小儿特重型重型颅脑损伤并发多器官损伤

目的 本总结了98例小儿特重型、重型颅脑损伤并发多器官功能衰竭的救治经验。方法 对二所医院二十年共同收救的小儿特重型、重型颅脑伤并发MSOF进行回顾性总结。结果 98例小儿特重型、重型颅脑伤并发MSOF存活27例（存活率27.55%），其中良好和中残24例（占24.5%)，重残3例（占0.31%)合并MSOF死亡71例（死亡率72.45%)。结论 颅脑损伤的程度与并发MSOF成正比关系，积极去除病因的发生发展是有效降低死亡率、提高生存质量的重要手段。     

特重型颅脑损伤救治体会(附56例报告)

重型颅脑损伤约占颅脑伤的20%,死亡率为30%～50%[1],而特重型颅脑损伤的死亡数占其中绝大多数,其死亡率高达 60%～80%[2].现将我科近3年来收治的特重型颅脑损伤56例的救治情况报告如下.     

重庆市秀山县颅脑损伤流行病学特点

目的分析重庆市秀山县颅脑损伤发生流行病学特点。方法采集秀山县2011-03—2013-03所有颅脑外伤病例,分析患者临床资料,了解颅脑损伤发生的概况、发生原因及临床特征。结果 2a中收治颅脑损伤1 434例。男∶女=2.2∶1,其中小儿(≤14岁)261例(18.2%),成年(15~59岁)835例(58.2%),老年(≥60岁)338例(23.6%)。轻型颅脑损伤1 132例(78.9%),中型颅脑损伤187例(13.0%),重型和特重型颅脑损伤115例(8.1%)。交通伤616例(43.0%),跌伤520例(36.3%),其他原因受伤298例(20.7%)。结论秀山县颅脑损伤发病率及病死率高,需改进抢救设备及措施,培养相关人才。     

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,GCS6~8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。     

重型颅脑损伤132例死亡原因分析

我院自1991年7月至1999年5月共收治重型颅脑损伤患者304例,死亡132例,死亡率42.1%。本文就重型颅脑损伤死亡原因进行分析,以期为今后提高重型颅脑损伤救治成功率提供临床依据。1临床资料1.1一般资料本组男98例,女34例。年龄2～78岁,平均46.5岁。其中20岁以内死亡6例(4.5%),21～40岁死亡47例(35.6%),41～60岁死亡43例(32.6%),60岁以上死亡36例(27.3%)。致伤原因:车祸60例(45.5%),跌坠伤47例(35.6%),打击伤20例(15.1%),其他5例(3.8%)。闭合型损伤101例(76.5%),开放型损伤31例(23.5%)。入院时GCS6～8分54例(40.9%),3～5分78例(59.1%)。手术清…     

重型、特重型颅脑损伤157例临床分析

目的总结重型、特重型颅脑损伤的救治经验。方法对2012年1月到2014年12月收治的157例重型、特重型颅脑损伤的临床资料进行回顾性分析。结果出院时按GOS评分评估疗效,恢复良好48例,中残37例,重残18例,植物生存8例,死亡46例;总死亡率为29.3%。手术治疗81例,死亡19例(23.5%);保守治疗76例,死亡27例(35.5%)。重型颅脑损伤89例,死亡9例(10.1%);特重型颅脑损伤68例,死亡37例(54.4%)。结论对重型、特重型颅脑损伤,尽早清除颅内血肿并去骨瓣减压,早期业低温治疗及呼吸机辅助呼吸,维持机体内环境稳定,防治并发症发生等可显著改善病人预后。     

重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗

目的探讨重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗。方法对2000年1月至2007年8月收治的432例重型、特重型颅脑损伤合并其他部位损伤患者的临床资料进行回顾性分析。所有病例均符合重型、特重型颅脑损伤合并其他部位损伤患者的诊断标准,并按损伤严重评分（ISS）和GCS评分对伤情进行评估。同时对漏诊组（50例）和非漏诊组（382例）患者进行分析比较。结果432例患者中有50例漏诊,漏诊率为11．57％。与非漏诊组比较,漏诊组患者ISS评分,GCS≤8的病例所占比例及死亡率均较非漏诊组患者高（P〈0．05）。视神经、空腔脏器及脊髓损伤漏诊率较高,这些易漏诊部位损伤的致残率和死亡率也较高。结论对重型、特重型颅脑损伤应重视其视神经、脊髓等合并伤的诊断,规范其诊疗流程,降低漏诊率。     

