脑外伤后抑郁与社会心理功能的关系

对188例脑外伤患者5年内发生抑郁症与社会心理问题之间的关系进行前瞻性研究。研究的主要 项目包括抑郁症的定式临床检查,抑郁严重程度的自我评估,功能症状,生活质量,未满足的重要需求以及心理社 会功能。根据首次和再次评估中抑郁症的不同发生形式可以将患者分为4组:无抑郁组、抑郁恢复组、迟发性抑郁 组和持续性抑郁组。各组的人口统计学资料和损伤相关因素均相似,但在社会心理功能上有显著的差异。无抑郁 组具有较好的社会心理功能,而持续性抑郁组的社会心理功能最差,其再次评估时的生活质量也明显降低。尽管 在首次评估时抑郁恢复组和迟发性抑郁组的社会心理功能相差不大,但再次评估时抑郁恢复组的社会心理功能得 到改善,而迟发性抑郁组则呈恶化趋势。另外受伤前精神性疾病的诊断并不能预测脑外伤后发生抑郁症的严重程 度。上述研究证实对脑外伤后精神和社会心理功能的改变应进行广泛和阶段性的评估。     

脑外伤后的疼痛问题

颅脑外伤病人的疼痛问题包括急性疼痛和慢性疼痛.慢性疼痛可加重或延长脑外伤病人的功能残疾.脑外伤病人的各种康复措施应特别强调对其慢性疼痛的处理.     

1例脑外伤后癔症患者的心理护理

颅脑外伤在临床上比较多见,常引起神经系统特别是大脑的损伤,亦可伴发各种精神症状。外伤后神经症是一类设有任何器质性病变的精神障碍[1]。它有各种类型,病症就是其中一种,可有精神神经或躯体症状,但无器质性的体征。本文报告1例脑外伤后癌症患者经正确处治和精心护理,取得了比较满意的效果,现报道如下。1病例介绍患者,男,22岁,职工,初中文化,于1996年5月12日在立交桥上行走时,被身后行驶的卡车撞倒,当即昏迷30分钟,无恶心、呕吐,四肢抽搐及大、小便失禁等,被他人送入我院,CT示：脑室内积气,查体：神志清,反应迟钝,…     

脑外伤后遗忘症

介绍脑外伤后遗症(PTA)的遗忘的发生、表现的类型以及持续时间等方面的基本特征,从精神心理的角度较为深入地研讨这种记忆障碍的内在机制,并从脑外伤康复的临床实践出发,着重介绍国内外几种常用的记忆量表,探讨如何对PTA进行测定和评估的问题.     

脑外伤后抑郁的诊断与治疗

脑外伤发病率约占全身各种创伤的33%,以15～45岁的青壮年多见,其中20%是重度颅脑损伤,约40%的患者留有中、重度残疾,抑郁的发生率为10%～70%,抑郁的发生也加重了脑外伤患者的躯体症状,增加了其他精神神经症状发生的风险,进而影响康复进程,降低了患者的生活质量。本文就脑外伤后抑郁诊断与康复治疗综述如下。     

脑外伤后帕金森综合征的评估

目的:观察脑外伤后帕金森综合征的发病情况。方法:采用Columbian帕金森病评估量表和McDowell帕金森病残疾指数量表对11例中度或重度闭合性颅脑外伤的患者进行评估,分析脑外伤后帕金森综合征对患者功能活动的影响。结果:本组患者的Columbian帕金森病评估量表平均得分为50.545±3.013,最低为48分,最高为61分,其中僵直、动作缓慢和步态紊乱相对得分较高;患者的McDowell帕金森病残疾指数量表平均得分为73.273±13.506,最低为58分,最高为84分,其中行走、如厕、洗澡、书写、上下楼梯等项相对得分较高。     

脑外伤后综合征的心理干预效果观察

<正>脑外伤后综合征是颅脑损伤的后遗症之一,其发病原因仍未完全明了,目前认为可能是在轻微器质性损伤的前提下,再加上病人心身因素与社会因素而促成[1]。因此,本研究将个性化的心理干预介入脑外伤综合征的治疗中,并取得了较好的效果。现报告如下。1资料与方法     

亚低温治疗重型颅脑损伤38例疗效分析

【目的】探讨使用亚低温治疗重型颅脑损伤患者的疗效。【方法】收治76例重型颅脑患者,格拉斯哥昏迷记分（GCS）3～8分、无其他严重并发症。随机分为亚低温组与对照组;患者入院后亚低温组行亚低温治疗,对照组行常规治疗。于伤后3个月时对两组患者的治疗效果进行GOS评分。【结果】亚低温组38例患者,恢复良好15例,中残7例,重残及植物生存9例,死亡7例。对照组38例患者,恢复良好11例,中残6例,重残及植物生存8例,死亡13例。【结论】亚低温治疗对重型颅脑损伤患者有较好的脑保护作用,患者预后得到改善。     

脑外伤患者的运动疗法

脑外伤后由于脑的损伤部位不同 , 其运动障碍表现多种多样 , 使脑外伤后康复难度加大 ; 脑外伤后的运动治疗需根据不同运动障碍类型采取不同治疗方法 . 本文详细介绍了脑外伤后不同运动障碍类型的运动疗法 .     

