Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Objectives

To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.

颅脑外伤病人代谢改变及营养支持

严重脑外伤后，病人存在不同程度的高耗能代谢、高分解代谢、高血糖及低蛋白血症，禁食病人一周内可丢失大量的氮和体重的１０％～１５％。资料表明：在准确估计病人代谢状态下，补充１００％～１４０％的静息代谢热量，１５％～２０％的氮热能比较理想。目前仍需研究的是能否通过调整营养成分及激素水平，或通过细胞因子的调节来降低分解代谢，提高氮贮备；研究是否肠内营养比肠外营养发生感染等并发症低。     

降温床用于颅脑外伤亚低温治疗的护理对照研究

研究降温床对颅脑外伤患者进行亚低温治疗的疗效、不良反应、护理要点。154例重型颅脑损伤及92例特重型颅脑损伤,分别随机分为亚低温组与对照组,监测项目：心电、呼吸、血压、血氧饱和度、电解质、血液粘膜测定、血小板计数、白陶土部分凝血活酶时间、意识、格拉斯哥昏迷评分（GCS）、瞳孔,注意有无冻伤、褥疮等不良反应发生。对于GCS＞3的患者不良反应少,GCS＝3患者中存在复温困难的现象。降温床行亚低温治疗能显著提高重型颅脑损伤的存活率,它为临床治疗重型颅脑损伤提供了一种新的途径。     

重型颅脑损伤患者的早期康复治疗

目的探讨重型颅脑损伤患者的早期康复效果。方法89例重型颅脑损伤患者随机分为治疗组49例和对照组40例。两组患者均给予神经外科常规护理及脱水剂、脑保护剂、营养支持，防治并发症等治疗；治疗组在此基础上增加康复治疗，以物理治疗为主，结合作业治疗、心理治疗、语言治疗。比较两组患者治疗前后的日常生活活动能力（ADI。）测评、残疾分级量表（DRS）测评、Fugl-Meyer运动功能积分和认知功能评定简易精神状态检查表评分（MMSE），以及平衡功能等。结果治疗组和对照组患者治疗前后的ADL、DRS、Fugl-Meyer积分和平衡功能差异有显著性意义（P〈0．05），MMSE评分差异无显著性意义（P〉0．05）。结论早期康复治疗能够最大限度地恢复重型颅脑损伤患者的功能，明显提高其生活质量和生活自理能力。     

创伤性颅脑损伤国内研究进展

创伤性颅脑损伤已成为发达国家青少年伤病致死的首位病因;我国的颅脑伤发生率和因颅脑伤致残、致死的伤员也逐年增加。近10年来,我国有条件的神经科开始逐渐重视颅脑外伤的基础研究和临床防治应用研究,并取得一定进展,但仍存在一些问题和不足,特别是实验研究条件与国际先进水平仍有较大差距。本文作者系统回顾了近年来国内有关创伤性颅脑损伤的最新研究进展,主要是外伤后的并发症、康复治疗,以及预后的研究进展,也包括基础的病理机制、动物模型,以及神经保护和修复再生技术的相关研究进展,并对比了国内外研究方向和研究水平的差异。     

重度颅脑创伤恢复期简易精神状态检查及影响因素的研究

目的探讨重度颅脑损伤患者简易精神状态检查(MMSE)评分的特点,分析年龄、损伤侧、损伤部位等因素对MMSE总分和各分项评分的影响。方法67 例重度脑外伤患者,记录患者一般资料,并采用MMSE进行评分,分析结果。结果患者在回忆、定向、计算、书写与绘图方面平均得分相对较低,而在命名、记忆、复述、理解方面得分相对较高。45~65 岁患者在MMSE总分和空间定向、阅读方面得分低于18~44 岁患者(P<0.05)。与基底节损伤相比,额叶损伤在时间定向、空间定向、记忆和计算得分上有显著性差异(P<0.05);额颞顶叶损伤在MMSE总分、时间定向、空间定向、计算和绘图得分上有显著性差异(P<0.05)。结论MMSE可以在一定程度上反映脑外伤患者的认知障碍程度,年龄和损伤部位会影响患者的认知障碍程度。     

