益脑活血汤联合早期康复治疗对创伤性颅脑损伤术后患者生活质量的影响

目的:观察益脑活血汤联合早期康复治疗对创伤性颅脑损伤术后患者生活质量的影响。方法:120例患者随机平均分为两组。对照组在术后1-2 d,生命体征平稳,神经症状不再恶化即可进行维持正常颅压、营养脑神经、高压氧、肢体功能训练、言语康复训练、心理指导等康复治疗。治疗组在对照组基础上加用益脑活血汤,1剂/d,水煎2次混合后共取汁400 mL,分早晚2次温服。两组均在治疗3月后统计疗效。结果:①两组FMA评分比较,两组疗效有显著性差异,治疗组优于对照组;②两组Barthel评分比较,两组疗效有显著性差异,治疗组优于对照组。结论:益脑活血汤联合早期康复治疗可以明显提高创伤性颅脑损伤术后患者的生活质量,且操作简便,无不良反应,依从性好。

火器性颅脑穿透伤的救治

一、概述 颅脑战伤在医疗救治机构中约占全身各部位战伤的14—17％,其阵亡率、伤死率和伤残率属各部位伤之首。 1862年Mclead报告Crimean战争中颅脑伤的死亡率为73.9％。1918年Cushing总结了第一次世界大战(Ⅰ战)火器性颅脑伤的救治经验,提出早期一次彻底清创的原则,使死亡率降为28.8％。在第二次世界大战(Ⅱ战)中,实行分级救治。

火器性颅脑穿透伤晚期癫痫灶切除一例

火器性颅脑伤伤员,癫痫的发生率为15～20％,我院手术治疗1例,现报告如下。患者男,19岁。于1984年4月在一次战斗中被炮弹炸伤左额顶部,伤后昏迷,右肢体偏瘫,经一线医院行清创术后伤口并发感梁,出现脑脊液漏,经抗炎换药等治疗,于伤后2个月愈合,伤后5个月出现癫痫大发作转入我院。查右额顶有9cm长疤痕,中有5×4cm颅骨缺损,左鼻唇沟稍浅,右上肢肌力4级,余神经系统体征阴性。入院后应用苯妥英钠、安定等抗癫痫治疗5个月,每月仍有癫痫大发作1～2次,先右肢体抽动,继之全身抽搐,意识丧失,脑电图正常。于1985年2月在局麻下行右额顶部致痫灶切除同行硬脑膜、颅骨修补术,术中用针形电极行皮层脑电图描记,可见脑膜一脑疤痕周围有棘—慢波出现,确为致痫灶。

126例颅脑火器伤处理分析

火器性颅脑穿透伤,伤情严重而复杂,致死率与死亡率明显高于其它部位伤,在处理方法上虽有规律可循,但必须依据伤情灵活掌握,正确的诊断及早清创,异物摘除,清除血肿是治疗的关键,尽可能减少第二次清创,降低感染率。本文通过对126例颅脑火器伤救治的回顾性分析,进一步探讨现今医疗条件下火器性颅脑损伤的处理原则。

腹部挤压性颅脑伤(附9例报告)

因胸部受挤压致颅脑伤者并非罕见，但因暴力直接作用腹部而引起脑伤的报道却甚少。我院10年中收治9例，男8，女11年龄5～48岁。致伤原因。车祸5例，塌方砸伤3例，坠伤1例。腹部伤情；均有较广泛腹腔脏器挫伤，合并脾破裂3例，肝破裂1例，肠破裂3例，膀胱破裂2例，膈肌破裂1例。

颅脑火器伤临床救治研究

颅脑创伤是平时最重要的部位伤。而在常规武器战争中，会造成战斗员的大量战伤，其中最致命性的仍是颅脑战创伤，且主要是火器性颅脑伤。本文报道我院1966年8月--2009年5月收治的颅脑火器伤56例，分析总结其临床特点及救治情况，以期提高诊治水平。

立体定向摘除脑深部金属异物——附8例报告

我科1985年6月至1987年8月收治8例火器性颅脑伤并脑深部金属异物存留伤员,应用脑立体定向摘除异物获得成功,报告如下: 临床资料一、一般情况本组8例均为男性青年战士,年龄18—21岁。二、伤因及负伤部位炮弹伤6例,地雷炸伤2例,颞部伤4例,额部伤2例。

Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury

Objective: To study the correlation between brain edema, elevated intracranial pressure (ICP) and cell apoptosis in traumatic brain injury (TBI). Methods: In this study, totally 42 rabbits in 7 groups were studied. Six of the animals were identified as a control group, and the remaining 36 animals were equally divided into 6 TBI groups. TBI models were produced by the modified method of Feeney. After the impact, ICP of each subject was recorded continuously by an ICP monitor until the animal was sacrificed at scheduled time. The apoptotic brain cells were detected by an terminal deoxynucleotide-transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. Cerebral water content (CWC) was measured with a drying method and calculated according to the Elliott formula. Then, an analysis was conducted to determine the correlation between the count of apoptotic cells and the clinical pathological changes of the brain. Results: Apoptotic cell count began to increase 2 h after the impact, and reached its maximum about 3 days after the impact. The peak value of CWC and ICP appeared 1 day and 3 days after the impact, respectively. Apoptotic cell count had a positive correlation with CWC and ICP. Conclusions: In TBI, occurrence of brain edema and ICP increase might lead to apoptosis of brain cells. Any therapy which can relieve brain edema and/or decrease ICP would be able to reduce neuron apoptosis, thereby to attenuate the secondary brain damage.

