颅脑损伤后脑脊液C反应蛋白动态变化及临床意义

目的探讨颅脑损伤后脑脊液C反应蛋白(C-reactive protein,CRP)的变化规律及与脑损伤程度、病情发展趋势和预后的关系。方法 65例颅脑损伤患者根据GCS评分分为轻型组15例、中型组20例与重型组30例,采集其伤后1d至数周的脑脊液,采用免疫比浊法测定脑脊液中CRP水平,对比实时影像学资料,并进行统计分析。结果轻、中型及重型组伤后7d内CRP水平及7dCRP均值均明显高于对照组(P<0.05),重型组高于中型组及轻型组(P<0.05),中型组高于轻型组(P<0.05);脑脊液CRP水平变化趋势与影像学改变一致。结论脑脊液中CRP水平是反映颅脑损伤后脑细胞损伤的敏感指标,对判断病情、疗效及预后有重要意义。     

神经特异性烯醇化酶、碱性髓鞘蛋白评估重型脑损伤预后的研究

目的：研究重型脑损伤后血清神经特异性烯醇化酶(NSE)，碱性髓鞘蛋白(MBP)浓度在预后的早期评估中的价值。方法：对2002-01／2002-12间40例重型脑损伤住院患者在伤后12h内进行血清NSE，MBP浓度检测，并结合格拉斯哥结局量表(GOS)评分进行比较分析。结果：40例重型脑损伤患者伤后血清NSE，MBP浓度均显著高于正常对照组，不同预后组之间NSE，MBP浓度存在显著差异。以伤后12h血清NSE浓度30mg／L，MBP 10mg／L浓度为分界标准评估预后，NSE评估预后的特异度为77％，敏感度67％；MBP特异度为64％，敏感度61％。ROC曲线(受试者工作特性曲线)则显示NSE对预后的评估较MBP更敏感更特异。结论：伤后血清NSE，MBP浓度对评估预后具有较高的特异性和敏感性。而NSE浓度在预后评估中的作用较MBP更为敏感、特异，因此可作为评估重型脑损伤预后的一种可靠的临床方法。     

神经特异性烯醇化酶、碱性髓鞘蛋白评估重型脑损伤预后的研究

目的:研究重型脑损伤后血清神经特异性烯醇化酶(NSE),碱性髓鞘蛋白(MBP)浓度在预后的早期评估中的价值。方法:对2002-01/2002-12间40例重型脑损伤住院患者在伤后12h内进行血清NSE,MBP浓度检测,并结合格拉斯哥结局量表(GOS)评分进行比较分析。结果:40例重型脑损伤患者伤后血清NSE,MBP浓度均显著高于正常对照组,不同预后组之间NSE,MBP浓度存在显著差异。以伤后12h血清NSE浓度30mg/L,MBP10mg/L浓度为分界标准评估预后,NSE评估预后的特异度为77%,敏感度67%;MBP特异度为64%,敏感度61%。ROC曲线(受试者工作特性曲线)则显示NSE对预后的评估较MBP更敏感更特异。结论:伤后血清NSE,MBP浓度对评估预后具有较高的特异性和敏感性。而NSE浓度在预后评估中的作用较MBP更为敏感、特异,因此可作为评估重型脑损伤预后的一种可靠的临床方法。     

Tau蛋白在颅脑损伤患者脑脊液中的改变及临床意义

[目的]探讨Tau蛋白在颅脑损伤患者脑脊液(CSF)中的改变以及临床意义.[方法]检测70例颅脑损伤患者伤后12 h、1d、3d、7d、12 d时CSF中Tau蛋白水平,并以30例行腰麻的非神经系统疾病患者为对照组.[结果]颅脑损伤重型组、轻中型组在伤后12h、1d、3d、7d、12d时CSF中Tau蛋白水平高于对照组,且差异有显著性(均P ＜0.05).且重型组CSF中Tau蛋白水平均高于轻中型组(P＜0.05).在伤后12h、1d、3d、7d、12 d时CSF中Tau蛋白水平死亡组＞不良组＞良好组,且组间比较差异均有显著性(P＜0.05).GCS评分与CSF中Tau蛋白水平呈显著负相关性(r=-0.610,P＜0.05).[结论]Tau蛋白在颅脑损伤患者CSF中呈高表达,CSF中Tau蛋白水平与颅脑损伤严重程度和预后密切相关.     

