深圳市急性颅脑损伤十年住院病例回顾性调查

目的统计深圳市十年来颅脑外伤的住院病历资料,以了解其流行病学特征,为有效防治颅脑创伤提供依据。方法抽取全市所有创伤病例总数的20%进行创伤流行病学调查统计,再抽取其中颅脑外伤病例进行分析。结果近十年来深圳市共有35万创伤住院患者,按等概率抽样抽取创伤病历55241份,其中颅脑创伤病历10067份,占19.3%。年发生率由1994年的84.22/10万至2003年的132.29/10万,平均年龄28.79岁,交通意外占56.9%:平均住院日17天,平均住院费用10947元人民币。结论颅脑损伤是创伤中最严重的损伤,交通事故是第一位原因,青年男性是最易发生伤害的人群。     

Glucose and oxygen metabolism after penetrating ballistic-like brain injury

Traumatic brain injury (TBI) is a major cause of death and disability in all age groups. Among TBI, penetrating traumatic brain injuries (PTBI) have the worst prognosis and represent the leading cause of TBI-related morbidity and death. However, there are no specific drugs/interventions due to unclear pathophysiology. To gain insights we looked at cerebral metabolism in a PTBI rat model: penetrating ballistic-like brain injury (PBBI). Early after injury, regional cerebral oxygen tension and consumption significantly decreased in the ipsilateral cortex in the PBBI group compared with the control group. At the same time point, glucose uptake was significantly reduced globally in the PBBI group compared with the control group. Examination of Fluorojade B-stained brain sections at 24 hours after PBBI revealed an incomplete overlap of metabolic impairment and neurodegeneration. As expected, the injury core had the most severe metabolic impairment and highest neurodegeneration. However, in the peri-lesional area, despite similar metabolic impairment, there was lesser neurodegeneration. Given our findings, the data suggest the presence of two distinct zones of primary injury, of which only one recovers. We anticipate the peri-lesional area encompassing the PBBI ischemic penumbra, could be salvaged by acute therapies.     

华东六省一市颅脑创伤合并颅面损伤住院患者调查

目的掌握华东六省一市颅脑创伤合并颅面损伤住院患者临床流行病学特点。方法从《2004年华东六省一市颅脑创伤住院患者》数据库中整群抽取合并颌面损伤患者,用SPSS13.0统计软件包分析。结果15611例颅脑创伤患者中合并颌面损伤患者占40.37%,男女比3.59：1,平均年龄（38.70±16.93）岁,17～58岁患者占所有年龄组的80.04%,各年龄组上性别对于颅脑创伤合并颅面损伤的发病有统计学意义（P〈0.01）。主要受害者是农民（46.11%）、工人（28.07%）、学生及儿童（9.08%）,文化程度以中学（55.16%）、小学（29.50%）和文盲（6.22%）最多。公路（67.22%）、公共场所（11.35%）和矿山工地（9.46%）是主要发生地点;主要致伤原因是车祸伤（66.20%）、击打伤（12.20%）和高处坠落伤（10.71%）,而且在各年龄组中车祸伤都是主要致伤原因（P〈0.01）。颅脑创伤合并颅面损伤较其他颅脑创伤病情重,合并伤多,预后差。结论颅颌面损伤是颅脑创伤中最常见的合并症,多为中青年男性,且文化层次相对较低,这类患者较其他损伤病情重,预后差,在检查、诊断和治疗上需要各学科通力合作。     

The risks of epilepsy after traumatic brain injury.

The aim of this study is to present the incidence of traumatic brain injury (TBI) and identify those characteristics of brain injuries that are associated with the development of seizures. We identified 5984 episodes of TBI (loss of consciousness, post-traumatic amnesia, or skull fracture) in Olmsted County, Minnesota, from 1935 to 1984. Of these, 4541 were followed for seizure. Injuries were classified as mild (loss of consciousness or amnesia less than 30 minutes), moderate (loss of consciousness 30 minutes to 1 day or a skull fracture), or severe (loss of consciousness of more than 1 day, subdural hematoma, or brain contusion). The incidence of TBI in the period from 1975 to 84 peaked at 800 per 100 000 in males aged 15-24. The relative risk of seizures was 1.5 (95 percent confidence interval 1.0-2.2) after mild injuries, but with no increase after 5 years; 2.9 (95 percent confidence interval 1.9-4.1) after moderate injuries; and 17.2 (95 percent confidence interval 12.3-23.6) after severe injuries. Significant risk factors were brain contusion with subdural hematoma, skull fracture, loss of consciousness or amnesia of 1 day or more, and age over 65 years. We conclude that TBI is a major public health problem and contributes to the occurrence of seizures and epilepsy.     