特重型颅脑损伤的基层救治经验

目的总结特重型颅脑损伤救治的经验。方法对我院2003年6月至2013年6月收治的76例特重型颅脑损伤患者进行回顾总结。结果 76例中死亡44例(58%),在存活的32例中,恢复良好中残22例(29%),重残10例(13%)。结论特重型颅脑损伤患者入院后应早诊早治,保持呼吸道通畅,根据手术指征行标准大骨瓣减压手术,及时处理合并伤、并发症,维持内环境稳定等综合性治疗措施,可显著改善患者的预后。     

围术期血清钠离子水平对重型颅脑损伤患者病情及预后的影响

目的研究重型颅脑损伤患者血钠紊乱的情况以及血钠在重型颅脑损伤病情及预后评估的临床应用价值。方法以我院98例重型颅脑损伤患者为研究对象,结合患者GCS评分观察其血钠检测情况,并研究患者预后与血钠紊乱的关系。结果重型组与特重型组血钠紊乱发生率、低钠血症发生率以及高钠血症发生率差异均有统计学意义(P0.05),均以特重型组发生率较高;2组低钠血症以及高钠血症血钠平均血清水平比较差异有统计学意义(P0.05),低钠血症以特重型组血钠平均水平较低,高钠血症以特重型组血钠平均水平较高。2组总病死率、低钠血症病死率及高钠血症病死率差异均有统计学意义(P0.05),均以特重型组发生率较高;血钠正常颅脑损伤患者病死率11.1%,低钠血症颅脑损伤患者病死率32.0%,高钠血症颅脑损伤患者病死率48.6%;差异均有统计学意义(P0.05),以高钠血症颅脑损伤患者病死率较高。结论血钠代谢紊乱程度可反映重型颅脑损伤患者病情的严重性并与患者预后关系密切,血钠紊乱程度越高往往预示着患者预后越差。     

重型颅脑损伤死亡相关因素分析

目的总结重型颅脑损伤患者的死亡率,探讨死亡的相关因素。方法建立颅脑损伤数据库,总结我科2000年1月至2005年12月之间收治的重型颅脑损伤患者的临床诊疗情况,并对影响患者死亡的相关临床特点进行比较分析。结果213例重型颅脑损伤患者中,车祸致伤152例(71.4%),手术103例(48.4%),其中血肿清除加标准大骨瓣减压术75例。GCS 3～5分患者死亡率61.2%,GCS 6～8分患者死亡率19.1%,总死亡率39.4%。外院转入99例(46.5%)。直接来院及入院时间在4h以内的患者死亡率明显下降。血糖明显升高(>13mmol/L)、上消化道出血和严重的低氧血症可以增加患者死亡率,尤其是晚期死亡者。结论在强化现场急救、规范住院治疗的基础上,完善转诊机制、减少转院、缩短入院时间,对降低重型颅脑损伤死亡率、尤其是早期(24h之内)的死亡,有重要意义。加强继发性损伤的治疗、预防并及时准确处理并发症,可以降低患者的中晚期死亡率。     

重型颅脑损伤并发多器官功能衰竭38例分析

目的 本文探讨总结了38例重型颅脑损伤并发神经源性多器官功能衰竭（MODS）的救治方法.方法 2003-01～2006-09间对38例重型颅脑损伤并发MODS病例进行临床回顾性分析,对其发生率、发生时间、好发受累器官及影响预后的相关因素等进行总结.结果 发生率为1.5 %,肺、胃肠道发生率高且常先受累,其次为心血管、肾、肝脏,病死率31.5%,并与脑损伤程度及受累器官密切相关.结论 颅脑损伤的程度与并发MODS成正比关系,积极去处病因的发生发展是有效降低病死率、提高生存质量的重要手段.     