脑脊液神经元特异性烯醇化酶的检测在颅脑外伤中的意义

目的探讨脑脊液神经元特异性烯醇化酶(NSE)与颅脑损伤程度及其预后的关系。方法用ELISA法测定了85例急性颅脑损伤患者的脑脊液NSE含量,结合昏迷和预后分级进行比较分析。结果(1)重型(A)、轻型(B)颅脑损伤患者12h内与对照组(C)的脑脊液NSE水平分别为(50.1±16.2)ng/ml、(20.6±9.1)ng/ml、(11.5±4.2)ng/ml,两两比较差异有统计学意义(PA-B<0.01、PB-C<0.01、PA-C<0.01);(2)死亡、植物生存组(E)、残废组(F)、恢复良好组(G)和对照组(C)的脑脊液NSE水平分别为(59.4±18.5)ng/ml、(30.2±10.3)ng/ml、(21.6±6.4)ng/ml、(11.5±4.2)ng/ml,两两进行t检验,结果为PE-F<0.01,PF-G<0.05,PE-G<0.01,PE-C<0.01,PF-C<0.01,PG-C<0.01。结论早期颅脑损伤后,脑脊液NSE水平在一定程度上反映颅脑损伤程度,也是预后评估的重要指标之一。     

颅内压联合PCT与NSE监测对重型颅脑损伤患者病情的预测价值研究

目的:探讨颅内压(ICP)及降钙素原(PCT)、神经元特异性烯醇化酶(NSE)联合监测模式对重型颅脑损伤患者病情的预测价值及预后影响。方法:选取2020年3月—2021年3月入我院接受治疗的重型颅脑损伤患者96例作为研究对象并建立颅脑损伤组，将同期入院进行体检的37例健康受试者纳入健康对照组。观察各组ICP、PCT、NSE表达水平及神经功能缺损量表(NIHSS评分)、认知功能量表(MoCA)评分结果，对比6个月后不同预后表现患者的ICP、PCT、NSE表达水平及NIHSS评分、MoCA评分结果，ROC曲线分析ICP、PCT、NSE单项监测方式与联合监测方式对重型颅脑损伤患者病情的诊断价值，采用Pearson相关系数分析ICP、PCT、NSE指标水平与NIHSS评分、MoCA评分的相关性，采用Spearman相关系数分析颅脑损伤患者预后情况与ICP、PCT、NSE表达水平的相关性。结果:颅脑损伤轻型组、中型组、重型组患者的PCT、NSE表达水平较健康对照组均呈明显上升态势(均P<0.05);NIHSS评分分值随着患者病情程度的加剧呈上升态势，MoCA评分分值呈下降态势(均P<...     

血浆D-二聚体在颅脑损伤患者早期诊断中的意义

目的探讨血浆D-二聚体的检测在颅脑损伤患者早期诊断中的意义。方法对选取的61例颅脑损伤患者和59例健康人的血浆D-二聚体水平进行分析,分为观察组和对照组,分析两组患者的血浆D-二聚体水平;再根据损伤的不同程度将观察组患者分为轻型组、中型组合重型组,分别为21例、20例和20例,观察三组患者的血浆D-二聚体水平。结果观察组患者于4 h、6 h及12 h的D-二聚体水平分别为(2.79±0.58)mg/L、(3.07±1.01)mg/L、(4.11±1.09)mg/L,明显高于对照组[(0.46±0.15)mg/L](P<0.05);重型损伤组和中型损伤组患者明显较轻型损伤组患者高,且重型损伤组患者明显高于中型组均差异有统计学意义(P<0.05)。结论血浆D-二聚体可以作为判断病情严重程度的有效指标。     

