严重脑损伤后早期肠内营养支持的合理应用

目的：传统的鼻饲营养方法因脑损伤胃动力下降早期难以安全实施。本研究对４１例严重脑损伤病人实施改良后的早期鼻饲喂养计划,观察其应用的合理性和临床效果。方法：实验组采用了早期鼻饲要素膳,对照组按常规方法实施鼻饲营养支持;实验组开始时间为伤后４８ｈ,对照组为伤后６－８天。     

重组人生长激素在重型颅脑损伤后低蛋白血症病人的应用观察

目的：观察重组人生长激素（rhGH)对重型颅脑损伤后低蛋白血症的治疗作用。方法：选择36例重型颅脑损伤后血清白蛋白＜32g/L病人，分成治疗组和对照组。治疗组每天注射思增8单位，共7－10天，使用后第5、10天检测血清白蛋白、转铁蛋白、前白蛋白。结果：治疗组使用rhGH后血清白蛋白、前白蛋白、转铁蛋白浓度均明显上升。结论：rhGH能有效地纠正重型颅脑损伤后的低蛋白血症     

The epidemiology of head injury in Cantabria

The epidemiology of head injury was studied in Cantabria, Spain, using a methodological design consisting of a cross-selectional analysis of one year of duration and an additional one year follow-up of all the patients included in the initial sample. The 477 cases identified represent a rate of 91/100,000, with males showing a head injury rate 2.7 times higher that than for females. Sixty per cent of all cases involved traffic accidents, falls accounted for 24% and industrial accidents were the cause in 8%. The annual age-adjusted mortality rate was 19.7/100,000. Over 92% of all deaths occurred prior to hospital admission. The presence of alcohol intoxication was evaluated in 211 cases by determining the osmolar gap. It was found that 51% of all the cases examined presented clear evidence of acute alcohol intoxication.Corresponding author.     

亚低温治疗重型颅脑损伤患者的护理

目的探讨重型颅脑损伤患者经亚低温治疗的护理措施。方法对72例重型颅脑损伤患者经用控温毯、冰帽,同时给予冬眠治疗,配合呼吸机辅助呼吸。严密观察生命体征,控制体温,监测颅内压,做好呼吸道管理、口腔护理、皮肤护理,加强营养等对症支持治疗。结果本组恢复良好（恢复劳动力）29例,占39％;轻残（活动有障碍）15例,占20％;中、重残（生活部分自理,不能自理或植物人）10例,占13％;死亡18例,占24％。结论亚低温治疗重型颅脑损伤效果满意,使患者病死率、致残率大大降低。具有临床护理推广价值。     

重型颅脑损伤后胃肠动力障碍与早期肠内营养支持

重型颅脑损伤后病人常见胃肠动力障碍,可引发严重的营养不良、免疫功能低下、感染、脓毒症和多器官功能障碍等并发症,预后较差.其防治受到了临床的高度重视,且是一大难点.以下就重型颅脑损伤后胃肠动力障碍及早期肠内营养支持方法作一简要综述.     

Nutritional support in head injury

Nutritional support is imperative to the recovery of head-injury patients. Hypermetabolism and hypercatabolism place this patient population at increased risk for weight loss, muscle wasting, and malnutrition. Nutrition management may be further complicated by alterations in gastrointestinal motility. Resting energy expenditure should be measured using indirect calorimetry and protein status measured using urine urea nitrogen. Providing early enteral nutrition within 72 hours of injury may decrease infection rates and overall complications. Establishing standards of practice and nutrition protocols will assure patients receive optimal nutrition assessment and intervention in a timely manner.     

