亚低温在急性颅脑损伤治疗中的价值

亚低温在急性颅脑损伤治疗中的价值张跃康，高立达，毛伯镛目前在国外有关亚低温对脑损伤，特别是对脑缺血的实验研究较为迅速，但大多滞留在疗效分析方面，对亚低温保护脑继发性损害的机理尚涉及较少。本文结合我们在这方面的研究，拟对亚低温在脑损伤的机理应用前景加以...     

亚低温治疗重型颅脑损伤临床分析

目的研究亚低温对重型颅脑损伤患者颅内压（ICP）及并发症的影响。方法重型颅脑损伤患者68例,随机分为亚低温组（n=38）及常温常规治疗组（n=30）。亚低温组接受32℃～35℃低温治疗,常温常规治疗组除亚低温治疗外,其余治疗同亚低温组。比较两组的ICP、预后和并发症的差异。结果亚低温治疗组伤后ICP显著低于常温常规治疗组（P（0.01）。预后显著好于常温常规治疗组（P〈0.05）。应激性溃疡、肝肾功能异常和外伤性癫痫的发生率显著低于常温常规治疗组（P〈0.01）。结论亚低温对重型颅脑损伤患者ICP升高有明显的治疗作用,可以改善重型颅脑损伤患者的预后,减少全身并发症。     

重型颅脑损伤急性期亚低温治疗的护理

重型颅脑损伤后 ,由于脑血管自身调节功能障碍、颅内压增高、高热以及呼吸功能不全、休克等多种因素造成脑组织缺氧 ,导致脑损害。早期采取亚低温治疗以降低脑组织耗氧量是降低重型颅脑损伤病人病死率、提高其生存质量的主要治疗措施。我院脑外科 1 997年5月至 2 0 0 0年 1 2月收治重型颅脑损伤病人 3 8例 ,在治疗、护理原发伤、保护和恢复脑功能同时 ,加强了对亚低温治疗的护理 ,取得了较好效果。报告如下。1　临床资料1 .1　一般资料3 8例中 ,男 2 5例、女 1 3例 ,年龄 1 6～ 6 3岁 ,平均(3 9.8± 1 5 .2 )岁。经头颅 CT扫描示原发性脑干…     

亚低温治疗重型颅脑损伤的监护进展

在重型颅脑损伤的治疗中,亚低温能显著减轻脑损伤后神经功能障碍和脑病理形态损害,保护血脑屏障功能,从而明显降低重型颅脑损伤患者的病死率[1],提高存活率和恢复良好率。但低温治疗亦可引起心肺功能、血液凝固系统及免疫机能的障碍,导致并发症的发生,严密观察病情及精心的护理对预防并发症的发生尤为重要。1　治疗机制亚低温治疗的机制尚未完全阐明,但已有实验研究指出可能机制有:1降低氧耗,改善能量代谢,减轻酸中毒;2抑制内源性毒性产物对脑细胞的损害;3减少Ca2+内流,调节Ca2+靶酶活性;4减轻再灌注脑损伤,保护血脑屏障,减轻脑水肿;5保护…     

亚低温治疗重型颅脑损伤的临床体会

目的 探讨亚低温脑保护疗法对救治重型颅脑损伤的疗效。方法 将132例重型颅脑损伤随机平均分为治疗组与对照组，进行对比分析，并且前瞻性分析两组疗效。结果 治疗组66例患者，存活率为77．3％，恢复良好率54．5％（36／66），病死率18．2％（12／66）。疗效明显优于对照组，未发生相关的并发症。结论 亚低温治疗能显著降低重型颅脑损伤患者的死亡率，改善颅脑损伤患者神经功能预后，并具有安全、显著降低病死率及癫痫发生率等优点。     

