重型颅脑损伤合并多发伤63例诊治分析

以颅脑损伤为主的严重多发伤,损伤机制复杂,病死率较高。我们自1997年1月-2004年1月收治重型颅脑损伤伴多发伤63例,现分析如下。     

车祸所致颅脑损伤435例临床分析

交通事故伤中颅脑损伤的死亡率占第一位。随着交通事业的不断发展,车辆的增多,车祸所致颅脑损伤呈逐年上升趋势。车祸所致颅脑损伤由于受伤机制复杂,伤情重,合并损伤多,死亡率高,已引起社会各界和医学界的广泛关注。1975年—1990年我院共收治车祸所致颅脑损伤435例,占同期颅脑损伤病人的38％,并与同期非车祸颅脑伤711例(对照组)作对比分析。现就其致伤特点,诊断及抢救等问题进行讨论。     

重型颅脑伤合并颌面伤30例

在颅脑损伤中约有30％合并有颌面伤，重型颅脑损伤合并颌面伤者尤属多见。此类损伤处理复杂，致残率和死亡率较高。探讨其有效救治措施是颅脑颌面外科的重要课题。我科自1998年6月至2003年6月，共收治30例患者。现报告如下。     

35例急性颅脑伤并发症的观察和护理

急性颅脑损伤,特别是重型颅脑损伤,伤情易发生变化,死亡率高,在合并颌面外伤的情况下,伤情更为复杂,常因并发呼吸道梗阻、失血、感染等致脑缺血缺氧,加重脑水肿。因此,在密切观察颅脑损伤的同时,应了解颌面外伤的伤情,掌握观察护理的重点,以提高颅脑损伤的救治成功率。我科从1991～1994年共收治中型或重型颅脑损伤合并严重颌面外伤患者35例。现报告如下。     

老年人颅脑损伤预后的相关影响因素分析

目的 探讨老年人颅脑损伤的相关影响因素和临床特点,以提高老年颅脑损伤的诊治水平. 方法总结2006年6月-2009年8月入院治疗的139例老年颅脑损伤患者,分析GCS、颅脑损伤类型、影响预后的主要并发症及临床治疗方法,探讨各种因素与预后的关系. 结果病死率与GCS、颅脑损伤类型、损伤后并发症密切相关.颅脑损伤表现为弥漫性脑肿胀、脑挫裂伤伴脑内多发性血肿、脑干损伤者病死率较高.颅脑损伤后伴有肺部感染、呼吸功能衰竭、上消化道出血或2～3种并发症同时发生时对预后产生不利影响. 结论颅脑损伤的程度、类型、并发症直接影响预后.老年人反应较为迟钝,主动做早期预见性检查和治疗可改善预后.     

颅脑伤合并多发伤72例诊治体会

重型颅脑损伤合并多发伤，临床上较为常见，由于伤情危重，损伤机制复杂，死亡率高。1996年5月～2004年5月。我院收治重型颅脑伤合并多发伤72例，收到满意效果。     

正确评价颅内压监测在重型创伤性颅脑损伤救治中的地位

颅内压的持续监测已有60年的历史,是现代创伤性颅脑损伤的里程碑式标记,近二三十年在重型颅脑损伤中得到日益广泛的应用.特别是随着美国重型颅脑损伤救治指南(1996,2000,2007)及欧洲颅脑损伤救治指南(1997)的推广,重型颅脑损伤患者的死亡率在进行性下降,从上世纪80年代的40％左右降到目前的20％左右.但是,颅内压监测和重型颅脑损伤预后之间的关系缺乏前瞻性随机对照研究(RCT)[1].在欧洲和美国,约30％的重型颅脑损伤患者并没有收治在神经外科中心,并不接受颅内压监测.2000年的一项调查显示,在加拿大仅20％神经外科医师认为颅内压监测可改善重型颅脑损伤患者的预后.另外,颅内压监测是一项有创监测,并非毫无风险,其有效性仍有争议[1-3].     

颅脑合并伤的防治问题

颅脑损伤合并其它部位损伤（颅脑合并伤），较单纯性颅脑损伤伤情更为严重和复杂，常伴有休克，死亡率较高，往往给早期诊断和及时处理带来困难，根据我们对颅脑合并伤处理的经验提出以下几点意见。     

重型颅脑损伤病人65例观察及护理

颅脑损伤是神经外科比较常见的发病率仅次于四肢损伤。伤情及愈后远比四肢损伤严重,尤其是重型颅脑损伤往往发病突然,病情危重多变,治疗困难,护理复杂,且死亡率和病残率较高。如观察处理不当,可贻误抢救时机。我院自１９９４－１９９９年共收治重型颅脑损伤６５例,现将我们的护理体会报告如下。１ 临床资料１．１ 一般资料 我院自１９９４－１９９９年共收治格拉哥斯昏迷记分≤８分以下重型颅脑损伤６５例,其中男４９例,女１６例,年龄４－８０岁,平均年龄２９．９６岁。１．２ 颅脑损伤类型 见表１。１．３ 临床表现 昏迷者５２…     

颅脑海水浸泡伤损伤机制研究进展

颅脑海水浸泡伤是一类特殊的复合型损伤, 低温、高渗、高碱、高盐、细菌感染等为主要致伤原因, 具有损伤机制复杂、救治困难、预后差等特点。目前, 颅脑海水浸泡伤损伤机制的研究主要是通过构建动物实验模型, 在组织、细胞、细胞器、分子等层面展开。但由于颅脑海水浸泡伤相比陆上单纯颅脑损伤伤情更为复杂, 故其稳定的疾病模型构建不易。针对颅脑海水浸泡伤损伤机制方面的研究大多相对单一、片面, 存在诸多不同观点, 其具体损伤机制至今尚未明确。笔者就颅脑海水浸泡伤损伤机制的研究进展进行综述, 以期促进颅脑海水浸泡伤机制的深入研究, 为临床救治提供参考。     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控...     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.