手术切除脑软化灶治疗外伤性难治性癫痫13例疗效分析及体会

外伤性癫痫是颅脑外伤后的严重并发症之一．大部分可通过应用抗癫痫药物得到控制．少数病人系统用药治疗2年以上仍不能控制．每月发作4次以上．属难治性癫痫，有极高的致死、致残率。本院自1999年1月至2004年1月．共收治此类病人13例．全部进行手术治疗．对疤痕病灶予以清除。结果满意。现将治疗体会报告如下。     

Treatment of arterial hypoxemia in early period of traumatic disease

Issues of arterial hypoxemia treatment in early period of traumatic disease, taking into account modern approaches, adopted in surgery of injuries and anesthesy-resuscitation. It is recommended to use the method proposed for the arterial oxygen content enhancing in an acute respiratory insufficiency of various genesis, including the cases of progressive posttraumatic disease.     

Hemodynamic and metabolic disorders in the early period of traumatic disease]

In the article are presented the results of study and treatment of 804 patients with polytrauma. In part of the patients in early period of the traumatic disease have been studied in complex the states of hemodynamics (circulating blood volume, specific peripheral resistance, cardiac index, central venous pressure, arterial pressure, heart rate) and metabolism (total protein, basal metabolism, the level of endogenous nitrogen in urine). On the basis of the obtained data there is proposed the evaluation of the hemodynamics changes, energetic and plastic losses at polytrauma that formed the basis of the pathogenetic therapy ensuring simultaneous correction of the detected disturbances. It allowed the author to reduce the number of unfavourable outcomes (anatomical by 20.9% (p less than 0.05), functional by 20.7% (p less than 0.05), labour by 19.5% (p less than 0.05) and lethality (at the multiple damages by 2.0% (p less than 0.05), at associated craniocerebral injury by 3.0%, at associated trauma of internal organs and locomotor system by 6.0% (p less than 0.05).     

Clinical characteristics of the early postshock period in traumatic disease]

The clinical course of an early (up to 14 days) postshock period of traumatic disease in 112 patients, treated for a combined trauma complicated with shock, has been studied. It has been established that within first 2 days after shock more than half of the patients develop increased coagulative activity of the blood, which rises still more in the following period. Progressive anemia, connected apparently with hemopoietic depression, is characteristic of the postshock period. In the second period (3--14 days after trauma) 60% of examined patients showed hypokalemia. A great percentage of inflammatory complications is likely to be due to the decrease of the defense--adaptative mechanisms, resulting from changes of the reactivity in the injured after shock.     

Etiological agents of bacteremia in the early period after liver transplantation

Bacteremia is one of the major infections in orthotopic liver transplantation (OLT). The study of 83 adults who underwent OLT from 2001 to 2004, included patients followed prospectively from the day of transplantation to 4 weeks after the procedure by bacteriological cultures. The microorganisms were investigated according to standard National Committee for Clinical Laboratory Standards (NCCLS) procedures. Blood samples were examined in 59 recipients (71.1%) before and in 76 patients (91.6%) during the month after transplantation. Among 249 investigated samples, 96 were positive, as cultured from 19 recipients before OLT and 48 patients afterward. The most common were Gram-positive cocci (n = 71) and coagulase-negative staphylococci (n = 52), including methicillin-resistant coagulase-negative staphylococci (MRCNS). Enterococcus spp. occurred in 9 isolates (high-level aminoglycoside-resistant enterococci [HLAR] strains were cultured). We cultured the Enterobacteriaceae family (n = 16 isolates) and (n = 15 isolates), Gram-negative nonfermenting rods some of which were extended spectrum beta-lactamase producing [ESBL(+)] strains. The predominance of Gram-positive cocci was caused by CNS, and the use of prophylaxis to reduce Gram-negative bacteria. The increased rate of isolation of bacteria with multidrug resistance (MDR) to antimicrobial agents may be due to their frequent use for prophylaxis of bacterial infections in OLT. These MDR bacterial strains caused severe BSI after OLT.     

Predicting the time of surgical interventions at the early period of traumatic disease

A mathematical system of equations for the determination of optimum terms of performing operations in patients with traumas of different localizations has been developed. The system includes parameters which show the severity of the victim's condition and efficiency of conservative therapy. Solution of the equations also facilitates prognosing the outcomes of trauma disease, its duration in the presence of shock, optimum volume and composition of the infusion therapy.     

Surgical treatment of traumatic epilepsy

Fifteen patients with traumatic epilepsy were treated surgically. Cortico-electroencephalography was used during the operation. Meningo-encephalo cicatrix was found in 8 patients, scar formation in brain parenchyma in 4, meningoencephalocele in 2, and porencephalia in 1. Seven of the 15 patients were examined by CT, showing more accurate localization of pathological changes. Seizure subsided in 8 patients. Anti-epileptic drugs were still used in 4 patients, but the frequency and severity of epileptic attack were obviously decreased. There was no operative mortality. The indications, techniques of the operation and the postoperative management were discussed.