冬眠亚低温治疗重型颅脑损伤

目的：探讨冬眠亚低温在重型颅脑损伤中的应用及疗效。方法：对本科自2003年10月至2005年10月间收治的重型颅脑损伤患者随机分为常温治疗组32例和亚低温治疗组32例。分别给予常温治疗和亚低温治疗。结果：冬眠亚低温治疗组恢复良好17例（53．1％）,死亡5例05．6％）,常温组恢复良好12例（37．5％）,死亡8例（25％）。两组相比差异显著（P〈0．05）。结论：冬眠亚低温治疗重型颅脑损伤简便,安全有效,能显著降低死残率,提高治愈率。     

亚低温治疗重型颅脑损伤的观察及护理

亚低温是轻度低温（３３℃～３５℃）和中度低温（２９℃～３２℃）的合称。国内临床研究大都选择３３℃～３５℃轻度低温治疗重型颅脑损伤，疗效显著犤１犦。本院颅脑外科在１９９９年１０月至２００２年２月，对４８例重型颅脑损伤患者施行亚低温疗法，取得一定疗效。现将观察方法及护理体会报告如下。临床资料１．一般资料：本组４８例，男３８例，女１０例；年龄１９～６８岁，平均４１岁。病人均经CT扫描和临床表现诊断为重型颅脑损伤，GCS评分３～８分。２．方法：本组病人均于入院４～６小时内开始亚低温治疗。降温采用Medi－Ther…     

冬眠亚低温治疗重型颅脑损伤的护理体会

<正> 在重型颅脑损伤的治疗中,亚低温(30℃～35℃)能显著降低脑耗氧量,减轻脑细胞功能破坏,促进脑细胞功能恢复,抑制内源性有害因子的释放,减少钙离子内流,减轻神经损伤,减少脑水肿,从而明显降低颅脑损伤后的残死率,改善预后。现报告我院自1999年1月～2001年1月对28例重型颅脑损伤病人亚低温治疗期间的护理体会。     

亚低温治疗重型颅脑损伤效果观察

将78例重型颅脑损伤病人随机分为亚低温组和对照组,各39例.两组病人均采用脱水、抗炎等治疗,亚低温组在此基础上施行亚低温治疗,即使肛温降至33～34 ℃,持续5～7 d.结果亚低温组血糖和血乳酸较对照组明显降低(P＜0.05);亚低温组在治疗后1 d颅内压即较对照组明显降低(P＜0.05),7 d基本降至正常.提示亚低温治疗能有效降低重型颅脑损伤病人的颅内压、血糖和血乳酸水平,改善预后.护理中应注意加强对皮肤、体温和生命体征的监护,采用自然复温法逐步复温效果较好.     

亚低温治疗重型颅脑损伤的护理配合

本院自2001年6月至2003年5月,采用亚低温治疗重型颅脑损伤68例,效果良好.现报告如下.     

颅脑损伤患者肺炎发生风险预测模型的系统评价

目的 系统地评价、分析颅脑损伤患者肺炎发生风险预测模型,为临床实践提供参考。方法计算机检索PubMed、Web of Science、Cochrane图书馆、Embase、万方数据库、中国知网、维普数据库、中国生物医学文献数据库中有关颅脑损伤患者肺炎发生风险预测模型的文献,检索时限为建库至2021年8月2日。由2名研究者独立筛选文献和提取数据,并使用预测模型研究的偏倚风险评估工具PROBAST分析纳入研究的偏倚风险和适用性。结果共纳入6项颅脑损伤患者肺炎发生风险预测模型开发研究;模型的受试者工作特征曲线下面积为0.806~0.949;GCS评分、机械通气、术后白蛋白水平、APACHE Ⅱ评分是纳入的6个模型中包含最多的预测因子。6项研究存在一定的偏倚风险,适用性尚不清楚,主要是因为未报告盲法、样本量不足、模型过度拟合、未报告或未处理缺失数据、模型性能缺乏评估。结论颅脑损伤患者肺炎发生风险预测模型的研究尚处于发展阶段,今后可开展多中心、大样本研究,结合大数据分析方法,开发预测性能优良、使用简便的预测模型,在使用过程中不断更新校正,为临床提供实际可用的模型。     

