基于液相色谱质谱联用系统的急性缺血性脑梗死患者血清代谢轮廓分析

目的通过代谢组学分析平台分析大动脉粥样硬化型急性缺血性脑梗死患者血清代谢轮廓变化,建立疾病区分模型并寻找特征代谢物,探讨其可能的代谢机制。方法用代谢组学分析平台对25例大动脉粥样硬化型急性缺血性脑梗死患者和23例健康志愿者的血清样本进行分析,用基于模式识别的多元统计学分析方法对实验数据进行处理并对差异性代谢物的变化趋势进行分析。结果成功构建了血清代谢轮廓的主成分分析模型(PCA)及正交偏最小二乘判别分析模型(OPLS-DA),从模型中筛选出60个具有显著差异的特征离子,在35个被鉴定的内源性代谢物中,缺血性脑梗死组与健康人对照组比较,25个代谢物含量明显升高,剩余的10个代谢物呈下降趋势。结论通过对该类型缺血性脑梗死患者血清代谢轮廓的分析,找到了与疾病相关的一组特征代谢物。     

血清S100B检测对创伤性脑损伤的诊断价值

目的 探讨血清S100钙结合蛋白B(S100B)在判断创伤性脑损伤(TBI)患者病情严重程度和预后评估中的应用价值.方法 选取该院救治的106例TBI患者,分别于伤后第1、3、5天检测血清S100B的水平;根据入院时的格拉斯哥昏迷评分(GCS)分为3组:轻度组65例、中度组14例、重度组27例;按照3个月时回访的格拉斯...     

尼莫地平对重型脑损伤患者疗效及预后的影响

目的探讨尼莫地平对重型颅脑损伤患者疗效及预后的影响。方法 6 4例重型颅脑损伤术后患者分为尼莫地平组 32例和常规组 32例 ,治疗前后评定格拉斯哥昏迷量表 (GCS) ,清醒患者评定日常生活活动 (ADL)及认知能力。随访 6个月 ,行格拉斯哥结局量表 (GOS)评定及Barthel指数和简易精神状态检查 (MMSE)评分。结果治疗后两组GCS评分均有明显提高 ,清醒患者MMSE评分尼莫地平组明显高于常规组。 6个月后两组GOS及ADL评分无显著差异 ,尼莫地平组MMSE评分高于常规组。结论尼莫地平可在颅脑损伤早期促进认知功能的恢复。患者的预后主要取决于脑损害的程度     

血糖水平与颅脑损伤时病情和预后的关系

目的 分析颅脑损伤患者的血糖水平与病情和预后的关系,指导临床治疗和预后判断。方法 按照格拉斯哥昏迷量表（GCS）评分将86例颅脑损伤患者分为轻型16例、中型24例和重型46例,分别在受伤后48h内、伤后1周、1个月和2个月对血糖进行检测,并结合损伤部位和残疾分级量表（DRS）对结果进行分析。结果 轻型颅脑损伤的血糖水平与对照组无显著性差异,中、重型患者受伤时血糖水平高,重型颅脑损伤时高血糖水平可持续2个月以上。DRS评分与伤后48h和伤后2个月时的血糖水平存在直线正相关,受伤后血糖水平越高,则残疾程度越重,预后越差。在中、重型颅脑损伤时,颅内损伤广泛并累及脑干功能和基底节区出血破入脑室的患者中血糖水平高且持续时间长。结论 颅脑损伤早期因应激反应出现高血糖,血糖水平可对病情和预后判断提供帮助。受伤时血糖水平高且持续时间长提示病情严重、预后欠佳。     

重型颅脑损伤患者免疫功能状态的临床观察

目的观察重型颅脑损伤患者T淋巴细胞亚群及免疫球蛋白的变化,探讨其临床意义。方法对48例重型颅脑损伤患者于康复治疗前后检测外周血T细胞亚群及免疫球蛋白水平,与对照组比较,结合临床评估分析免疫功能状态在病情及预后评估中的作用。结果重型颅脑损伤患者康复治疗前细胞及体液免疫功能均明显抑制,CD     

Post-concussion symptoms after mild traumatic brain injury: influence of demographic factors and injury severity in a 1-year cohort study

Purpose. To assess the prevalence and variation of post-concussion symptoms within the first year after mild traumatic brain injury (TBI), and explore the association between injury severity, demographic factors and symptoms.