早期肠内营养在重型颅脑损伤患者急性胃肠损伤中的应用

目的　观察急性胃肠损伤在重型颅脑损伤患者中的发生及其相关因素，急性胃肠损伤后喂养的可行性，并探讨临床结局与肠道喂养之间的关系。方法　收集患者的临床资料,包括性别、年龄、有无急性胃肠损伤及急性胃肠损伤分级、急性生理与慢性健康状态（APACHE）Ⅱ评分、格拉斯哥昏迷量表(GCS)评分、死亡率、24 h喂养率及7 d热量达标率等。根据急性胃肠损伤分级将患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组，对性别、年龄、APACHEⅡ评分、GCS评分、死亡率，24 h喂养率及7 d热量达标率进行观察。根据临床结局对患者进行死亡与存活分组，对GCS评分、24 h喂养率及7 d热量达标率结果进行观察。结果　重型颅脑损伤患者86例均发生急性胃肠损伤,其中Ⅰ级30例、Ⅱ级26例、Ⅲ级21例、Ⅳ级9例。根据急性胃肠损伤分级，4组间APACHEⅡ评分、GCS评分及死亡率差异有统计学意义(均P＜0.05或P＜0.01)，随胃肠道功能障碍越重，患者APACHEⅡ评分越高、GCS评分越低及死亡率越高。4组间患者24 h喂养率和7 d热量达标率比较差异有统计学意义(P＜0.01)，随胃肠道功能障碍加重，患者24 h喂养率及7 d热量达标率呈下降趋势。根据不同临床结局分组，死亡组24 h喂养率、7 d热量达标率和GCS评分明显低于存活组(P＜0.01)。死亡率与24 h喂养率(r=-0.478，P＜0.01)及7 d热量达标率(r=-0.795，P＜0.01)和GCS评分(r=-0.638，P＜0.01)呈负相关。结论　急性胃肠损伤与重型颅脑损伤密切相关，颅脑损伤、特别是重型颅脑损伤的患者，应根据患者的胃肠功能状态进行评估，尽快采取切实有效的营养支持措施，纠正代谢紊乱，改善负氮平衡状态，促进伤者康复。     

Methods to place a value on additional evidence are illustrated using a case study of corticosteroids after traumatic brain injury

ObjectivesTo establish whether evidence about the effectiveness of a health care intervention is sufficient to justify the use of the intervention in practice and show how value of information (VOI) analysis can be used to place a value on the need for additional evidence and inform research prioritization decisions.Study Design and SettingMeta-analysis provides an estimate of the effect of an intervention with uncertainty. VOI analysis determines the adverse health consequences of not resolving this uncertainty. A case study examining the evidence before the high profile trial of Corticosteroid Randomisation After Significant Head injury (CRASH) shows the consequences on patient outcomes if this trial had not been successfully funded.ResultsThe consequences of uncertainty before CRASH were high at 40 deaths and 1,067 years of full health per annum. VOI analysis indicates that CRASH was worthwhile and the UK National Health Service would have had to spend an additional £205 million elsewhere to generate health benefits similar to CRASH.ConclusionsVOI analysis can be integrated with the results of meta-analysis to help inform whether a particular research proposal is potentially worthwhile and whether it should be prioritized over other research topics that could be commissioned with the same resources.     

闭合性腹部伤合并颅脑伤35例临床分析

目的提高对闭合性腹部伤合并颅脑伤的认识,提高救治成功率。方法对笔者所在医院2003年5月～2010年9月收治的35例闭合性腹部伤合并颅脑伤患者的临床资料进行回顾性分析。结果35例患者经积极抢救存活28例,死亡6例,植物生存1例,死亡率17．14％。结论根据闭合性腹部伤合并颅脑伤的发生特点,应全面考虑,早期诊断,对于伴有意识障碍、昏迷的颅脑损伤合并腹部外伤患者,一定要积极的常规腹腔穿刺,减少漏诊、漏治。手术顺序需先治疗危及生命的损伤,注重围术期处理,提高生存率。     

216例颅脑损伤应激性溃疡预防及治疗探讨

目的探讨颅脑损伤应激性溃疡预防和治疗,提高治愈率。方法回顾性分析216例颅脑性损伤应激性溃疡患者的临床资料。结果本组216例中颅内血肿清除加去骨瓣减压129例。45例患者中在死亡、出院时有21例消化道出血已停止。42例患者均经保守治疗痊愈,无消化道出血死亡病例。结论早期预防和正确处理是减少颅脑损伤后应激性溃疡出血的机会,从而提高对颅脑损伤的治愈率。     