颅脑损伤患者血清可溶性E-选择素变化及其意义

目的研究颅脑损伤后E-选择素的变化和意义。方法采用酶联免疫吸附法(ELISA)对30例重型颅脑损伤(GCS3~8分)和25例轻-中型颅脑损伤(GCS9~15分)患者连续测定伤后12、24、48、72、96h血清可溶性E-选择素和预后评分(GOS)。观察可溶性E-选择素与GOS之间的关系。结果重型颅脑损伤组在伤后12h可溶性E-选择素水平最高,连续96h高于正常(P<0.05),升高水平明显高于轻-中型颅脑损伤组。伤后12h可溶性E-选择素>60μg/L的患者预后明显不良(P<0.05)。结论可溶性E-选择素水平在颅脑损伤后明显升高,而且与预后相关。     

创伤性脑损伤患儿血清神经元特异性烯醇化酶、皮质醇的水平特点及其意义

目的:探讨创伤性脑损伤患儿血清神经元特异性烯醇化酶(NSE)、皮质醇(COR)的水平及其与患者病情和预后的相关性。方法:创伤性脑损伤患儿62例纳入研究,于伤后24 h检测患者血清NSE和COR水平,同时采用小儿危重症评分(PCIS)及格拉斯哥昏迷评分(GCS)评估患儿病情,采用格拉斯哥预后量表(GOS)评估患儿预后。结果:根据GOS评分,患儿分为预后良好组50例,预后不良组12例;预后良好组伤后24 h PCIS和GCS评分明显高于预后不良组(P0.05),血清NSE、COR水平明显低于预后不良组(P0.05)。患儿血清NSE、COR与PCIS评分和GCS评分呈负相关(均P0.05)。伤后24 h血清NSE和COR预测预后的ROC曲线下面积分别为0.901和0.756(均P0.05)。结论:创伤性脑损伤患儿血清NSE和COR水平与病情程度相关,在预测患儿预后方面有一定应用价值。     

血清神经元特异性烯醇化酶和肌酸激酶同工酶在颅脑损伤患者的变化

目的 探讨急性颅脑损伤患者血清神经元特异性烯醇化酶(NSE)及肌酸激酶心型同工酶(CK-MB)的变化情况.方法 将148例急性颅脑损伤患者分为3组(轻型组、中型组、重型组),监测不同时间段(1d、3d、7d)NSE和CK-MB的变化情况,并进行比较.结果三组患者入院NSE、CK-MB均升高,各组间与对照组比较,差异有显著性意义(P<0.01).结论 动态监测急性颅脑损伤患者体内NSE和CK-MB的变化,有助于临床判断病情进程及预后,为采取更有效的治疗措施提供实验依据.     

Combined brachial plexus and vascular injury in the absence of bony injury

Neurovascular injury to the axillary vessels is well described in association with fracture or dislocation involving the shoulder joint or the humerus. Such injury however can also occur in the absence of bony injury. A case is presented of damage to the axillary artery and brachial plexus following blunt trauma. This case demonstrates that complex neurovascular damage can occur in the absence of fracture or dislocation. The importance of a thorough clinical assessment is highlighted and priorities with regard to diagnosis and management are discussed.     

Head injury in the workplace

Work related head injuries do not occur frequently in comparison to other injuries, but their importance lies in their relative severity, both in terms of work days lost and long term morbidity, making it important for the occupational health nurse to have knowledge of how to deal with the initial injury and residual problems. In head injury, most of the treatment is aimed toward prevention of hypoxia, airway obstruction, hypercapnia, hypotension, and bleeding. The Glasgow Coma Scale is used for the severely head injured person. The residual cognitive impairment, emotional disturbances, and behavioral changes after head injury tend to continue long after the physical disabilities have resolved. Therefore, the occupational health nurse needs to assist recovering individuals and their families and coworkers to learn to cope with physical, cognitive, behavioral, and intellectual deficits.     

