Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale

This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury

Fifty-one patients with mild （n -- 14）, moderate （n = 10） and severe traumatic brain injury （n = 27） received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality： Group 1,Hunt and Hess grade≤II and surgical clipping;Group 2,Hunt and Hess grade≤II and endovascular embolization;Group 3,Hunt and Hess grade≥III and surgical clipping;Group 4,Hunt and Hess grade≥III and endovascular embolization.Level of consciousness was evaluated using the Glasgow Coma Scale,functional status using the Glasgow Outcome Scale,level of the mobility using the Mobility Scale for acute stroke patients,and independence in activities of daily living using the Barthel Index.After early physiotherapy,the level of consciousness and functional status improved significantly in Groups 1,3,and 4;mobility improved significantly in all groups;and independence in activities of daily living improved significantly in Groups 1 and 3.At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4.Level of consciousness,functional status,mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients with a worse clinical status at presentation had a poorer functional status at discharge.The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.

Changes of Nitric Oxide and Its Relationship with Clinical Features,Intracranial Pressure and Outcome in Acute Head Injury

To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.

Factors affecting outcomes of surgically treated patients with cranial extradural hematoma: A cross-sectional study

Objective: To evaluate the factors resulting in the poor outcomes in patients with extradural hematoma (EDH).Methods: The study was conducted at the Neurosurgery Teaching Hospital in Baghdad with a group of 100 surgically treated EDH patients and was carried prospectively from February 1st, 2015 to May 1st, 2017. The baseline information (gender, age, cause of injury, time interval between injury and reception, Glasgow coma scale, etc.) of the patients was recorded, and the variables affecting the outcomes were analyzed. Results: In the study, 80% of patients were male;54% were between 10-29 years old;the commonest cause of injury was fall accounting for 51%;78% of the patients got good functional recovery, and 10% had a residual disability;12% died. Better functional recovery was found among patients with a shorter time interval (≤3 h) (P=0.001), while the longer time interval (>3 h) increased the residual disability (P=0.005). In addition, functional recovery increased six times with higher Glasgow coma scale (P=0.001), and inversely related to mortality (P=0.005). Conclusions: Age between 10 and 29 years, male gender, and depth of hematoma more than 5 cm are at higher risks of poor outcomes of patients with surgically treated EDH. Neurological conditions on admission and time interval between injury and reception are also important factors.

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

基于机器学习的脑膜瘤术后短期结局预测模型

目的基于脑膜瘤患者的术前真实世界临床变量,使用机器学习算法构建术后短期预后不良的预测模型。方法回顾性地收集了2011年9月—2022年3月在同济大学附属第十人民医院神经外科进行手术切除治疗的脑膜瘤患者的临床变量和出院时的格拉斯哥预后评分(Glasgow outcome scale,GOS)。使用GOS评分将患者进行分组,≤3级的患者定义为预后不良。将患者按照7∶3的比例随机分为训练集和验证集,分别使用支持向量机(support vector machines,SVM)、随机森林(random forest,RF)、梯度提升(gradient boosting,GB)、自适应增强(adaptive boosting,AdaBoost)和多层感知器(multilayer perceptron,MLP)算法在训练集上进行建模,使用验证集检验模型的预测能力。针对预测能力较好的模型使用Shapley Additive Explanations(SHAP)算法进行模型解释。结果收集了424个脑膜瘤患者的42种临床特征数据和GOS评分,筛选后有23种临床特征纳入了训练集的机器学习模型构建。基于不同算法的机器学习模型在验证集中的预测能力表现不同,AdaBoost的表现最优,曲线下面积为0.925。SHAP算法提示在AdaBoost模型中,脑膜瘤最大径、入院时血压、术前的钙离子浓度、血尿素浓度和血肌酐浓度对模型决策的贡献度较大,提示这些术前临床特征与脑膜瘤患者术后短期预后存在相关性。结论本研究使用真实世界大数据,构建了一种可解释的基于AdaBoost算法的机器学习模型,在预测脑膜瘤患者术后短期不良结局上具有良好的效果。

修改版昏迷恢复量表对意识障碍患者预后的评估价值

目的探讨修改版昏迷恢复量表(CRS-R)对意识障碍患者预后的评估价值。方法对29例重症脑部病变意识障碍患者进行CRS-R评分,根据评分分为植物状态(VS)和最小意识状态(MCS)。在患者出院≥3个月后进行格拉斯哥结局量表(GOS)评分;并对两个量表评分的相关性进行分析。结果本组VS患者20例、MCS患者9例,二者CRS-R评分分别为(5.15±2.35)分和(11.88±4.01)分。VS患者GOS评分≤3分(预后差)的比率(95%,19/20)显著高于MCS患者(44.4%,4/9)(P<0.05)。Pearson相关分析显示,CRS-R评分与GOS评分呈正相关(r=0.558,P<0.05)。CRS-R评分的子项中,运动、言语和交流与GOS评分呈正相关(r=0.663,r=0.637,r=0.424,均P<0.05);而听觉、视觉和唤醒度与GOS评分无关。结论意识障碍患者CRS-R评分越高,预后越好。