武汉市2009年居民伤害死亡状况及疾病负担分析

目的分析武汉市2009年伤害死亡的流行特征和疾病负担,为制定伤害预防控制策略和措施提供科学依据。方法采用粗死亡率、标化死亡率、潜在寿命损失年、标化潜在寿命损失年、潜在工作损失年等指标对武汉市2009年居民病伤死亡监测资料伤害死亡数据进行分析。结果 2009年武汉市伤害的粗死亡率为45.50/10万,标化率为33.01/10万,男性（54.77/10万）明显高于女性（35.77/10万）,农村（49.66/10万）明显高于城市（42.63/10万）,伤害死亡的主要原因依次是交通事故、溺水、跌落、自杀、意外中毒和他杀,0-岁人群伤害的主要死因是溺水,15-岁人群则是交通伤害,65岁及以上人群则以跌落为主,其次为交通事故和自杀。因伤害导致的YPLL,SYPLL和WYPLL分别为73 470年、84 734年和50 073年,分别占全死因的24.01%、30.36%和31.62%,远远高于伤害占全死因的比例7.46%。结论伤害是导致＂早死＂和寿命损失的重要疾病负担,由于伤害死亡带来的社会和经济损失应引起相关卫生部门更多的重视,根据伤害的死亡谱和危险人群制定有效的防控措施,最大限度的减少伤害所致的死亡与残疾。     

重型颅脑损伤术后并发大面积脑梗塞的病因分析

目的：分析颅脑损伤术后合并大面积脑梗塞的病因,寻找有效对策。方法：回顾性分析16例重型颅脑损伤术后合并大面积脑梗塞患者的临床资料。结果：参照GOS标准,16例患者出院时4例死亡（25．0％）,植物生存3例（18．8％）,重残3例（18．8%）,轻残4例（25．0％）,良好2例（12．5％）。结论：重型颅脑损伤术后患者的脑血管痉挛、颅内压增高、术中持续低血压、血管损伤等因素是颅脑损伤术后大面积脑梗塞的高危因素,需密切观察病情,妥善处理,从而提高生存质量。     

长春市儿童青少年意外伤害致死水平变化趋势分析

目的:探讨长春市儿童青少年意外伤害致死水平变化趋势,从而为预防工作的开展提供科学依据。方法:对长春市城乡482名0～15岁儿童青少年2007～2010年期间意外伤害发生情况进行回顾性调查并做统计分析。结果:意外伤害粗死亡率为15.99%,农村显著高于城市(χ2=23.56,P<0.01),男性显著高于女性(χ2=11.23,P<0.01),15～岁组发生率最高(57.67%),0～岁组发生率最低(5.39%)。意外伤害致死类型前3位依次为疾病和死亡的外因、运输事故、所有其他外因。结论:意外伤害死亡是长春市儿童青少年第1位死因,应对儿童青少年人群大力开展有针对性的意外伤害防控工作。     

珠海市居民交通伤害死亡状况及疾病负担研究

目的探讨2011-2016年珠海市户籍居民交通伤害死亡原因及疾病负担情况,为制定交通伤害相关防控策略提供科学依据。方法利用2011-2016年珠海市户籍居民交通伤害死因监测数据,计算死亡率、标化死亡率、年度变化百分比(APC)、潜在寿命损失年(PYLL)、PYLL率等指标。率的检验采用χ²检验。结果 2011-2016年珠海市户籍居民交通伤害死亡率为6.58/10万,其中男性10.48/10万,女性2.53/10万,男性明显高于女性(χ²=156.78,P<0.01);交通伤害死亡率及标化死亡率在6年间总体均下降,从7.97/10万(7.57/10万)下降至4.82/10万(4.13/10万)。交通伤害死亡人群以骑摩托车者、行人、骑自行车者为主,占交通伤害总死因的85.39%;交通伤害死亡年龄分布主要在20～59岁的青年和中年人群,占所有年龄死亡65.66%。2011-2016年珠海市户籍居民去除交通伤害后人均寿命增加0.21岁,总的潜在减寿年数(PYLL)为15 894.63人年,平均减寿年数(AYLL)为36.88人年;2011-2...     

Assessing the performance and clinical impact of a computerized prognostic system in severe head injury

The ability to predict outcome in the early stages of severe head injury would have several uses. A computerized system which has been developed in Glasgow to assist clinicians in this task, based on information from over 2500 severely head-injured patients, is described, with particular attention to the testing of the statistical properties of the system, and, more importantly, the assessment of its clinical impact.     