Rehabilitation and outcome of the adult traumatic brain injury

One-hundred and seventy traumatic brain injured persons were admitted to Kanagawa Rehabilitation Hospital for a rehabilitation program during a five-years period. The average age was 30.7 years and the male to female ratio was 5:1. The most common cause of injury was an traffic accident. They exhibited various physical and cognitive dysfunctions. Patients with severe physical and/or cognitive dysfunction had difficulty in community re-integration after finishing the hospital rehabilitation. At present, social resources for traumatic brain injury patients and family to fulfill their various needs are so few that they tend to be isolated from the community.     

Neurodevelopmental outcome after severe traumatic brain injury in very young children: role for subcortical lesions

Traumatic brain injury is a major cause of mortality and morbidity in children younger than 15 years of age. To evaluate the role of subcortical lesions on neurodevelopmental outcomes, long-term outcomes of 50 children with severe traumatic brain injury before 4 years of age (accidental injury, n = 21, nonaccidental injury, n = 29) were reviewed retrospectively and compared with late magnetic resonance imaging (MRI) findings: no visible lesions, cortical lesions, or subcortical lesions. Subcortical lesions occurred in both accidental and nonaccidental traumatic brain injuries. Traumatic brain injury severity (initial Glasgow Coma Scale or coma duration) was significantly associated with subcortical lesions. Long-term motor or visual deficiencies occurred in one third of patients and cognitive deficiencies in 52.1%. Although deficiencies occurred without visible MRI lesions, global outcome scores, motor delay, visual impairment, head growth slowing, global intellectual quotients, and planning performances were significantly worse in patients with subcortical lesions. An alarming deterioration in intellectual quotient over time was noted. It was concluded that neurodevelopmental outcomes are worrisome after severe traumatic brain injury in young children, and subcortical lesions affect the prognosis.     

Demographics, injury characteristics and outcome of traumatic brain injuries in northern Sweden

OBJECTIVES - To describe demographics, injury characteristics and outcome of traumatic brain injury (TBI) in northern Sweden over 10 years. MATERIAL AND METHODS - Data were retrospectively collected on those individuals (n = 332) in Norrbotten, northern Sweden, with a TBI who had been transferred for neurosurgical care from 1992 to 2001. RESULTS - A majority were older men with a mild TBI and an acute or chronic subdural hematoma following a fall. Younger individuals were fewer but had more often a severe TBI from a traffic accident. Most individuals received post-acute care and brain injury rehabilitation. A majority had a moderate or severe disability, but many were discharged back home with no major changes in their physical or social environment. CONCLUSIONS - Our data confirm the relationship between age, cause of injury, injury severity and outcome in relation to TBI and underscore the need for prevention as well as the importance of TBI as a cause of long-term disability.     

重型颅脑损伤患者精神障碍的临床分析

目的 探讨重型颅脑损伤后精神障碍的发生率、表现形式及影响因素。方法 以深圳市1999年10月1日至2000年9月30日因交通事故所致重型颅脑损伤的183例幸存者为研究对象,在颅脑损伤治疗后（平均6个月）,由2名精神科副主任医师根据中国精神疾病分类方案与诊断标准第2版修订本对这些伤者的精神状态进行评估。结果 （1）在183例中,罹患各类精神障碍者共165例,发生率为90．2％,其中智能障碍者为142例（77．6％）。（2）在183例,中度及其以上智力损伤者为29例（15．8％）。（3）有智力损伤组的脑干损伤、颅内血肿及≥3个脑叶损伤的比例高于无智力损伤组（P＜0．01）;伴有精神障碍组的平均年龄（P＜0．05）、脑干损伤（P＜0．05）及≥3个脑中损伤（P＜0．01）的比例高于无精神病性障碍组;有人格改变组额叶损伤、开颅清除血肿并减压治疗的比例高于无人格改变组（P＜0．01）。结论 重型颅脑损伤后精神障碍的发生率较高,应引起有关临床学科的重视。     

