本文通过对自1998年5月至2003年5月,收治127例重型颅脑损伤病人急救护理的回顾性研究,发现院前急救护理与病人的预后有着密切的关系,完善的院前急救护理措施是降低死亡率、致残率的关键.     

38例小儿颅脑损伤的护理

小儿颅脑损伤病情复杂，变化快，如不及时抢救治疗，将给患儿带来不可逆的后果。因此，护理人员具有急救知识，熟悉病情，掌握护理要点，对提高治愈率，降低病死率有极其重要的意义。我院１９９５年１月至１９９７年１月收治小儿颅脑损伤３８例，护理体会介绍如下。１临床...     

颅脑损伤合并严重多发性复合伤的急救护理

目的:分析总结颅脑损伤合并复合伤的早期救护效果。方法:对我院收治的56例颅脑损伤合并严重复合伤患者的基本特点及治疗情况进行分折。结果:全组抢救成功50例(89.3%),死亡6例(10.7%)。结论:正确、及时、有效的急救护理可有效控制颅脑损伤合并严重多发性复合伤患者的死亡率和残疾率。     

铁路交通事故颅脑损伤的特点与急救

本文收集了１９９６～２０００年在杭州管区内铁路上发生的交通事故伤８２例进行分析，试图找出其特点并总结急救体会。临床资料１．一般资料：本组共８２例。直接受伤（指火车直接正面撞击躯体）共１８例全部入院前死亡；间接受伤（指与火车侧面接触或挂住和气浪冲击等非火车直接正面撞击躯体）共６４例；其中最小１２岁，最大８０岁，平均年龄２９岁。男性４８例；女性１７例。伤后入院时间最短的３０分钟，最长的１９小时。２．损伤类型：开放性颅脑损伤１２例；闭合性颅脑损伤５２例，其中脑震荡１７例；脑挫伤３５例。合并有骨折的５３…     

Emergency treatment of craniocerebral firearm wounds

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重型颅脑损伤高压氧治疗患者呼吸困难的监测与护理

目的对重型颅脑损伤患者高压氧治疗中出现呼吸困难进行监测并实施护理干预,以保障患者治疗安全。方法 89例重型颅脑损伤患者中46例治疗中出现呼吸困难,根据病情采用相应的护理措施。结果13例患者加压5min时出现呼吸困难,25例在稳压吸氧时出现呼吸困难,6例在减压阶段出现呼吸困难,均经及时有效的处理后缓解;2例出现间停呼吸,紧急减压出舱,中止治疗。结论高压氧治疗前需全面评估患者病情,做好充分准备,保证治疗前和治疗中呼吸道通畅,根据病情给予不同的吸氧方式和氧流量,及时发现处置病情变化,是保障重型颅脑损伤患者高压氧治疗的关键。     

Raeder's syndrome associated with intracranial internal carotid artery aneurysm

Raeder's syndrome consists of oculosympathetic paresis and ipsilateral facial pain, with variable involvement of the trigeminal and oculomotor nerves. A 63-year-old woman experienced severe facial pain, a partial Horner's syndrome, and restriction of ocular movements on the left side. A left carotid angiogram disclosed a giant aneurysm of the cavernous portion of the internal carotid artery. This is the third reported case of Raeder's syndrome due to aneurysm of the intracranial internal carotid artery. Her facial pain was relieved by carotid ligation, and serial computed tomographic scans showed decrease of aneurysmal size.     

Unbranched-site aneurysm of intracranial internal carotid artery]

Most intracranial saccular aneurysms arise from the angle between a parent vessel and an arterial branch. Saccular aneurysms without relation to any arterial branch are rare. During the last 24 years, 210 patients with intracranial internal carotid artery (ICA) aneurysms were directly operated on at our institution. We found eight saccular aneurysms arising from intracranial ICA without relation to any arterial branch. So we call them unbranched-site aneurysms of intracranial ICA, and describe their unique characteristics. Of the eight cases with unbranched-site aneurysm of intracranial ICA, three were men and five were women. The age ranged from 31 to 61 years with an average age of 48. Seven cases suffered a subarachnoid hemorrhage due to ruptured unbranched-site aneurysm, and the other case had been admitted to our department because of accompanying ruptured left internal carotid-posterior communicating aneurysm. All cases of unbranched-site aneurysm presented intraoperative and/or angiographic findings of arteriosclerosis, and five of the patients had a past history of hypertension. Of the four unbranched-site aneurysms at the C2 portion of ICA, two arose from the lateral wall, one arose from the superior wall and the other arose from the infero-lateral wall of ICA. Of the four unbranched-site aneurysms at the C1 portion of ICA, three arose from the superior wall and the other arose from the supero-medial wall of ICA. Radical operation was performed in all cases and intraoperative rupture occurred in two cases. It was suggested that arteriosclerotic change in the arterial wall, and local hemodynamic stress played important roles in the development of unbranched-site aneurysms of intracranial ICA.     

Ruptured intracranial aneurysm associated with spontaneous occlusion of internal carotid artery

Summary Out of 921 patients diagnosed and treated for intracranial aneurysm in 5 cases (0,5%) the co-existence of ruptured aneurysm and occlusion of the internal carotid artery was found. 4 patients were treated surgically-aneurysm clipping-without serious post-operative complications and 6 months follow-up showed satisfactory results. In 4 of 5 cases the aneurysm was located on the anterior communicating artery (ACA); this fact may support the hypothesis concerning a possible role of enhanced blood flow in aneurysm formation and rupture. In cases with good collateral blood flow extra-/intracranial bypass before aneurysm occlusion seems not to be necessary. The risk of operation in those patients is not as high, as might be expected.     

External carotid endarterectomy with internal carotid artery transposition flap angioplasty for symptomatic internal carotid artery occlusion

The external carotid artery is an important collateral pathway for cerebral perfusion when the internal carotid artery is occluded. After internal carotid artery occlusion, there is a definite risk of ipsilateral neurological events. The authors retrospectively examined their experience with endarterectomy of the external carotid artery for symptomatic internal carotid artery occlusion. Results based on the authors' experience and on historical data show external carotid endarterectomy to be a safe procedure. Obliteration of the cul-de-sac appears to be a very important factor in the prevention of reocclusion or recurrence of symptoms after external carotid endarterectomy. Use of the internal carotid artery stump for patching of the endarterectomized external carotid artery is both safe and effective in treating symptomatic internal carotid artery occlusion.     

Indications for revascularization in patients with internal carotid artery stenosis

Three different strategies should be associated for ischaemic stroke prevention in patients with internal carotid artery stenosis: vascular risk factors control, anti-thrombotic agents, and carotid revascularization. Patients are selected for carotid revascularization on the basis of the presence of clinical symptoms and degree of stenosis. The optimal indication for carotid surgery is a severe recently symptomatic stenosis, since the benefits are marginal in high-grade asymptomatic stenosis, and in moderate symptomatic stenosis. Angioplasty with endoprothesis is an alternative to surgery, but it must be restricted to symptomatic stenosis either in randomized trials, or in severe stenosis in patients in whom surgery is contra-indicated.