火器伤性脑脓肿15例报告

脑脓肿是颅脑火器伤的严重并发症,为晚期死亡的主要原因。常因早期清创不及时、不彻底或颅内遗留异物所致。我院自1959～1981年共收治火器伤性脑脓肿15例,占同期颅脑火器伤142例的1.06％。手术结果:14例痊愈,1例死亡。现将本病的发病因素、诊断及手术处理讨论如下。 临床资料 1.一般资料:男14例,女1例,年龄为2～42岁。平均22岁。致伤火器:步枪伤6例,手榴弹片伤4例,霰弹伤(鸟枪)3例,火药枪后拴反冲至颅内2例。伤型多为盲管伤共12例,深切线伤3例。所有     

颅脑火器伤早期死亡36例分析

颅脑火器伤主要于战时发生,伤情变化快,早期死亡率很高。我们观察一组因火器伤早期死亡的125例中,颅脑伤占第一位(29.6％)。现将野战条件下,火器性颅脑伤伤后7天内死亡,且资科完整的36例分析于下。一般资料性别和年龄 36例均为男性,年龄为17～31岁。受伤情况枪伤12例,炸伤24例。34例穿透伤,内盲管伤19例,贯通伤10例,切线伤5例;头皮软组织伤合并闭合性脑损伤2例。受伤部位(以入口部位计)为额部14例,颞部13例,顶部7例,枕部2例。     

高原地区(拉萨)颅脑交通伤的特点及救治分析

目的：探讨现代高原交通事故所致颅脑伤的特点及治疗措施。方法：回顾性分析本科近7年间收治的拉萨市交通事故所致颅脑伤656例。其中男性532例，女性124例；平均年龄32．6岁。本组轻型颅脑损伤123例．中型241例，重型292例。结果：汽车交通事故为本组病例颅脑损伤的主要交通事故原因，出租车为肇事高发车群。高发时间在7～9月份。本组手术治疗273例；非手术治疗383例。其中轻型颅脑损伤无一例重残或死亡；中型颅脑损伤重残42例，死亡12例，重残、死亡率为8．2％；重型颅脑损伤重残66例，死亡123例，重残、死亡率为28．8％。结论：(1)拉萨市出租车肇事是造成颅脑交通伤的重要原凶，7～9月为高发时间；(2)高原低氧环境，常致颅脑损伤伤情加重，进展快．特点是伤情重，合并伤多，死亡及致残率高。尽早清除颅内血肿，去大骨瓣减压，亚低温治疗，维持内环境稳定及防治并发症等措施，可改善重型颅脑损伤的预后。     

战时颅脑火器伤的一线救治

目的 研究探讨现代战争中颅脑火器务的特点和一线救治措施。方法 回顾性研究1985年云南前线师救护所救治的500例员中，38例颅脑火器伤伤员的一线急救，包括早期清创、早期开颅等处理，分析其致伤原因、特点与一线救治体会。结果 29例经清创处理后安全后送，7例经师救护所治疗7至19d痊愈归队；死亡2例，其中1例合并创伤性血气胸死亡。结论 战时师救护所对颅脑火器伤准确的伤性判断、及时有效的清创、安全合理的后送是完成颅脑火器伤前沿救治的有效保证。     

重型颅脑损伤并多器官功能衰竭45例临床分析

目的 探讨重型颅脑损伤并发多系统器官衰竭(MSOF)的主要临床特征和预防、治疗对策。方法 对586例重型颅脑损伤患者中并发MSOF的45例患者进行原发病的治疗及各种指标的监测。结果 重型颅脑损伤后MSOF的发生率7．68％；既往有疾病的器官发生MSOF机率较高，达69％；颅脑损伤越重，MSOF发生率越高，GCS 6～8分者MSOF发生率为3．4％，3～5分者发生率为8．1％，脑疝者发生率为10．4％；死亡31例，病死率68％。结论 早期开颅手术，解除颅内高压，控制肺部感染，密切监测各器官功能，加强对器官功能的支持，可降低MSOF的发生率。     

急性颅脑损伤134例手术后死亡原因分析

目的分析急性颅脑损伤患者手术治疗后的死亡原因。方法回顾性分析134例急性颅脑损伤手术死亡病人的临床资料。结果原发或继发性颅脑损伤过重为急性颅脑损伤病人经手术后死亡的主要原因：严重的合并伤和术后并发症是死亡的重要因素。结论颅脑损伤手术后死亡的原因是多方面的，需要对此类病人采取综合救治措施，以降低其死亡率。     