Methods. Prospective study of patients with mild TBI followed up at 3, 6 and 12 months (N = 96 included, n = 52 attending all follow-ups). Sociodemographic factors, injury mechanisms and impact of injury (Glasgow Coma Scale score, Abbreviated Injury Severity Score (AIS), Injury Severity Score) were recorded at inclusion. Symptoms were reported in the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at the follow-ups. The sumscore of all symptoms in RPQ was calculated for each subject. Scores were also calculated separately for the cognitive, physical and behavioural symptoms.

Results. Twenty-nine subjects met the post-concussion syndrome criteria at 3 months, and 22 patients at 6 and 12 months. The cognitive symptoms were more prominent than the physical and behavioural symptoms. The cognitive and physical symptoms were associated with AIS for the head injury at 3 months, but not at 12 months. Considerable individual variability in the symptom pattern was found, and the subjects who attended only the 3-months follow-up reported a lower level of symptoms than those attending all follow-ups.

Conclusions. Persistence of symptoms was a considerable problem even 1 year after the injury, with cognitive symptoms dominating. More severe AIS scores were associated with a higher level of cognitive and physical symptoms at 3 months, but not at later follow-ups. Strategies to prevent and treat these symptoms should be focussed in clinical practice.     

中老年脑外伤患者急性创伤性凝血病的危险因素分析

目的确定急性单纯性创伤性脑损伤(iTBI)是否是急性创伤性凝血病(acutetraumatic coagulation,ATC)的独立危险因素,以及评估与该并发症相关的危险因素.方法回顾性收集了2013年6月1日至2018年6月1日期间苏州大学附属第一医院符合研究标准的急性创伤患者345例.根据简明损伤评分量表(AIS评分)将纳入研究的患者分为三组:急性单纯性创伤性脑损伤组(iTBI组)、含TBI的多发伤组及非TBI的多发伤组.以ATC及进展性出血性损伤(progressive hemorrhagic injury,PHI)作为因变量,分别建立多因素Logistic回归模型,分析ATC、PHI的危险因素.结果本研究纳入了345例符合标准的患者作为研究对象,其中iTBI组78例;含TBI的多发伤组(TBI+组)120例;非TBI的多发伤组(NTBI组)147例.TBI+组患者ATC的发生率最高(36.7%),与类似损伤程度的NTBI患者比较,iTBI相关ATC的发生率并无明显升高.ATC患者的总体院内病死率为39.3%,而非ATC患者的总病死率为17.6%(P<0.01).iTBI不是发生凝血功能障碍的独立危险因素(OR 1.25,95%CI0.34~4.67,P=0.73).多变量分析确定了创伤严重程度评分(ISS)、格拉斯哥昏迷评分(GCS)≤8分、休克指数>1及年龄>75岁是创伤后凝血功能障碍的独立危险因素.多变量分析确定了ISS评分、INR>1.5及血小板计数(PLT)<100×109/L均与PHI独立相关.结论①iTBI不是发生凝血功能障碍的独立危险因素,但当其合并多发伤时则明显增加ATC的发生率.②ISS评分、GCS评分≤8分、休克指数>1及年龄>75岁是创伤后发生ATC的独立危险因素.③ISS评分INR>1.5及PLT<100×109/L均是PHI的独立危险因素.     

重型颅脑损伤术后血糖及乳酸水平与预后的关系

目的：探讨重型颅脑损伤（Traumatic brain injury,TBI）术后血糖及乳酸水平与预后的关系。方法：将84例TBI手术治疗后收入我科的患者,入组条件为入院时格拉斯哥昏迷指数评分（GCS）低于8分,既往无糖尿病史,术中未输注含糖液体,无其他部位严重损伤,无重要脏器疾患,住院时间大于一周的患者,于手术后0h、24h、48h分别抽取静脉血进行血糖测定,抽取动脉血进行乳酸测定,根据预后（出院时的预后情况）分为存活组和死亡组,然后分别比较不同时段及两组间血糖和乳酸水平与预后的关系。结果：84例TBI患者术后血糖和乳酸的平均水平均高于正常参考值（P〈0.05）。术后0h、24h及48h的血糖水平与预后呈负相关（相关系数r值分别为-0.581、-0.443、-0.177,均P〈0.05）,乳酸水平与预后亦呈负相关（相关系数r值分别为-0.300、-0.364、-0.117,均P〈0.05）。死亡组0h,24h的血糖及乳酸水平显著高于存活组（P〈0.05）。结论：TBI术后特别是早期,血糖及血乳酸水平均有不同程度升高,两者与预后均具有一定的相关性。我们可以将其作为早期评估预后的指标之一。     