Current controversies in the management of patients with severe traumatic brain injury

BACKGROUND: Traumatic brain injury is a major cause of mortality and morbidity, particularly among young men. The efficacy and safety of most of the interventions used in the management of patients with traumatic brain injury remain unproven. Examples include the 'cerebral perfusion pressure-targeted' and 'volume-targeted' management strategies for optimizing cerebrovascular haemodynamics and specific interventions, such as hyperventilation, osmotherapy, cerebrospinal fluid drainage, barbiturates, decompressive craniectomy, therapeutic hypothermia, normobaric hyperoxia and hyperbaric oxygen therapy. METHODS: A review of the literature was performed to examine the evidence base behind each intervention. RESULTS: There is no class I evidence to support the routine use of any of the therapies examined. CONCLUSION: Well-designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful.     

Kinematic analysis of jaw function in children following traumatic brain injury

Primary objective: To investigate jaw movements in children following traumatic brain injury (TBI) during speech using electromagnetic articulography (EMA).

Methods and procedures: Jaw movements of two non-dysarthric children (aged 12.75 and 13.08 years) who had sustained a TBI were recorded using the AG-100 EMA system (Carstens Medizineletronik) during word-initial consonant productions. Mean quantitative kinematic parameters and coefficient of variation (variability) values were calculated and individually compared to the mean values obtained by a group of six control children (mean age 12.57 years, SD 1.52).

Main outcomes and results: The two children with TBI exhibited word-initial consonant jaw movement durations that were comparable to the control children, with sub-clinical reductions in speed being offset by reduced distances. Differences were observed between the two children in jaw kinematic variability, with one child exhibiting increased variability, while the other child demonstrated reduced or comparable variability compared to the control group.

Conclusions: Possible sub-clinical impairments of jaw movement for speech were exhibited by two children who had sustained a TBI, providing insight into the consequences of TBI on speech motor control development.     

Memory outcome at 5 years post-childhood traumatic brain injury

Primary objective: This study seeks to extend previous findings by documenting memory performance in a sample of 70 children at 5 years post-injury. It was anticipated that increasing injury severity would be associated with decreased performance on working and complex memory tasks. It was also expected that injury severity would significantly predict memory, but that the time from insult to subsequent testing would be associated with an increased relationship to non-injury factors.

Research design: Participants were assessed at 5 years post-injury, aged between 6-14 years, using measures of immediate, working and complex memory.

Methods and procedures: The sample comprised 18 children who had sustained a severe TBI, 24 with a moderate TBI, 11 with a mild TBI and 17 healthy controls, matched for age, gender and socio-economic-status.

Results: Results indicated that severe TBI was associated with decreased complex auditory-verbal memory performance, although children with TBI did not display impairment on immediate, working or complex visual-spatial memory. While injury severity significantly predicted complex memory outcome, non-injury factors failed to significantly predict either working or complex memory performance.

Conclusions: Future research should be engineered towards further clarifying what influences recovery from childhood TBI in the elongated post-injury period.     

Amantadine treatment following traumatic brain injury in children

Primary objective: The focus of this paper is to review the current literature on the use of amandatine in children who have sustained a head injury.

Main outcomes and results: A MEDLINE search was conducted and yielded five papers. They were composed of prospective, retrospective and case study designs. Dosage use and side effect profiles were consistent with expected norms. Efficacy was measures primarily by alertness and arousal and positive results were found for all studies on these dimensions. Behavioural and cognitive measures of outcome yielded mixed results.

Conclusions: The studies reviewed for this paper suggest that amantadine is clinically beneficial for children who have sustained head injuries. Double blind placebo controlled trials with larger sample sizes are needed to further substantiate these findings.     

Theory of mind in children with traumatic brain injury

Objective: This study was designed to examine the existence of deficits in mentalizing or theory of mind (ToM) in children with traumatic brain injury (TBI).