颅内动脉瘤破裂的患者预后影响因素分析

目的探讨颅内动脉瘤破裂的患者预后影响因素。方法回顾性分析576例颅内动脉瘤破裂患者的病历资料,对患者的年龄、性别、入院时有无头痛症状、Hunt-Hess分级、手术时机和手术方式等进行单因素和多因素logistic回归分析,根据格拉斯哥预后评分（GOS）评价影响手术预后的相关因素。结果单因素分析结果显示,患者的年龄、入院时有无头痛症状、Hunt-Hess分级、手术时机和手术方式是影响破裂颅内动脉瘤患者预后的影响因素（P〈0.05,P〈0.01）。多因素logistic回归分析显示,年龄（OR=0.329,95%CI：0.144～0.735,P=0.021）、Hunt-Hess分级（OR=1.358,95%CI：2.531～5.622,P=0.002）、手术时机（OR=1.826,95%CI：1.521～2.103,P=0.019）和手术方式（OR=0.428,95%CI：0.246～0.745,P=0.003）是影响破裂颅内动脉瘤患者预后的独立危险因素。结论准确的病情综合分析、最佳的手术时机和正确的手术方式是提高患者预后的关键。

血塞通注射液联合西药治疗重型颅脑外伤的临床观察

目的 观察血塞通注射液(简称血塞通)治疗急性重型颅脑外伤的临床效果。方法 按标准选取重型颅脑外伤患者87例,随机分成两组,对照组(43例)行常规治疗,治疗组(44例)在常规治疗的基础上加用血塞通治疗,治疗后1、2周分别测颅内压(ICP)和行格拉斯哥昏迷评分(GCS),3个月后行格拉斯哥预后评分(GOS),比较两组的疗效。结果 治疗组ICP低于对照组,GCS高于对照组,GOS优于对照组,3项指标两组比较差异均有显著性(P<0.05)。结论 血塞通对重型颅脑外伤患者具有明显的临床治疗效果。

影响小儿重症病毒性脑炎预后的相关危险因素分析

目的观察小儿重症病毒性脑炎的临床特点,探讨影响其预后的危险因素,为临床早期识别重症病毒性脑炎,指导临床治疗及预防提供理论依据。方法选取2012-09—2015-09在我院儿科及重症监护病房住院并首次确诊为重症病毒性脑炎的151例患儿为研究对象。对所有入组患儿进行定期随访,回顾分析入组患者的临床及辅助检查资料。并应用Lo-gistic回归模型分析影响重症病毒性脑炎患儿预后的危险因素。结果重症病毒性脑炎患儿预后良好率为56.2%,预后不良率为43.8%。预后良好组与预后不良组性别、年龄、住院时间、有无发热、意识障碍、合并低钠血症、低钾血症、CSF白细胞数、CSF蛋白量组间比较差异均无统计学意义(P>0.05);预后良好组发热时间、惊厥及惊厥时间、意识障碍时间显著短于预后不良组,意识障碍程度Glasgow评分显著低于预后不良组,其组间比较差异均具有统计学意义(P<0.05);预后良好组脑电图异常、头颅MRI异常情况所占比例低于预后不良组,差异均具有统计学意义(P<0.05)。Logistic回归分析显示发热时间、惊厥时间、意识障碍及意识障碍时间、意识障碍程度、脑电图异常、头颅MRI异常可增加重症病毒性脑炎患儿预后不良的发生风险,是影响重症病毒性脑炎患儿预后的危险因素。其风险比分别为2.59、5.62、2.68、4.59、4.97、11.59、9.74。结论发热时间、惊厥时间、意识障碍及意识障碍时间、意识障碍程度、脑电图异常、头颅MRI异常可增加重症病毒性脑炎患儿预后不良的发生风险,是影响重症病毒性脑炎患儿预后的危险因素。

肠内免疫营养对急性重型颅脑损伤患者免疫功能及预后的影响研究

目的评价肠内免疫营养对急性重型颅脑损伤患者T淋巴细胞亚群、机械通气及预后的影响。方法选取2014年8月—2016年2月于杭州师范大学附属医院重症医学科治疗的急性重型颅脑损伤患者72例为研究对象。采用随机数字表法,将患者分为治疗组和对照组,各36例。治疗组、对照组分别给予肠内免疫营养制剂和等氮、等热量的匀浆支持治疗。记录两组机械通气时间及2周脱机成功率,于入院第1、7、14天检测T淋巴细胞各亚群分布,采用格拉斯哥预后量表评价患者6个月后神经功能。结果治疗组机械通气时间较对照组短,且2周内脱机成功率高于对照组(P<0.05)。入院第7、14天,治疗组CD_3^+、CD_4^+、CD_4^+/CD_8^+高于对照组(P<0.05)。6个月后,治疗组格拉斯哥预后量表评分优于对照组,平均分高于对照组(P<0.05)。结论急性重型颅脑损伤患者及时合理使用肠内免疫营养支持治疗,有助于改善机体免疫功能,缩短机械通气时间,提高脱机成功率,促进神经功能恢复。