颅脑损伤患者血清C-反应蛋白和血糖水平的动态变化及其意义

目的研究颅脑损伤患者血清C-反应蛋白（CRP）、血糖（Glu）水平的动态变化及其意义。方法97例颅脑损伤患者按照病情计分法分为重型组（29例）、中型组（31例）、轻型组（37例）3组,35例健康体检者为健康对照组。用生化分析仪测定颅脑损伤患者伤后6h、1d、3d、14d血清中CRP、Glu水平。结果颅脑外伤患者伤后6h血清CRP、Glu含量均有不同程度升高,与健康对照组比较差异均有统计学意义（P〈0．01）。颅脑损伤患者CRP和Glu水平与患者入院时的GCS评分呈负相关,与其病情呈正相关,重型组患者血清cRP、Glu升高最为明显;中型和轻型组次之,3组之闻的差异有显著性;病情重和预后差的患者其CRP、Glu水平升高幅度大且持续时间更长。结论血清CRP、Glu水平监测可作为颅脑损伤严重程度评价的指标,动态观察颅脑外伤患者血清CRP、Glu水平对疗效观察和预后判断具有重要价值。     

脑干听觉诱发电位对重型颅脑损伤植物状态评估的价值

目的研究脑干听觉诱发电位 (BAEP)对重型颅脑损伤植物状态患者脑干功能的评估以及对预后判断的价值。方法对 30例重型颅脑损伤植物状态患者在综合康复治疗前及治疗 1个月后行BAEP检查及格拉斯哥昏迷量表 (GCS)评分。 6个月后进行随访 ,行格拉斯哥预后量表 (GOS)评分并复查BAEP。分析BAEP分级与GCS评分、GOS评分的关系以及清醒前后BAEP变化的特点。结果康复治疗前BAEP异常率为 93.3% ( 2 8/30例 ) ,康复治疗 1个月后BAEP异常率为 86 .7% ( 2 6 /30例 ) ,其中Ⅳ级减少 5例 ( 16 .7% ) ,而Ⅰ级增加 2例 ( 6 .7% )。BAEP分级越高 ,则预后越差。有 12例 ( 4 0 % )患者意识恢复 ,意识改善后BAEP的主要变化是Ⅴ波的出现 ,其次是各波分化的改善和潜伏期的缩短。结论BAEP检测可评估重型颅脑损伤植物状态患者脑干功能并为预后判断提供依据。Ⅴ波的出现提示脑干功能的恢复 ,是意识改善的脑电生理学指标     

Negative impact of litigation procedures on patient outcomes four years after severe traumatic brain injury: results from the PariS-traumatic brain injury study

Purpose: To analyze the effect of litigation procedures on long-term outcomes in severe traumatic brain injury.

Materials and methods: Prospective observational follow-up of an inception cohort including 504 adults with severe traumatic brain injury recruited in 2005–2007 in the Parisian area, France, with initial, one- and four-year outcomes measures.

Results: Four years after the traumatic brain injury, 147 patients, out of 257 who survived the acute phase, were assessed. Among these patients, 53 patients declared being litigants and 78 nonlitigants (litigation status was unknown in 16 cases). Sociodemographic characteristics, type of injury and initial severity did not differ significantly between litigants and nonlitigants, except for Injury Severity Score (worse in litigants) and the proportion of road traffic accidents (higher in litigants). One- and four-year outcomes were significantly worse in litigants for autonomy, participation, psychiatric and cognitive function but not quality of life (measured with the Glasgow Outcome Scale-Extended, the working activity status, the Brain Injury Community Rehabilitation Outcome, the Hospital Anxiety and Depression scale, the Neurobehavioral Rating Scale-revised and the Quality of Life after Brain Injury, respectively). Multivariate analyses highlighted litigation procedure as an independent significant predictor of lower autonomy, participation and psychiatric function and tended to predict lower cognitive function, but not lower quality of life, after adjustment for pretrauma characteristics, Injury Severity Score, road traffic accidents and work-related accident status.

Conclusions: Patients with severe traumatic brain injury have a worse prognosis when involved in a litigation procedure and require special attention in clinical practice.

• Implications for rehabilitation

• The influence of litigation procedure on health and social outcomes in severe traumatic brain injury is a major issue that entail numerous levels of complexities.

• A wide range of interactions and factors related to the prolonged process of litigation against a third party may influence recovery.

• Results from the PariS-Traumatic Brain Injury study suggest that patients with a severe Traumatic Brain Injury who are involved in a litigation procedure within French jurisdiction compensation scheme have a worse prognosis than patients who do not.

• Health professionals should be aware of the potential adverse effects of litigation procedures on recovery, and provide appropriate interventions and information to patients and families in such cases.