Research design: ToM functioning was assessed in 12 children aged 6-12 years with TBI and documented frontal lobe damage and compared to 12 controls matched for age, sex and verbal ability. Brief measures of attention and memory were also included.

Main outcome and results: The TBI group was significantly impaired relative to controls on the advanced ToM measure and a measure of basic emotion recognition. No difference was found in a basic measure of ToM.

Conclusion: Traumatic brain damage in childhood may disrupt the developmental acquisition of emotion recognition and advanced ToM skills. The clinical and theoretical importance of these findings is discussed and the implications for the assessment and treatment of children who have experienced TBI are outlined.     

A systematic review of treatments for mild traumatic brain injury

Objectives: To assess the effectiveness of interventions for mild traumatic brain injury (MTBI) in adults as found in the literature.

Research design: Systematic review of the literature.

Methods: Six electronic databases and 18 journals within the brain injury field were manually searched between the years 1980-2003. References from articles were scanned for further literature. Studies that met broad inclusion criteria were subjected to a formal test of relevance. Those found to be relevant were qualitatively tested for their methodological soundness.

Results: One thousand and fifty-five studies were initially identified and 163 were assessed using the relevance tool, yielding 20 studies for review. Four categories of interventions were identified: Pharmacotherapy, Cognitive Rehabilitation, Patient Education and Other. The majority of studies were weak, however there is evidence to support the effectiveness of patient education interventions.

Conclusions: There are few rigorous studies evaluating treatment of MTBI. Limitations of the current literature are presented.     

Cerebral protection in traumatic brain injury

With advances in the understanding of the pathophysiology of traumatic brain injury, many novel cerebroprotective measures have been developed. Many of them have undergone preclinical trials and have shown promising results, but the results have not translated into clinical benefits. Evidence of these cerebroprotective measures including NMDA‐receptor antagonist, steroids, free radial scavengers, nimodipine, ziconotide, bradykinin receptor antagonist and dexanabinol has been reviewed. Problems encountered in clinical studies of traumatic brain injury are mainly related to the heterogenicity of traumatic brain injury and the design of clinical studies. Given all these difficulties, clear benefit of these measures cannot be shown and an optimum treatment strategy has yet been developed.     

A review of pharmacological treatments used in experimental models of traumatic brain injury

Primary objective: We provide a review of recent chronic and delayed rehabilitative pharmacological treatments examined in experimental models of traumatic brain injury. There is a specific emphasis on studies aiming to enhance cognitive recovery.

Main outcomes and results: Decreased neuronal activity is believed to contribute to persistent cognitive disabilities. Neurotransmitter based rehabilitative treatments that increase neuronal activity may assist in the recovery of cognitive function. However, timing and dosage of drug treatment are influential in cognitive enhancement. Drug treatments that affect single and multiple neurotransmitter systems have the ability to significantly influence recovery of function following brain injury.

Conclusions: Understanding the relationship between neural disturbances and functional deficits following brain injury is challenging. Cognitive impairment may be the result of a single event or multiple events that occur after the initial insult. Increasing neuronal activity during the chronic phase of injury seems to be an effective treatment strategy for facilitating cognitive recovery. Pharmacological agents do not necessarily display the same effects in an injured brain as in a non-injured brain. Thus, further research is needed to establish the effectiveness of rehabilitative drug treatments.     

创伤性脑损伤后肺损伤的发病机制研究进展

背景 创伤性脑损伤(traumatic brain injury,TBI)患者可能发生肺损伤,严重时甚至发生肺功能障碍.脑与肺通过复杂途径相互联系.发生肺功能障碍的TBI患者病死率增加、 加强治疗病房住院时间延长且神经预后较差.目的 综述TBI后肺损伤的研究进展.内容 讨论TBI后肺损伤的发生特点并综述其潜在机制.趋向 根据具体情况评估TBI患者发生肺损伤的潜在风险,并在其临床症状出现前进行相应干预有助于降低发生TBI后肺损伤的风险.