脑震荡患者血清S100B蛋白的变化与认知功能障碍的相关性

目的 分析脑震荡患者血清S100B含量变化与认知功能损害的相关性,探讨血清S100B水平在脑震荡认知障碍预后判断中的意义. 方法 采用酶联免疫法分别测定126例脑震荡患者急诊入院后6h、12h和第3天的血清S100B浓度,并和同期轻型单纯脑外伤患者比较.脑震荡患者常规治疗后,于入院后第1天、第14天及3个月后进行简易智能精神状态检查量表(MMSE)评估,将S100B浓度与MMSE评分进行相关性分析. 结果入院6 h、12 h后脑震荡组患者血清S100B浓度均明显高于对照组,差异有统计学意义(P＜0.05).入院6 h血清S100B浓度与各时段MMSE评分均具有相关性(P均＜0.05);入院12 h、第3天血清S100B浓度与各时段MMSE评分均无相关性(P均＞0.05). 结论 脑震荡患者早期(6 h)血清S100B含量异常升高,并与认知功能损害有明显相关性,可作为认知功能损害预后判断的重要指标.     

颈部脊髓硬膜外电刺激综合治疗颅脑损伤后持续性植物状态疗效观察

目的探讨颈部脊髓硬膜外电刺激综合治疗对颅脑损伤后持续性植物状态(PVS)治疗效果。方法 200例颅脑损伤后PVS患者分成2组,对照组100例采用常规治疗,包括脑室分流术、复方丹参注射液、神经节苷酯、美多巴、溴隐亭和高压氧(HBO)等治疗;治疗组100例在常规治疗的基础上加用颈部脊髓硬膜外电刺激(cSCS)治疗。按PVS量表评分和临床疗效标准评定疗效,对2组疗效指标进行比较。结果对照组有效率47%(其中优良率14%),无效率45%,死亡率8%;治疗组有效率68%(其中优良率31%),无效率26%,死亡率为6%,治疗组有效率和优良率与对照组比较差异均有统计学意义(P<0.01)。结论 cSCS综合治疗可解除颅脑损伤后PVS患者的脑积水,改善脑的血液循环和氧供,促进脑细胞康复、再生和苏醒,提高脑内多巴胺浓度,激活脑干网状结构,是治疗脑外伤后PVS的一种有效方法。     

海上环境下海水浸泡复合型颅脑火器伤治疗的实验研究

目的 对海上环境下海水浸泡复合型颅脑火器伤提出有效的治疗方法,并探讨其治疗效果.方法 成年健康杂种犬60只制作成复合型颅脑火器伤动物模型,包括颅脑枪弹伤、胸腹部开放伤、四肢伤、烧伤,致伤后海水浸泡30min.按随机数字表法将其分为常规治疗组(对照组)和综合治疗组(治疗组),每组各30只.对照组采用常规治疗,治疗组在常规治疗的基础上加温低张液体、β-七叶皂甙钠、盐酸纳洛酮、左氧氟沙星和复温等综合治疗,并对两组动物进行经颅多普勒超声、动脉血气分析、血浆渗透压检测、颅内压监测和疗效比较.结果 治疗3 h后治疗组脑血管痉挛发生率低,经颅多普勒超声显示血流速度接近正常;12 h后治疗组血浆渗透压、代谢性酸中毒各项指标达到正常水平;24 h后治疗组颅内压明显下降.治疗组与对照组治疗后7 d动物存活率分别为70%和53%.治疗组各项指标都明显优于对照组,比较差异有统计学意义(P＜0.05).结论 早期温低张液体对复温、降低血浆透渗压、纠正电解质平衡、提高生存率有重要的意义,纳洛酮具有脑保护作用,β-七叶皂甙钠可减缓脑水肿的进程,降低颅内压和改善脑组织氧代谢;综合治疗对海水浸泡复合型颅脑火器伤具有显著疗效.