脑外伤功能障碍的早期康复和护理

地震后脑外伤是自然灾害危及生命、导致残疾的主要原因。在脑外伤患者生命体征稳定后,应尽早介入康复,详细评价外伤后所造成的各种功能障碍,采取积极有效的康复治疗和护理。本文针对脑外伤后常见的功能障碍情况,大体介绍了目前常用的康复和护理措施。     

脑外伤的并发症和继发障碍的康复治疗

脑外伤并发症和继发障碍的康复治疗和护理是脑外伤康复的重要组成部分,了解脑外伤常见并发症和继发障碍的种类、发生机制、预防和康复治疗手段,能有效减少其发生率,缓解脑外伤患者的痛苦,提高患者的日常生活能力和生活质量,提高康复治疗效果,同时也能减少患者家庭和社会的经济负担,促进脑外伤患者早日回归家庭,回归社会。     

Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes

Introduction: Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures. Methods: This retrospective observational study included all moderate/severe TBI cases (CDC Barell Matrix Type 1) in the pre-implementation cohort of the Excellence in Prehospital Injury Care (EPIC) TBI Study (NIH/NINDS: 1R01NS071049). Cases were compared across four cohorts of initial trauma center temperature (ITCT): <35.0°C [Very Low Temperature (VLT)]; 35.0–35.9°C [Low Temperature (LT)]; 36.0–37.9°C [Normal Temperature (NT)]; and ≥38.0°C [Elevated Temperature (ET)]. Multivariable analysis was performed adjusting for injury severity score, age, sex, race, ethnicity, blunt/penetrating trauma, and payment source. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for mortality were calculated. To evaluate non-mortality outcomes, deaths were excluded and the adjusted median increase in hospital length of stay (LOS), ICU LOS and total hospital charges were calculated for each ITCT group and compared to the NT group. Results: 22,925 cases were identified and cases with interfacility transfer (7361, 32%), no EMS transport (1213, 5%), missing ITCT (2083, 9%), or missing demographic data (391, 2%) were excluded. Within this study cohort the aORs for death (compared to the NT group) were 2.41 (CI: 1.83–3.17) for VLT, 1.62 (CI: 1.37–1.93) for LT, and 1.86 (CI: 1.52–3.00) for ET. Similarly, trauma center (TC) LOS, ICU LOS, and total TC charges increased in all temperature groups when compared to NT. Conclusion: In this large, statewide study of major TBI, both ETs and LTs immediately following prehospital transport were independently associated with higher mortality and with increased TC LOS, ICU LOS, and total TC charges. Further study is needed to identify the causes of abnormal body temperature during the prehospital interval and if in-field measures to prevent temperature variations might improve outcomes.     

重型闭合性颅脑损伤综合康复的效果评定

目的：研究康复科住院的重型闭合性颅脑损伤患者经综合康复治疗后残疾水平恢复情况及影响残疾水平恢复的因素。方法：对49例住院的重症闭合性颅脑损伤患者进行回顾性调查研究。在入院后及出院前采用残疾分级量表（DRS）对患者的残疾水平进行评定；患者的年龄、性别、病程、康复治疗时间对康复治疗效果的影响进行多元回归分析，并分析昏迷时间与DRS评分的关系。结果：治疗前与治疗后DRS评定结果差异有显著性，残疾水平明显下降。非手术组改善较手术组明显，考虑与手术组病情较重有关。DRS评定结果与昏迷时间及治疗时间有关，良复治疗时间长则功能恢复好，残疾水平低。结论：综合康复治疗后残疾水平明显降低，昏迷时间短及康复治疗时间则残疾水平低；脑损伤的严重程度是决定残疾水平恢复的最重要因素。