重型颅脑外伤的院前急救探讨

随着社会的发展,创伤导致的死亡人数已占总死亡人群的第4位及中青年死亡的首位,而其中50%～70%是因重型颅脑外伤所致眼1演。重型颅脑外伤指格拉斯哥昏迷评分(GCS)3～8分的颅脑外伤患者,因其较高的死亡率和致残率,一直是创伤救治的重点和难点。而及时、规范有效的院前急救是患者获得良好预后的重要前提条件。笔者对本市急救中心2002年1月至2003年9月收治的160例重型颅脑外伤患者的院前急救,做一总结探讨,报告如下。1资料与方法1.1病例资料:本组160例,全部病例均由120急救车现场接诊,根据存在的头部伤情及严重意识障碍(GCS3～8分)为诊断标…     

重型颅脑外伤患者早期肠内营养支持

重型颅脑外伤患者营养不良的发生率可达40%～100%[1],早期营养支持可能提高其生存率,减少致残率。2008年1月至2009年12月笔者共对68例重型颅脑外伤患者的治疗进行观察和比较,     

标准大骨瓣减压术治疗重型颅脑损伤的应用体会

<正>重型颅脑损伤由于伤情严重,病情变化迅速,常合并严重的急性颅内压增高,致残率及死亡率高。早期手术救治及去骨瓣减压是缓解颅内高压及降低死亡率的重要方法。本院于2003年1月至2007年12月期间,对收治的重型颅脑损伤且需行去骨瓣减压术的83例病人,进行了标准外伤大骨瓣开颅减压术治疗。效果满意,现报告如下。     

849例重型颅脑损伤的诊治分析

重型颅脑损伤是常见病、多发病．具有高死亡率、高致残率。本院自2004年1月1日至2008年2月29日,共收治重型颅脑损伤患者849例．笔者对此进行总结分析。     

机械通气在重型颅脑外伤患者中的早期应用

目的观察早期应用呼吸机在治疗重型颅脑外伤患者中的作用。方法将重型颅脑外伤患者随机分成两组，一组常规应用鼻导管给氧或口咽通气道加面罩吸氧，另一组给予机械通气呼吸机辅助治疗。结果通过早期应用呼吸机辅助呼吸，患者血氧分压明显改善，与对照组相比，差异有统计学意义（P〈0．05）。后期致残率亦较对照组改善，差异有统计学意义（P〈0．05）。结论在抢救重型颅脑外伤患者的过程中，早期、正确地使用呼吸机，对改善患者的呼吸状况及预后有明显效果。     

神经节苷脂治疗重型颅脑损伤临床研究

目的:探讨神经节苷脂在重型颅脑损伤治疗中的作用。方法:选择我院收治的重型颅脑损伤患者62例,分为常规组和神经节苷脂组。分析比较昏迷时间、死亡率、GOS等神经功能指标。结果:神经节苷脂组昏迷时间和GOS明显优于常规组,死亡率低。结论:神经节苷脂可缩短重型颅脑损伤患者的昏迷时间,有助于降低其死亡率和致残率,是值得推广的一种神经保护剂。     

高龄患者急性重型颅脑外伤手术治疗抢救体会

目的探讨高龄患者急性重型颅脑外伤手术抢救治疗要点及提高疗效方法。方法回顾分析2005年1月至2011年6月抢救治疗高龄急性重型颅脑外伤患者手术治疗共83例。术前积极准备,手术采用去骨瓣减压颅内血肿清除术,术后加强监护,常规内科方面治疗,积极预防并发症。结果参照格拉斯哥预后评分：随访6～12月,恢复良好28例,中残22例,重残20例,死亡13例。结论高龄患者急性重型颅脑外伤发症多、死亡率高,采用系统性、综合性抢救治疗,可提高抢救成功率。     

164例重型颅脑外伤的观察和护理

重型颅脑外伤是脑外科常见急症 ,其特点是病情重、复杂多变 ,并发症多、死亡率高。因此要求护士观察病情要认真、及时、准确 ,护理要细心、周到、全面。近两年我院收住重型颅脑外伤 164例 ,总结颅脑外伤的观察和护理体会如下 :1　临床资料2 0 0 3年以来 ,我病区收住重型颅脑外伤 164例 ,非手术治疗 72例 ,手术治疗 92例 ,康复出院 88例 ,好转出院 66例 ,死亡10例。2　护理观察2 .1　注意意识状态 :重型颅脑外伤患者均存在不同程度的意识障碍 ,护士可通过对话、呼唤 ,给予痛觉刺激以及是否睁眼情况来判断患者意识状态程度 ;护士记录时应作动…     

颅脑外伤患者凝血功能异常与预后的相关性研究

目的了解颅脑外伤患者急性期凝血功能改变情况,并分析凝血功能异常与颅脑损伤程度（GCS评分）及预后（GOS评分）的关系。方法监测124例单纯颅脑外伤患者急性期凝血指标,进行DIC评分,对患者入院时颅脑损伤程度及外伤后6个月的临床预后进行评分。结果超过50%的单纯颅脑外伤患者发生凝血功能异常,其中重型颅脑外伤患者及预后不良的颅脑外伤患者PT明显延长,D-DT水平明显升高,其差异具有显著性。结论凝血功能改变,尤其是DIC多发生于脑外伤后6小时内,在重型颅脑外伤患者及预后不良的颅脑外伤患者中表现的更加明显。PT、D-DT水平在颅脑外伤患者预后的评估中起重要作用,可作为患者预后的预测指标。     

脑血流速度对外伤性脑梗塞的预测作用

目的观察重型颅脑外伤术后脑血流动力学指标的时程变化规律,揭示脑血流动力学指标对外伤性脑梗塞的预测价值。方法选取重型颅脑外伤术后患者104例,正常对照组40例,TCD检测大脑前、中、后动脉平均血流速度,对数据进行相关统计分析。结果重型颅脑外伤术后第1天大脑中、前、后动脉平均血流速度明显升高,第3天到达高峰,后逐渐下降,经Mann—Whitney U检验,5个时间点的平均血流速度均显著高于对照组（P〈0．001）。重型颅脑外伤术后第1天、第3天、第5天、第7天和第14天,脑梗塞组大脑前、中、后动脉平均血流速度均明显高于非脑梗塞组（P〈0．05）。ROC曲线辨别了大脑巾、前、后动脉平均血流速度的判定界值,对预测重型颅脑外伤术后外伤性脑梗塞有较高的灵敏度和特异度。大脑中动脉平均血流速度的曲线下面积显著大于大脑前、后动脉平均血流速度的曲线下面积（P〈0．05）。结论脑血管痉挛是颅脑外伤继发性脑损伤的重要危险因素．参与外伤性脑梗塞的病理生理机制,大脑动脉平均血流速度,特别是大脑中动脉平均血流速度可早期预测外伤性脑梗塞的发生．可指导临床,降低颅脑外伤的死亡率和致残率。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.