A survey of vocational status 10 years after traumatic head injury

Productivity is one of the components of occupational performance in occupational therapy. Thus, work status is an important area to address after head injury. Many studies on long-term outcomes after head injury document return to work post injury but often do not report the nature of employment after injury. The aim of this study was to examine change in vocational status 10 years after head injury and explore participants' perception of how this injury affected career plans. Eighty-three out of 100 subjects were traced 10 years post injury from a large trauma centre in Canada. Of these, 59 agreed to participate in a telephone interview where data on employment were collected. Occupations before and after injury were coded using three indices (Hollingshead Index, Blishen Socioeconomic Index for Occupations, and the Pineo Socioeconomic Classification of Occupations). The study shows that, on average, subjects who are employed before and after injury stay at the same level of vocational status or improve slightly. Younger age (p<0.05) and being male (p<0.10) were associated with an increase in status. Six major themes on how injury affected career plans emerged. It is recommended that greater attention be given to coding occupations in research, clinical work and follow-up studies of head injured subjects. Copyright © 1997 Whurr Publishers Ltd.     

Sexual behavior after head injury in Indian men and women

Disorders in sexual function constitute one of the most prevalent and least discussed problems following head injury. The disorders are often the outcome of an interaction between the neurological sequelae, the psychological makeup of the individual, and the sociocultural context of the couple. In a study of 34 head-injured patients, only 13 reached their premorbid level of sexual functioning over a period of 1 year. Deviant behavior, total loss of sexual function, and sexual dysfunction were noted in the rest. Deviant behavior was consistently associated with frontal lobe damage. Otherwise, neurological indices of head injury in the dysfunctional group were not different from those of the clinically recovered group. Associated psychiatric disturbances, gender-role differences, the impact on the marital harmony of the couple, and the role of sociocultural beliefs in the etiology of the disorders are analyzed and discussed, with a particular emphasis on Indian culture.This study is a part of the ICMR financed project on Adjustmental Problems of Head Injured Patients, conducted in the Department of Neurosurgery, Madurai Medical College, Madurai.     

Factors influencing ergonomic conditions and employment rate after an occupational musculoskeletal injury

In 195 cases of musculoskeletal occupational injury individual and work related factors and their relationship with reduction of physical work load and active employment was studied. Data concerning the injuries were obtained and after 18 months the work places were assessed. Information on employment status was obtained by a postal questionnaire after 3 years. Multiple logistic regression was used to explain the two outcome measures. Injuries classified as diseases and informative injury reports were factors positively associated with reduction of work load. Male gender, higher education, and a sick-leave shorter than 6 months were factors positively associated with employment.     

Outcomes after head injury: level of agreement between subjects and their informants

This study examined the extent and nature of agreement between the responses of 42 young adults with traumatic brain injury and their informants (family members or friends) on selected outcome measures. A telephone interview was conducted approximately five years post injury with items measuring quality of life, impairment, disability and handicap. Levels of agreement were analysed using kappa and intraclass correlation coefficients. In general, agreement was higher on objective, observable items from all outcome measures such as physical function and productivity. However, there was some disagreement on these items as well as more substantial disagreement on subjective items, so clinicians are cautioned against substituting informant responses for those of TBI clients. These results were similar for mild, more moderate and severely injured clients. Copyright © 1997 Whurr Publishers Ltd.     

护理干预对重型颅脑损伤患者气管切开后医院感染的影响

目的探讨护理干预对重型颅脑损伤患者气管切开后医院感染的影响。方法选择2010年1-12月,重型颅脑损伤患者168例为干预组,采取地面消毒,加强患者气道管理,使用震动排痰机排痰,改进吸痰方法;加强医护人员手卫生清洁及患者营养等干预措施;以2008年1月-2009年12月,重型颅脑损伤患者230例为对照组,按疾病护理常规进行护理,对两组发生呼吸道感染的情况进行统计分析。结果干预组呼吸道感染率为34.7%,对照组感染率为16.7%,两组比较差异有统计学意义;年龄及住院时间干预组与对照组比较,差异均有统计学意义(均P<0.05)。结论重型颅脑损伤患者呼吸道感染的控制应以预防为主,加强护理管理,采取有效的护理干预,可降低重型颅脑损伤患者呼吸道感染的发生率。