重型颅脑损伤90例死亡原因分析

目的探讨重型颅脑损伤死亡原因和救治经验。方法2007年1月至2011年1月收治的重型颅脑损伤病人761例,死亡10例,对90例死亡患者的临床资料进行回顾性分析。结果重型颅脑损伤病人761例,死亡90例,死亡率11．8％。其中GCS3—5分死亡65例,GCS6~8分死亡25例。伤后1～3d内死亡24例,4～6d死亡19例,7~9d死亡26例,10～30d死亡21例。结论早期诊断,综合救治,积极预防并发症是救治重型颅脑损伤的关键。     

颅脑火器伤救治体会

目的:探讨颅脑火器伤的临床特点及救治经验.方法:对8例颅脑火器伤患者的临床救治资料进行回顾性分析.结果:恢复良好2例,中残4例,重残1例,死亡1例.结论:早期正确的术前急救和手术处理加上积极地术后治疗能够使颅脑火器伤患者获得满意疗效.     

小儿交通事故伤致颅内血肿及多发伤28例临床分析

目的 总结小儿交通事故伤致颅内血肿合并多发伤的诊治体会。方法 28例小儿交通事故伤致颅内血肿合并其他部位损伤。年龄1-14岁。均行头部开颅手术及其他部位损伤的处理。结果 本组病人中共治愈23例。治愈率82.3%,中残2例。死亡3例。死亡原因主要为重型颅脑损伤。其次为失血性休克和其它内脏并发症。小儿交通伤的临床表现严重而复杂，主要特点有：（1）头部损伤程度重；（2）合并伤多；（3）容易漏误诊。结论 小儿交通伤致颅内血肿合并其他部位损伤的病情凶险而复杂。应根据患儿伤情程度及局部情况及时手术及处理。早期诊断和及时治疗是治愈本病的关键。     

老年人交通事故性颅脑损伤45例死因分析

一、临床资料与方法１一般资料：本组男３１例,女１４例。年龄６２～８９岁,平均６８岁。致伤方式,车撞人,车撞车和车辆自身事故三种,其中车撞人事故最多３０例。本组重型颅脑损伤３２例,中型１０例,轻型３例。合并伤３７例,其中合并骨折１５例,合并颌面损伤１６例,合并胸部损伤８例,合并腹部损伤４例,其中有部分有二处以上损伤。诊断：颅脑损伤由头颅ＣＴ证实,合并伤诊断由放射及超声诊断证实。治疗：根据病情采取非手术治疗和手术治疗。２死亡原因：本组非手术治疗死亡１４例,手术治疗后死亡３１例。本组颅脑损伤致死…     

Penetrating head injury: a prospective study of outcomes

The purpose of our study was to describe the outcomes of persons with penetrating brain injury resulting from a gunshot wound to the head. It is a prospective study of 442 patients admitted with gunshot wounds to the head over a 7 year period to our University Trauma Center Emergency Department, an urban trauma center and an inpatient rehabilitation hospital with a specialized brain injury unit. Measures and factors described include initial Glasgow Coma Scale score, Revised Trauma Score, the Disability Rating Scale, Functional Independence Measure, levels of cognitive functioning, patient demographics, length of stay, hospital charges, and discharge disposition. Initially 36% of patients expired in or were dead upon arrival to the Emergency Department; 64% of patients survived to be admitted for inpatient care. Of those admitted, 41% expired within the first 48 h of admission. Fifty-two percent of those admitted had severe injuries, 7% moderate injuries, and 42% had mild head injuries. Sixty-two percent of the survivors were discharged from acute care to private residences. The remaining 38% were discharged to programs providing varying levels of care depending upon their level of functioning and care needs. Patients sustaining severe injuries following gunshot wound(s) to the head have high early mortality. Survivors able to participate in an inpatient rehabilitation program have good potential for functional improvement.     

Implications of Psychometric Measurement for Neuropsychological Interpretation

The present study sought to determine whether cognitive outcome and course of recovery in civilian penetrating brain injury due to gunshot can be distinguished from that of non-penetrating brain injury due to motor vehicle accident. Matched survivors of penetrating and non-penetrating brain injury were assessed with a brief neuropsychological test battery at inpatient rehabilitation, 1 year post-injury, and 2 years post-injury. The traumatic brain injury groups were found to have patterns of performance marked by reliably distinct differences in isolated areas, with different cognitive predictors of brain injury type present in early versus later recovery. The degree of recovery over the first 2 years appeared to be quite similar for penetrating and non-penetrating injuries.      

Penetrating brain injury due to a large asbestos fragment treated by decompressive craniectomy: case report

We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.     