脓毒症患者血磷浓度变化对疾病预后的影响

目的研究脓毒症患者血磷水平变化及其与脓毒症患者预后的关系。方法回顾性分析82例脓毒症患者血磷水平变化,及其与急性生理学及慢性健康状况评分(APACHEⅡ)和预后的关系。结果脓毒症组血磷水平[(0.79±0.27)mmol/L]较对照组[(1.04±0.43)mmol/L]低(t=3.296,P<0.01);正常血磷组与低磷血症组死亡率比较差异有统计学意义(χ2=4.457,P<0.05);存活组与死亡组血磷低于正常值的标本数差异有统计学意义(χ2=8.483,P<0.01);血磷水平与APACHEⅡ评分值呈负相关(r=-0.239,P<0.01)。结论脓毒症患者易出现低磷血症,并且血磷水平低者,预后较差,血磷水平可作为判断脓毒症患者预后的简易指标之一。

老年急性脑梗死患者脑氧摄取分数变化的临床价值探讨

目的探讨老年急性脑梗死后脑氧摄取分数(OEF)变化及临床价值。方法将58例老年脑梗死患者根据格拉斯哥昏迷评分(GCS)分为重症组32例,非重症组26例,通过颈内静脉置管采血检测颈内静脉血氧饱和度(SjvO_2),同时检测脉搏血氧饱和度,并计算OEF。比较2组SjvO_2和OEF,并分析两者与GCS、格拉斯哥匹斯堡昏迷评分(GCS-P)、格拉斯哥预后评分(GOS)的相关性,以及OEF对预后的预测价值。结果与非重症组比较.重症组患者SjvO_2明显升高,OEF明显降低,差异有统计学意义(P<0.01)。SjvO_2与GCS、GCS-P、GOS呈负相关,OEF与GCS、GCS-P、GOS呈正相关(P<0.01)。OEF≤30%患者的预后不良发生率明显高于OEF>30%患者(P<0.01)。结论 OEF可作为老年颈内动脉系统急性脑梗死后,评估脑功能损伤程度和预测预后的重要指标。

幕上自发性脑出血患者早期预后影响因素的评估

目的 评估影响幕上自发性脑出血患者早期预后的临床、实验室和影像学因素。方法 采用 EL ISA法检测 5 4例自发性幕上出血患者发病第 1、2、3、4、7、14d的血清神经元特异性烯醇化酶 (NSE)水平。计算脑实质内血肿体积 ,记录脑室出血积分、中线移位、入院时及病程中 Glasgow昏迷评分 (GCS)、发病 30 d时 Glasgow预后评分 (GOS)。检测入院时血压、血糖和周围血白细胞 (WBC)数。结果 预后恶劣组具有显著升高的 NSE峰值、血糖及血压水平、周围血 WBC数和较大的脑实质或脑室出血量、明显降低的 GCS(P<0 .0 5 ) ,其中入院时 GCS及 NSE峰值为独立预测因素。 NSE动态曲线在发病 2 4～ 48h的骤升预示死亡。病程中 NSE>2 5 ng/ ml的患者全部死亡。结论 上述指标均是脑出血早期预后的重要预测因素。

心肺复苏后昏迷患者脑电图模式对预后的预测

目的探讨心肺复苏后昏迷患者脑电图评估时间和脑电图模式对预后预测的价值。方法选择64例心肺复苏后昏迷患者行脑电图评估。按首次脑电图监测时间段将患者分为1～3d、4～7d及〉7d监测组。脑电图监测包括全面抑制、爆发-抑制、α／θ昏迷和慢波增多四个模式，临床预后（格拉斯哥预后评分）以6个月为终点。分别统计四个脑电图模式在三个时间段内预测预后的敏感性、特异性、阳性预测值、假阳性率及总符合率。结果心肺复苏后脑电图全面抑制模式在7d内预测预后不良敏感性（67％～80％）、特异性（100％）较高；爆发-抑制模式在7d内预测预后不良特异性高（100％），但敏感性（6％～8％）低；α／θ昏迷模式预测预后不良敏感性为3％～40％、特异性为50％～67％；慢波增多在7d内预测预后良好敏感性（100％）、特异性（91％～94％）均高。结论心肺复苏后早期（7d内）脑电图显示全面抑制和爆发-抑制模式预测预后不良准确、可靠；慢波增多模式预测预后良好准确、可靠；α／θ昏迷模式预测预后不良的准确性和可靠性有限。