Abstract：

Objective To investigate the effective treatments of combined injury with craniocerebral firearm wound in dogs immersed by seawater under maritime environment. Methods Models of combined injury with craniocerebral firearm wound, including craniocerebral gunshot wound,open chest injury, open abdominal injury, open trauma of extremities and burn injury, were established in 60 healthy adult mongrel dogs. Animal models after being wounded were immersed by the seawater for 30 min, and then, they were equally randomized into conventional treatment group and comprehensive treatment group; 30 dogs in the conventional treatment group were given routine treatment and the other 30 dogs in the comprehensive treatment group were given lukewarm glucose liquid, β-aescin, naloxone hydrochloride, levofloxacin and re-warming treatments besides the conventional treatment. Transcranial Doppler ultrasound, blood gas analysis, measurement of plasma osmotic pressure and intracranial pressure (ICP) monitoring were performed on the dogs of the 2 groups; and the treatment efficacy of the 2groups were compared. Results Low incidence rate of brain vasospasm was noted and TCD indicated that blood flow speed approached normal in the comprehensive treatment group 3 h after the treatment.The plasma osmotic pressure and the indicators of metabolic acidosis reached normal levels in the comprehensive treatment group 12 h after the treatment. The ICP significantly decreased in the comprehensive treatment group 24 h after the treatment. Survival rate in the comprehensive treatment group (70%) was significantly higher as compared with that in the conventional treatment group (53%)7 d after the treatment (P＜0.05). All the indexes in the comprehensive treatment group were better than those in the conventional treatment group (P＜0.05) Conclusion Early infusion of lukewarm hypotonic solution can significantly reduce the osmotic pressure, correct the electrolyte balance, help the re-warming and prolong the survival rate. Naloxone possesses protective effect on brain. The β-aescine sodium can diminish viscosity, slow down brain edema progress, obviously reduce ICP and improve brain tissue oxygen metabolism. In a word, comprehensive treatment in effective in treating combined injury with craniocerebral firearm wound.     

重型颅脑交通伤院前与院内联合急救的研究

目的探讨重型颅脑交通伤的临床特点,观察院前与院内联合急救重型颅脑交通伤的效果。方法2005年1月至2010年10月我院医疗队实施院前与院内联合急救192批次,救护重型项脑交通伤伤员672例,对伤员现场分类,心、肺、脑复苏,手术急救,后送途中有效处理,院内急救？手术与术后处理,观察临床治疗结果。结果根据格拉斯哥预后评分（GOS）判断：在672例伤员中,良好264例（39％）,中残154例（23％）,重残74例（11％）,植物生存27例（4％）,死亡153例（23％）,其中死于伤后1h以内39例（25％）,24h以内101例（66％）,24h以上52例（34％）;死于院前51例（33％）,急诊室10例（7％）,住院后92例（60％）：结论颅脑交通伤的创伤因素多,具有创伤重,变化快,多伴复合伤、多发伤,预后差的特点。采用院前与院内联合急救措施可明显降低颅脑交通伤的死残率。     

颅咽管瘤与生长激素缺乏

颅咽管瘤患者术前、术后均可产生生长激素(growth hormone,GH)缺乏,目前大家较为一致的看法是由于肿瘤本身的空间占位效应所造成。少数颅咽管瘤患儿尽管出现生长激素缺乏,生长速度仍可正常,其中的原因尚不清楚。目前尚无较为满意的GH缺乏的检测方法。GH缺乏的替代治疗对儿童颅咽管瘤患者的意义更大:此病以儿童为高发;儿童生存期长,长期的生长发育过程需要GH;与GH治疗相关的并发症对儿童的伤害更大。GH替代治疗的推荐使用剂量成人为1-2IU/m~2/d。文献显示GH和IGF-1对许多肿瘤组织的细胞生长起潜在诱导作用,虽然不少的儿童内分泌学家认为GH的替代治疗不会增加颅咽管瘤复发的危险性,但亦有相关文献资料显示GH确有加速残存肿瘤生长的作用。