Consistency and idiosyncrasy of semantic categorization by individuals with traumatic brain injuries

Purpose: Information about semantic categorization consistency may help practitioners to implement augmentative and alternative communication (AAC) options for people with traumatic brain injuries (TBIs). The researchers sought to determine the consistency and extent of general consensus agreement with which adults with TBI organize semantic information. Methods: The researchers compared the semantic categorization consistency of 10 participants with severe TBI to 10 neurotypical adults matched on age and gender. Participants performed a semantic categorization task three times over a 1-month period. The experimental task consisted of two stages: (a) sorting ordinate exemplars into superordinate categories and (b) sorting subordinate exemplars into the previously established ordinate categories. Results: Results showed that participants with TBI were less consistent across trials and more idiosyncratic than neurotypical peers in placing exemplars within categories. Although some participants with TBI achieved higher general consensus agreement scores with experimental task repetition, their performance did not reach levels comparable to those of neurotypical participants. Conclusions: Individually, semantic categorization patterns of some people with severe TBI conform to those of neurotypical adults; patterns of others do not. Some, but not all, survivors demonstrate increased consistency given task repetition. These findings have implications for AAC design and instruction for people with TBI.

• Implications for Rehabilitation

• Clinicians should evaluate the manner in which an individual with TBI categorizes semantic information rather than assuming that he/she intuitively uses the hierarchical superordinate–ordinate–subordinate categorization pattern common to neurotypical adults.

• Clinicians should evaluate the consistency with which an individual with TBI categorizes semantic information before determining the manner of organizing content within an AAC system or device.

• When individuals with TBI display idiosyncratic and/or inconsistent patterns of semantic organization, clinicians should explore the possibility that repeated exposure to specific lexical items or direct instruction about categorization strategies will normalize and/or stabilize performance.

     

Concomitant injuries and its influence on functional outcome after traumatic brain injury

Abstract

Purpose: This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.

Method: A retrospective cohort study was performed in a single-center recruiting patients with first episode of TBI. The types and severity of extracranial concomitant injuries were documented for patients who fulfilled the inclusion criteria. Injuries with Abbreviated Injury Scale (AIS) grade 3–6 were considered to be high grade. A cross-sectional functional assessment was conducted at 18 months post-injury using Glasgow Outcome Scale.

Results: A total of 100 patients were included in the analysis. Extracranial concomitant injuries were seen in 78% of the patients. Three commonest injuries were facial (44%), lower extremity (20%) and upper extremity (12%) injuries. Among the AIS grade?≥?3, injury involving the chest was most common (41%). Presence of extracranial concomitant injuries AIS grade?≥?3 was significantly associated with disability in TBI patients at 18 months (OR 12.74, 95% CI 2.39–67.95, p?=?0.003).

Conclusion: Presence of extracranial concomitant injuries was high. In TBI survivors, extracranial concomitant injuries AIS grade?≥?3 influenced the long-term functional outcome at 18 months, causing moderate and severe disabilities.

• Implications for Rehabilitation

• Concomitant injuries should be suspected in patients with traumatic brain injury, especially in a high-speed trauma mechanisms as the incidence can be as high as 78% as in this study and may interfere with the long term rehabilitation and outcome.

• This study shows that severe extra cranial concomitant injuries are associated with a poor long term functional outcome even in the mild traumatic brain injury patients and therefore need to be addressed early in the rehabilitation of this group of patients.

• Early diagnosis and management of severe concomitant injuries is warranted and may improve the functional gains in the long term after traumatic brain injury.

     

创伤性脑损伤后应激性高血糖45例分析

目的对创伤性脑损伤（TBI）后来该院就诊的45例患者进行血糖随访,入院后采集患者血糖进行分析,探讨高血糖与创伤性脑损伤程度是否相关。方法将45例患者按照格拉斯哥评分法分为轻、中、重3组,采集患者入院前3d血糖,每2小时测1次,所得数据进行方差分析。结果重度脑损伤组比轻度和中度组血糖明显增高,差异有统计学意义（P＜0．01）。而其中共死亡8例,死亡组的血糖也明显高于剩余存活组,差异有统计学意义（P＜0．01）。结论通过对TBI患者的血糖动态随访,证实了 TBI患者血糖增高的程度与脑损伤严重程度存在相关性,并且血糖增高与患者的预后也存在相关性。     

脑外伤后康复用药

脑外伤的康复用药主要是防止脑外伤后脑组织的继发性损害及促进神经功能的恢复 . 前者包括钙通道阻滞剂、抗自由基及抗兴奋性氨基酸等药物 ; 后者主要是促进中枢神经功能的恢复 . 本文就其药理、用法和注意事项予以阐述 .     

重型颅脑损伤合并伤的救治策略与预后分析

目的探讨重型颅脑损伤合并伤的救治策略与预后的影响因素。方法对480例重型颅脑损伤合并伤的死亡率进行统计学单因素χ2分析和多因素Logistic回归分析。结果重型颅脑损伤合并颈椎损伤、胸部损伤、多发合并伤、休克明显增加其死亡率。结论合并颈椎损伤、胸部损伤、多发合并伤、休克是影响重型颅脑损伤预后的重要因素,仔细迅速的体检,必要的影像学检查,颈椎损伤及早颈部制动防止二次损伤,积极抗休克治疗,尽早手术控制胸腹腔内出血,合理的救治顺序是降低重型颅脑损伤合并伤患者死亡率的关键。     

颅脑损伤的作业治疗

本文概括介绍了颅脑外伤的发病率、病因、分型、严重程度评价和临床表现 , 作业治疗的定义 , 作用和理论基础 , 颅脑损伤的作业治疗原则 , 治疗程序 , 不同时期 ( 急性期 , 恢复期和后期 ) 的治疗目的和治疗方法 .