地震伤的影像诊断价值

目的 探讨地震伤的影像诊断价值.方法 回顾性分析143例地震伤的影像学及临床资料,143例患者均行x线平片检查,78例行CT检查,19例行MRI检查.结果 143例地震伤患者经影像学检查明确四肢骨折81例,单发骨折34例,多发骨折47例,开放性骨折6例,闭合性骨折75例.关节脱位14例,软组织内异物5例,膝关节半月板损伤1例,气性坏疽1例.脑硬膜外血肿4例,颅内血肿2例,脑挫裂伤9例,肾挫伤2例、肝挫伤1例.22例脊椎地震伤患者中,脊椎压缩骨折20例,爆裂性骨折2例.单发椎体骨折12例,多发椎体骨折10例,共累及31个椎体骨折.31个椎体骨折中,颈椎3个,胸椎12个,腰椎14个,骶椎2个.30例胸部地震伤均为复合伤,其中肋骨骨折18例,胸椎骨折8例,肩胛骨骨折3例,锁骨骨折3例,胸骨骨折1例,胸壁软组织伤5例,肺挫裂伤5例,肺内血肿1例,肺部感染4例,气胸及液气胸6例,双侧胸腔积液1例.结论 影像学检查有利于地震伤的及时准确诊断和治疗方式的选择.     

Innovations in the management of cerebral injury

During the past decade, brain tissue oxygen monitoring has been studied predominantly in Europe. Cerebral oxygenation monitoring was implemented in many intensive care units and correlations of intracranial pressure, cerebral perfusion pressure, end-tidal carbon dioxide monitoring, fever and partial pressure of brain tissue oxygenation (Pbto2) have been described (Crit Care Nurse. 2003;23[4, pt 1]:17-27). The monitoring of brain tissue oxygen is now being done and researched in the United States. This article will discuss the history of treatment of traumatic brain injury and how treatment interventions are changing with the latest technological advances in monitoring of cerebral oxygen levels and suggested interventions and factors that affect brain tissue oxygenation. It is clear that by understanding the causes of hypoxia and ischemia--along with the interventions to treat them--the critical care team will be better able to prevent low oxygen states in the brain and optimize treatment, thus improving patient outcome.     

Biomarkers in acute lung injury: insights into the pathogenesis of acute lung injury

Studies of potential biomarkers of acute lung injury (ALI) have provided information relating to the pathophysiology of the mechanisms of lung injury and repair. The utility of biomarkers remains solely among research tools to investigate lung injury and repair mechanisms. Because of lack of sensitivity and specificity, they cannot be used in decision making in patients with ALI or acute respiratory distress syndrome. The authors reviewed known biomarkers in context of their major biologic activity. The continued interest in identifying and studying biomarkers is relevant, as it provides information regarding the mechanisms involved in lung injury and repair and how this may be helpful in identifying and designing future therapeutic targets and strategies and possibly identifying a sensitive and specific biomarker.     

Spinal cord injury in the elderly

Caring for patients who have sustained an SCI requires the nurse to be knowledgeable in the pathophysiology of the disorder, the sequelae following the injury, and the nursing care activities. Additional knowledge is required of the nurse when the patient with SCI is elderly. The nurse must be familiar with the changes in the body systems caused by aging, the alterations in the spine from aging, and how these changes impact the sequelae and nursing care activities.     

Inhalation injury in the burn patient

Patients who survive to hospital admission after bums with inhalation injury face a difficult and potentially prolonged course of treatment in the burn center. Continuing survival and especially functional outcome hinges on the patient's receiving comprehensive, well-coordinated care from an interdisciplinary team of skilled health care providers. The best care plan combines close monitoring of vital organ/tissue perfusion indicators, aggressive management of pulmonary compromise, and scrupulous attention to all details of nursing care. Many patients suffer complications from their injuries or treatment, and not all survive. Those who do may face prolonged and painful therapies on the way to recovery. The expert nurse managing and caring for this unfortunate population faces tremendous clinical challenges but also has the opportunity and satisfaction of helping each patient achieve the best possible outcome.