脑外伤后进展性出血性脑损伤的诊治体会

目的研究脑外伤后进展性出血性脑损伤的临床特点,总结其发病机制,探讨及时诊断、治疗的方法。 方法回顾性分析解放军第二五一医院神经外科自2015年1月至2017年6月收治的167例脑外伤后进展性出血性脑损伤患者的临床资料。本组患者入院时按GCS评分：3~5分11例,6~8分36例,9~12分83例,13~15分37例。临床表现均有不同程度的颅高压症状,观察治疗过程中,76例患者出现意识障碍或意识障碍加深,94例患者肢体肌力减退,81例患者频繁呕吐,43例患者躁动,5例患者脑疝。 结果手术治疗94例,保守治疗73例。所有患者依据GOS评分判断：恢复良好114例,中残32例,重残13例,死亡8例（4.8%）。 结论动态CT观察是早期发现进展性出血性脑损伤的有效方法。对外伤性颅内血肿的患者绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,应进行专科监测和动态CT观察,根据患者血肿量的变化及时调整治疗方案。     

颅内压监测在重型颅脑损伤中的应用

目的探讨颅内压(ICP)监测在重型颅脑损伤中的作用及意义。方法应用颅内压监护仪对42例重型颅脑损伤患者进行颅内压监测,对颅内压的变化与临床特征进行比较分析。结果 ICP 5~15 mmHg 5例,16~20 mmHg 14例,21~40 mmHg 17例,40 mmHg 6例。ICP初值与患者病死率有关,且呈负相关,差异具有统计学意义。结论重型颅脑损伤患者进行ICP监测对及早判断病情、治疗方面有重要价值。     

Are cognitive outcome and recovery different in civilian penetrating versus non-penetrating brain injuries?

The present study sought to determine whether cognitive outcome and course of recovery in civilian penetrating brain injury due to gunshot can be distinguished from that of non-penetrating brain injury due to motor vehicle accident. Matched survivors of penetrating and non-penetrating brain injury were assessed with a brief neuropsychological test battery at inpatient rehabilitation, 1 year post-injury, and 2 years post-injury. The traumatic brain injury groups were found to have patterns of performance marked by reliably distinct differences in isolated areas, with different cognitive predictors of brain injury type present in early versus later recovery. The degree of recovery over the first 2 years appeared to be quite similar for penetrating and non-penetrating injuries.     

Penetrating craniocerebral injury from an underwater fishing harpoon

Weapon injuries other than gunshot wounds or low-velocity stab wounds to the head are extremely rare. We report the case of a 6-year-old girl who sustained a penetrating craniocerebral injury after being accidentally shot with an underwater fishing harpoon. This mechanism of injury seems to share characteristics of both high- and low-velocity projectiles. We discuss the management of this unusual injury in a child, remarking that foreign body removal in these cases must be carried out following the original direction of the projectile trajectory. We review the current literature on craniocerebral injuries caused by similar objects, especially those occurring in children. Received: 18 December 1998     

二次脑创伤的基础与临床研究

低血压或高热等是引起脑外伤病人二次脑创伤常见因素。本研究首先在大鼠弥漫性脑损伤模型基础上，造成大鼠低血压及高热，观察大鼠脑皮层脑血流（ＣｏＣＢＦ）变化。１６只ＳＤ大鼠随机分为假手术对照、脑损伤并二次脑创伤两组。结果表明，伤后４ｈ与假手术组对比，合并二次脑创伤组ＣｏＣＢＦ显著降低。随后对１６５例重型颅脑损伤病人进行回顾研究，探讨二次脑创伤因素如高热、低血压对颅脑损伤预后的影响。表明合并二次脑创伤因素者预后差。基础与临床研究提示，二次脑创伤者预后差的原因可能是其导致脑血管痉挛，脑血流下降，直接影响正常脑代谢     

Penetrating brain injury by drill bit

Non-missile low velocity penetrating brain injuries are unusual among civilian population. They show specific characteristics different from missile wounds. In this paper we describe a rare case of self-inflicted penetrating head trauma by electric drill. We document neuroimaging studies and review the management concerning this pathology. To our knowledge, this is the first case of intracranial retained drill bit with such radiological findings reported in the literature. An 80-year-old male with no previous psychiatric disorder presented at our hospital after suffering an accident while working with an electric drill. Physical examination revealed right lower extremity plegia and three penetrating scalp wounds to the left parasagittal region. Skull X-ray and computed tomography demonstrated an intracranial metallic foreign body located in the left parietal lobe and an intraparenchymal hematoma with no mass effect close to the foreign body. The patient was taken to the operating room to remove the drill bit fragment. Antibiotic and antiseizure prophylaxis were administered. Postoperative computed tomography confirmed no residual metallic fragments and functional recovery was excellent. After psychiatric assessment, suicide attempt was confirmed and antidepressive therapy was then started. On follow-up, no complication was documented. It is essential to exclude penetrating brain trauma whenever a scalp wound is noticed in order to provide proper treatment and prevention care. The permanent neurological deficit in low velocity injuries is related to the degree and location of the primary injury. It also depends on an early diagnosis and treatment and the absence of delayed complications.