Critical score of Glasgow Coma Scale for pediatric traumatic brain injury

The aim of this study is to determine the predictive critical value of the Glasgow Coma Scale for use as a determinant of outcome for children with traumatic brain injuries. A total of 309 children, aged 2-10 years, were enrolled in this study. Each subject underwent the following assessments: Glasgow Coma Scale; clinical data; brain computed tomography; and Glasgow Outcome Scale assessments. The receiver operating characteristic curve indicated that a critical point of the Glasgow Coma Scale set at 5 was most strongly correlated with outcome of pediatric traumatic brain injury. Subarachnoid hemorrhage with brain swelling and edema, subdural, intracerebral hemorrhage, and basal ganglion lesions were associated with severe injury and poor outcome (P < 0.05). However, cortical lesions did not affect injury severity and outcome. In injuries associated with traumatic brain injuries, only chest trauma had a tendency to be associated with poor outcome (P < 0.05). Of the factors analyzed, the score of the Glasgow Coma Scale was the most effective predictor for outcome in pediatric traumatic brain injury. Furthermore, the predictive critical score of the Glasgow Coma Scale should be set at 5 for pediatric traumatic brain injury. The computed tomographic findings also were important in determining injury severity and predicting outcome.     

Suicide after traumatic brain injury: a population study

OBJECTIVES: To determine the rates of suicide among patients who have had a traumatic brain injury. METHODS: From a Danish population register of admissions to hospital covering the years 1979-93 patients were selected who had had either a concussion (n=126 114), a cranial fracture (n=7560), or a cerebral contusion or traumatic intracranial haemorrhage (n=11 766). All cases of deaths by the end of the study period were identified. RESULTS: In the three diagnostic groups there had been 750 (0.59%), 46 (0.61%), and 99 (0.84%) cases of suicide respectively. Standardised mortality ratios, stratified by sex and age, showed that the incidence of suicide among the three diagnostic groups was increased relative to the general population (3.0, 2.7, and 4.1 respectively). In all diagnosis groups the ratios were higher for females than for males, and lower for patients injured before the age of 21 or after the age of 60. The presence of a codiagnosis relating to substance misuse was associated with increased suicide rates in all diagnosis groups. There was a tendency, among patients with cerebral contusions or traumatic intracranial haemorrhages, for suicide risk to increase with duration of stay in hospital. Cox regression analyses for proportional hazards confirmed that there was a significantly greater risk of suicide among patients with cerebral contusions or traumatic intracranial haemorrhages than among patients with concussion or cranial fractures (hazard ratios=1.42 and 1.50 respectively). There was, however, no evidence of a specific risk period for suicide after injury. CONCLUSION: The increased risk of suicide among patients who had a mild traumatic brain injury may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally the physical, psychological, and social consequences of the injuries as directly contributing to the suicides.     

创伤性颅脑损伤后血钠紊乱的危险因素与预后

目的探讨创伤性颅脑损伤发生血钠紊乱的危险因素以及对预后的影响。方法回顾性分析80例中、重型颅脑损伤病例资料。分析血钠紊乱的发生率,外伤性脑损伤后首次CT扫描时的伤情表现和意识状态。结果 36例发生血钠紊乱,20例表现为高钠血症,16例表现为低钠血症。血钠紊乱在硬膜下血肿、脑内血肿和弥散性轴索损伤的病例中发生率更高。弥漫性脑损伤的病例血钠紊乱的发生率比局限性脑挫裂伤组高。结论弥漫性脑损伤病例血钠紊乱的发生率比较高。局限性脑损伤与血钠紊乱的比例并没有相关性。     

Spinal cord injuries in Taipei, Taiwan, 1978-1981

This survey of spinal cord injuries in Taipei city from January 1978 to December 1981 was carried out by a review of the hospital records. During these four years 560 patients with acute spinal cord injury (SCI) were admitted to the hospitals in the city of Taipei. Of these, 123 were inhabitants of Taipei city, showing the annual incidence of SCI in Taipei to be 14.6 per million population. As a result of injury 118 patients were paraparetic, 180 were paraplegic, 117 tetraparetic and 145 were tetraplegic. The average age was 36 years and 2 months and one third were in the 20 to 29 year age group. The male/female ratio was 4.9. The causes of SCI were traffic accidents (44.5%), accidental falls (28.5%), struck by object (14.6%) and sports injury (3.4%). The mortality rate was 6.0%. Respiratory complication was the leading cause of death, accounting for 58% of the total deaths.     