重型颅脑损伤术后大面积脑梗死临床分析

目的 分析重型颅脑损伤开颅术后大面积脑梗死发生的相关因素及治疗效果. 方法 选择东莞市石碣医院神经外科自2002年1月至2008年4月收治的重型颅脑损伤行开颅术治疗的332例患者,其中术后出现大面积脑梗死20例,回顾性分析术后出现或未出现大面积脑梗死这两类患者术前GCS评分,出血量,颅底骨折,瞳孔变化,是否有脑疝存在及持续时间情况;采用标准大骨瓣减压术治疗及常规综合治疗,并对其疗效进行评价. 结果 术前GCS评分<5分、颅内出血量60 mL以上及颅底骨折合并脑疝持续时间长者大面积脑梗死发生率明显增加.本组20例患者随访12月.应用GOS评估预后,其中良好8例,中残3例,重残2例,植物生存3例,死亡4例.结论 开颅术后出现大面积脑梗死是多种因素所致,术前GCS评分越低、颅内出血量大、颅底骨折合并脑疝持续时间长是其发生的重要原因;及时发现并行标准大骨瓣减压、脱水降颅内压、改善脑循环、预防脑血管痉挛、亚低温等治疗可有效降低其致残率和病死率.改善预后.     

重型颅脑损伤术中急性脑膨出原因及处理

目的总结重型颅脑损伤开颅术中发生急性脑膨出的原因及处理。方法对近年我科收治的重型颅脑损伤开颅术中发生急性脑膨出的原因及疗效进行回顾性分析。结果几年来共收治310例GCS3～8分手术的重型颅脑损伤病人,开颅术中发生急性脑膨出29例（9．4％）,因急性脑肿胀引起10例（34．5％）,因迟发性血肿引起18例（62．1％）,其他原因1例（3．4％）;其中急性脑肿胀者死亡10例（34．5％）,迟发性血肿者死亡6例（20．7％）,总死亡16例（55．2％）,植物生存2例（6．9％）,重残3例（10．3％）,轻残5例（17．2％）,恢复正常生活者3例（10．3％）。结论急性脑肿胀与迟发性血肿引起的脑膨出预后不同,前者死亡率几乎达100％,而远隔部位迟发性血肿只要处理及时,预后良好。     

Factors affecting outcome in the pediatric patient with multiple trauma. Further experience with the modified injury severity scale

In a 5-year period of prospective study, 369 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a Modification of Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except that the classification of neurological injuries are scored by the Glasgow Coma Scale (GCS) and other neurological findings (presence of a surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 23.8 with 33% of MISS scores greater than 25 and 67% less than 25. Among those with MISS scores greater than 25 there was a 44% mortality and 31% disability. In the group with MISS scores less than 25, there were no mortalities, and a 1% disability (p less than 0.001). Overall mortality was 14% with 9% disability. Mean MISS scores for death and disability were 35.1 and 29.6, respectively. Neurologic injuries were present in 274 patients (74%). 163 patients had severe head injury (coma greater than 6 h duration). 86% of all deaths were due to head injury and all but 2 deaths had some degree of head injury. The remaining 14% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 74% mortality, while those with grades 4 and 3 injury had 8 and 1.5% mortality. In a comparison with pediatric patients with head injury only (coma greater than 6 h, no multiple trauma) there was found to be a 12% mortality in the head injury only group versus a 33% mortality in the multiple trauma plus head injury group. The MISS serves as an accurate predictor of morbidity and mortality in pediatric trauma. The best predictors of outcome were a MISS less than 25 and the degree of neurological injury.     

小脑幕裂孔切开术治疗脑疝的有关问题探讨

目的 探索更安全、简便的小脑幕裂孔切开方法.方法 对1994年7月至2006年10月收治的136例重型特重型颅脑伤合并有颞叶钩回疝患者在开颅清除血肿去骨瓣的基础上加行小脑幕裂孔切开术,采用正确的切口、合适的体位,使用特制的钩刀.结果 GCS 3～5分51例,6～8分85例,恢复良好72例(52.9%),中残21例(15.4%),重残16例(11.8%),植物生存8例(5.9%),死亡19例(14.0%).结论 安全、简便的小脑幕裂孔切开术可进一步改善脑疝患者的预后.     