经额内镜与经侧裂显微镜手术治疗基底节区脑出血的疗效对比

目的比较经额内镜与经侧裂显微镜手术治疗基底节区脑出血的疗效。方法回顾性分析85例手术治疗的基底节区脑出血患者的临床资料,其中采用经额内镜手术治疗41例(经额内镜组),经侧裂显微镜手术治疗44例(经侧裂显微组)。比较两组患者手术时间、术中出血量、术后血肿清除率、术后再出血率、术后颅内感染率、术后脑梗发生率、术后7 d格拉斯哥昏迷量表(GCS)评分及术后6个月格拉斯哥预后量表(GOS)评分。结果经额内镜组手术时间短于经侧裂显微组,术后脑梗发生率低于经侧裂显微组(均P<0.05),而两组患者术中出血量、术后血肿清除率、术后再出血率、术后颅内感染率、术后7 d GCS评分、术后GOS评分比较,差异均无统计学意义(均P>0.05)。结论经额内镜技术治疗基底节区脑出血患者疗效与经侧裂显微镜手术相当,手术时间更短,术后脑梗死发生率更低。

救逆通瘀汤在心肺复苏自主循环恢复患者中的应用研究

目的 观察＂救逆通瘀汤＂对心肺复苏自主循环恢复患者的治疗效果.方法 94例患者分为标准治疗组和中药干预组（各47例）,分别采取常规治疗方法和常规治疗方法加＂救逆通瘀汤＂中药治疗,比较两组患者自主循环恢复后24 h、72 h、7 d、1个月和6个月存活率,72 h、7 d急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）,1个月和6个月格拉斯哥预后评分（GOS）.结果 ①存活率：标准治疗组和中药干预组自主循环恢复后24 h（63.8% vs. 65.9%）、72 h（44.6% vs. 51.0%）、7 d（36.1% vs. 46.8%）、1个月（23.4% vs. 40.4%）比较差异无统计学意义（P均＞0.05）;6个月比较差异有统计学意义（21.2% vs. 40.4%,P＜0.05）.②APACHEⅡ评分：72 h比较差异无统计学意义[（24.3±7.9）分 vs.（22.1±6.8）分,P＞0.05],7 d比较差异有统计学意义[（21.6±4.8）分vs.（17.1±6.5）分,P＜0.05].③GOS评分：1个月[（3.1±1.1）分vs.（3.7±1.2）分]和6个月[（3.2±1.4）分vs.（4.2±1.5）分]比较差异有统计学意义（P均＜0.05）.结论 ＂救逆通瘀汤＂有促进心肺复苏自主循环恢复患者脑功能恢复的作用,可提高患者远期存活率和生存质量.

老年脓毒症41例临床特点分析

目的分析老年脓毒症患者临床特点及与预后的关系,以提高老年脓毒症的诊治水平。方法根据脓毒症诊断标准入选的41例老年患者,根据预后分为死亡组与存活组,分析两组患者年龄、临床症状、原发病、基础疾病等临床特征。结果在老年脓毒症病例中,死亡组较存活组平均年龄大、基础疾病多、白细胞计数高、血清白蛋白浓度低、有意识改变、休克、多器官功能障碍综合征的患者增加,两组比较差异均有统计学意义(P<0.05);且老年人脓毒症原发感染部位为呼吸系统感染占63.4%。结论老年脓毒症患者预后与患者年龄、基础疾病、脓毒症严重程度有关。

格拉斯哥预后评分对腹腔镜胃结直肠癌根治术近期临床结局的预测意义

目的:研究格拉斯哥预后评分(Glasgow prognostic score,GPS)对腹腔镜胃结直肠癌根治术后近期临床结局的预测意义。方法:回顾分析2014年6月至2016年3月接受腹腔镜胃结直肠癌根治术的226例患者的临床资料,根据术前外周血C反应蛋白(C reactive protein,CRP)、血清白蛋白(albumin,ALB)水平将患者分为3组,GPS 0组(CRP≤10 mg/L且ALB≥35 g/L)、GPS 1组(CRP>10 mg/L或白蛋白<35 g/L)与GPS 2组(CRP>10 mg/L且白蛋白<35 g/L),对比分析3组患者的临床资料、术后并发症及近期生存情况。结果:3组患者年龄、术前合并慢性病、肿瘤标志物、肿瘤TNM分期差异有统计学意义(P<0.05),性别、肿瘤部位、体质指数差异无统计学意义(P>0.05)。3组患者术后并发症发生率、术后近期生存曲线差异有统计学意义(P<0.05)。结论:GPS可作为预测腹腔镜胃结直肠癌根治性手术的预后参考指标,GPS评分高的患者预后可能较差。