The incidence and outcome of severe brain trauma - Design and first results of an epidemiological study in an urban area

Epidemiological data on the incidence, the prehospital and hospital care and the outcome of traumatic brain injury in Germany are scarce. It is therefore difficult to estimate the importance of this injury with respect to magnitude as well as effectiveness and efficiency of therapeutic concepts. We therefore planned a study that was supposed to provide population based epidemiological data in the field of severe brain trauma from the site of the accident until discharge from hospital.All 90.000 prehospital emergencies that were cared for by emergency physicians in Cologne from January 1990 until December 1996 were screened for identification of severe brain trauma. Their clinical course was reviewed using standard records and patients were included if they had their accident within the city of Cologne and fullfilled the final inclusion criteria of GCS ≤ 8 or AISHead ≥ 3. 650 eligible patients were identified of whom 530 had complete datasets (follow-up 80 %). Univariate statistical analysis was performed for all relevant variables. The main study endpoints were incidence and outcome of severe brain trauma.The annual incidence of severe brain trauma in Cologne (1 mio. inhabitants) was 93. The average age was 39 years and 71 % of the patients were male. The average prehospital GCS was 6.8, the average prehospital Trauma Score was 8.3 points. 49 % of the study population suffered from multiple injuries. The overall mortality rate was 46,6 %. 60 % of deaths occurred within the prehospital setting.The incidence of severe brain trauma in Cologne in this study was significantly lower compared to what could be expected from the literature. The overall mortality was high, especially the high prehospital death rate is striking.     

The incidence and outcome of severe brain trauma - Design and first results of an epidemiological study in an urban area

Epidemiological data on the incidence, the prehospital and hospital care and the outcome of traumatic brain injury in Germany are scarce. It is therefore difficult to estimate the importance of this injury with respect to magnitude as well as effectiveness and efficiency of therapeutic concepts. We therefore planned a study that was supposed to provide population based epidemiological data in the field of severe brain trauma from the site of the accident until discharge from hospital. All 90.000 prehospital emergencies that were cared for by emergency physicians in Cologne from January 1990 until December 1996 were screened for identification of severe brain trauma. Their clinical course was reviewed using standard records and patients were included if they had their accident within the city of Cologne and fullfilled the final inclusion criteria of GCS /=3. 650 eligible patients were identified of whom 530 had complete datasets (follow-up 80 %). Univariate statistical analysis was performed for all relevant variables. The main study endpoints were incidence and outcome of severe brain trauma. The annual incidence of severe brain trauma in Cologne (1 mio. inhabitants) was 93. The average age was 39 years and 71 % of the patients were male. The average prehospital GCS was 6.8, the average prehospital Trauma Score was 8.3 points. 49 % of the study population suffered from multiple injuries. The overall mortality rate was 46,6 %. 60 % of deaths occurred within the prehospital setting. The incidence of severe brain trauma in Cologne in this study was significantly lower compared to what could be expected from the litera-ture. The overall mortality was high, especially the high prehospital death rate is striking.     