Plasma glucose level in Nigerian Africans with head injury

Trauma is often associated with increased plasma glucose concentrations. This prospective study was designed to determine random plasma glucose concentrations in patients with head injury in our center and to determine if this is related to injury severity and outcome. Patients with head injury in whom the plasma glucose concentration could be determined at our accident and emergency unit during the study period were included. We obtained information on demographic data, diagnosis, injury severity using Glasgow Coma Scale scores, treatment with glucose-containing fluid prior to presentation in our center, plasma glucose on admission, 24 hours later and 72 hours later and outcome at discharge using the Glasgow Outcome Scale score. Hyperglycemia was defined as glucose concentrations above 11.1 mmol/L. Fifty eight patients were included in the study from October 2004 to December 2005. There were 46 males and 12 females (4:1). The mean age (± standard deviation [SD]) was 31.3 (16.4) years. Fourteen patients (24.1%) had mild head injury, 21 patients (36.2%) had moderate head injury and 23 patients (39.7%) had severe head injury. The outcome was good in 29 patients (50%), moderate disability in five patients (8.6%), severe disability in one (1.7%) and death in 10 (17.2%). Eighty percent of the patients who died had severe head injury. Most of the patients had a plasma glucose in the normal range irrespective of the severity of the head injury. Only one patient had a plasma glucose in the hyperglycemic range and that patient had a severe head injury. Fifty percent of the patients who died had a plasma glucose concentration in the normal range; none in the hyperglycemic range. This study shows that the plasma glucose is generally below hyperglycemic concentration in our patients irrespective of the severity of head injury.     

重型颅脑损伤合并严重多发伤的临床救治

目的评估重型颅脑损伤合并严重多发伤的临床救治结果。方法对22例重型颅脑损伤合并严重多发伤进行回顾性总结。结果预后按GOS评分,良好者8例（36．4％）,轻残4例（18．2％）,重残2例（9％）,植物生存3例（13．6％）。死亡5例（22．7％）。结论早诊断、早治疗、积极抗休克治疗、合理的救治顺序是提高重型颅脑损伤合并严重多发伤的治疗效果,减少致残率及降低死亡率的有效措施。     

Intracranial blood flow velocity after head injury: relationship to severity of injury, time, neurological status and outcome.

Middle cerebral artery (MCA) blood flow velocity was measured daily by transcranial Doppler ultrasonography in 121 patients with severe (50), moderate (16) and minor (55) head injury during their hospital stay, and the results compared with findings in control subjects. Admission MCA velocity was significantly lower after severe 35.8 (31.9-39.7) cm/s, mean (95% confidence limits), moderate 45.5 (40.0-51.0) cm/s and minor 51.7 (47.9-55.5) cm/s head injury when compared with normal controls 60.1 (56.9-63.3) cm/s. Initial mean velocity in severe head injury was significantly lower than in moderate and minor injury. At discharge, MCA velocity in severe injury remained below normal 46.2 (43.2-49.0) cm/s, whereas, in moderate and minor injury flow velocity had returned to normal. Correlation (r = 0.46, p less than 0.01) was found between MCA velocity and Glasgow Coma Score (GCS) on admission but not on discharge. Persistently low flow velocity was found in all 10 patients who died within 72 hours (early deaths). An admission MCA velocity of less than 28 cm/s correctly predicted 80% of the early deaths. Patients who made a good recovery or had only moderate disability at six months showed a significant increase in velocity from admission 36.2 (31.5-41.2) cm/s to discharge 47.8 (43.7-51.9) cm/s in contrast to those who were severely disabled, in whom velocity generally remained low.     

显微手术天幕缘切开在创伤性脑疝复位中的应用

目的 探讨显微手术天幕缘切开、罂粟碱明胶海棉片贴敷在重型颅脑损伤颞叶钩回疝形成患者中的应用.方法 对我科自1999年1月到2004年3月收治的92例重型颅脑损伤合并颞叶钩回疝继发脑干损伤患者,在开颅清除血肿的基础上加行显微镜下天幕缘切开、环池冲洗、罂粟碱明胶海棉贴敷.结果 GCS 3～5分30例,6～8分62例.恢复良好47例(51.0%),中残19例(20.6%),重残7例(7.6%),植物生存8例(8.7%),死亡11例(11.9%).结论 显微手术天幕缘切开、罂粟碱明胶海棉片贴敷能够彻底解除脑干受压、防治血管痉挛进而减轻由此引发的脑干继发性损伤,降低病残率和死亡率.