Life-long history of injuries related to seizures

There is meager information in the literature regarding the characteristics and risk factors for injuries caused during epileptic seizures in adults. Previous studies focused mainly on specific types of injuries incurred, and only few explored associated risk factors. A questionnaire regarding lifetime seizures and their traumatic consequences was administered to 298 consecutive epileptic patients and their caretakers or relatives. Ninety-one of them (30%) have reported trauma: 185 events (age 39.8+/-18 years, 54 males), of which 61 were severe. This translates to one seizure-related injury every 21 patient-years, and a serious injury once every 64 patient-years. The most common site of injury was the head (55% of the events). Blunt injuries occurred most frequently (40%), followed by cuts (28%). Severe injuries included fractures and dislocations (17%), burns (6%), brain concussion (6%), subdural hematoma (3%) and intracerebral hematoma (1%). Most injuries occurred at home. The 91 patients with traumatic events were compared with the 207 epileptic patients without previous trauma (age 37.8+/-14.7 years, 112 males). Patients with seizure-related trauma had significantly earlier onset age of epilepsy. They more commonly had generalized from onset tonic-clonic, complex partial, myoclonic or absence seizures but fewer had partial seizures with secondary generalization. The risk of trauma was mostly related to seizure type (generalized tonic clonic from onset and myoclonic seizures). This information may be helpful for better management of epileptic patients.     

Head injuries during one year in a central hospital in Norway: a prospective study. Epidemiologic features

Annual age-adjusted incidence rate of head injuries in Akershus County in 1974 was estimated to be 236/100,000, 307/100,000 for males and 164/100,000 for females. The highest incidence rate occurred in males in the age group 10-19 years (489/100,000) and the lowest among females in the age group 30-39 (68/100,000). In all age groups, the incidence rate was higher in males than females. This prospective study included 488 patients, of whom 88.9% had minor head injuries and 11.1% severe head injuries. 16 patients (3.3%) died due to their head trauma. Skull fracture was detected in 10.4% of the patients who survived the first 24 h, and 2.5% had operations. The mean hospital stay was 8.8 days, 10.2 days for the patients injured in traffic accidents and 7.0 days for the others. Besides having a higher incidence rate of head injuries, males suffered severe head injuries more often and their death rate was higher than head-injured females.     

小儿交通事故伤致颅内血肿及多发伤28例临床分析

目的 总结小儿交通事故伤致颅内血肿合并多发伤的诊治体会。方法 28例小儿交通事故伤致颅内血肿合并其他部位损伤。年龄1-14岁。均行头部开颅手术及其他部位损伤的处理。结果 本组病人中共治愈23例。治愈率82.3%,中残2例。死亡3例。死亡原因主要为重型颅脑损伤。其次为失血性休克和其它内脏并发症。小儿交通伤的临床表现严重而复杂，主要特点有：（1）头部损伤程度重；（2）合并伤多；（3）容易漏误诊。结论 小儿交通伤致颅内血肿合并其他部位损伤的病情凶险而复杂。应根据患儿伤情程度及局部情况及时手术及处理。早期诊断和及时治疗是治愈本病的关键。     

207例重型颅脑损伤合并多发伤的救治分析

目的探讨重型颅脑损伤合并多发伤的临床救治经验。方法选取我科收治的207例重型颅脑创伤合并多发伤患者,回顾性分析其临床资料以及治疗方法,总结重型颅脑创伤合并多发伤的治疗经验以及疗效。结果预后按格拉斯哥结果评分法(GOS评分),恢复良好70例(33.8%),轻残42例(20.2%),重残29例(14%),植物生存10例(4.8%),死亡56例(27.2%)。结论早期诊断,尽早判断伤情,合理把握抢救顺序,及时抢救危及生命的器官损伤,重视术后的综合治疗,则可提高颅脑损伤合并多发伤抢救成功率,减少伤残率和病死率。     

The significance of skull fracture in mild head trauma differs between children and adults

Objective The objective was to determine whether the age of patients with mild head injury and skull fracture influences the level of risk for acute intracranial injuries.Method A study was conducted of 156 patients with skull fracture, 60 children (aged <14 years) and 96 adults, detected among 5,097 consecutive patients with mild head injury (Glasgow Coma Scale [GCS] score of 15–14 points) arriving at the Emergency Department of a Level I University Hospital Trauma Center during 1998. Acute intracranial injuries were defined as traumatic brain injuries identified by cranial computed tomography scan, excluding pneumocephalus.Results Compared with the children, this risk of intracranial injury was 13 times greater in the adults aged 14–54 years and 16 times greater in the over-54-year-olds. Besides age over 14 years (p<0.0001), compound skull fracture (p<0.001), and a GCS score of 14 (p<0.001) were factors significantly associated with intracranial injury in the logistic regression analysis.Conclusions Skull fracture in mild head injury implies a greater risk of intracranial injury in adults than in children.