Early changes of endothelin,nitric oxide and arginine-vasopressin in patients with acute cerebral injury

Objective: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine vasopressin (AVP) in patients with acute moderate or severe cerebral injury. Methods: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS≤8 in 27cases ) or severe (GCS>8 in 21 cases) cerebral injury (Group A), in 42 cases of non cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. Results: The early plasma concentrations of ET ( 109.73 ng/L±12.61 ng/L ), NO ( 92.82 μmol/L± 18.21 μmol/L ) and AVP ( 49.78 ng/L±14.29 ng/L ) in Group A were higher than those in Group B ( 67.90 ng/L ±11.33 ng/L , 52.66 μmol/L±12.82 μmol/L and 29.93 ng/L±12.11 ng/L , respectively, P<0.01 ) and Group C ( 50.65 ng/L±17.12 ng/L , 36.12 μmol/L ±12.16 μmol/L and 5.18 ng/L ± 4.18 ng/L , respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L± 18.12 ng/L , 108.19 μmol/L±13.28 μmol/L and 58.13 ng/L±16.78 ng/L , respectively, which were significantly higher than that of the patients with moderate cerebral injury ( 92.33 ng/L±16.32 ng/L , 76.38 μmol/L ±12.71 μmol/L and 36.18 ng/L±12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L± 15.23 ng/L , 118.18 μmol/L±10.12 μmol/L and 63.49 ng/L±14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma ( 81.13 ng/L ±12.37 ng/L , 68.02 μmol/L±13.18 μmol/L and 45.63 ng/L±12.41 ng/L respectively, P<0.01 ). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. Conclusions: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.

Analysis on the risk factors of intracranial infection secondary to traumatic brain injury

Objective： To discuss the characteristics and risk factors for intracranial infection post traumatic brain injury to prevent and better the clinical care. Methods： Retrospective study of 520 patients with traumatic brain injury were included, 308 male and 212 female. The risky factors of intracranial infection were identified. Results： Thirty two cases （6.54%, 321520） of intracranial infection were diagnosed, lntracranial infection most likely happened 4-10 days after injury. Cerebrospinal fluid leakage, drainage, multiple craniotomies were significant related to intracranial infection. Logistic regression predicted cerebrospinal fluid leakage and drainage as independent factors. Conclusion： Intracranial infection is a serious complication after traumatic brain injury, Patients with drainage or cerebrospinal fluid leakage are more risky for intracranial infection, Aggressive precaution should be taken to better outcome.

Early changes of arginine vasopressin and angiotensin II in patients with acute cerebral injury

Objective: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT II) in patients with acute moderate and severe cerebral injury. Methods: The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non cerebral injury and 30 healthy volunteers. Results: The early plasma concentrations of AVP ( 50.23 ng/L± 15.31 ng/L) and AT II ( 248.18 ng/L± 82.47 ng/L) in cerebral injury group were higher than those in non cerebral injury group (AVP for 30.91 ng/L± 11.48 ng/L and AT II for 120.67 ng/L± 42.49 ng/L, P< 0.01 ). The early plasma concentrations of AVP and AT II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L± 4.23 ng/L and AT II for 43.11 ng/L± 16.39 ng/L, P< 0.001 ). At the same time, the early plasma level of AVP ( 58.90 ng/L± 18.12 ng/L) and AT II ( 292.13 ng/L± 101.17 ng/L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L± 12.16 ng/L and AT II for 201.42 ng/L± 66.10 ng/L, P< 0.01 ). The early level of AVP and AT II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP ( 45.98 ng/L± 13.48 ng/L) and AT II ( 263.28 ng/L± 80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L± 15.56 ng/L and AT II for 319.82 ng/L± 108.11 ng/L, P< 0.01 ). Conclusions: AVP and AT II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT II will be. The early plasma level of AVP and AT II may be one of the severity indexes of cerebral injury.

Current status and development of traumatic brain injury treatments in China

Due to its high incidence, high disability rate, and high mortality rate, traumatic brain injury （TBI） poses a serious threat to human health. This manuscript describes the urgent problems currently existing in China＇s TBI treatment and proposes a scheme of a nationwide collaboration platform for the treatment of TBI so as to improve the overall level of TBl treatment in China, and reduce disability and mortality rates in TBI patients.

Effects of mild hypothermia on patients with lower intracranial pressure following severe brain injury

Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1β and interleukin-6). Results: There were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences. Conclusions: Mild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.

The prospective study of the relationship between perimesencephalic cistern of CT scanning and the outcome of the patients with acute craniocerebral injury

Objective: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebral injury.Methods: The CT scan features including the states of perimesencephalic cisterns, the deformations of the midbrain and the ratios of the occipitofrontal diameter and the transverse diameter of the midbrain of 132 cases were measured. The GOS of the patients 3 months after trauma were regarded as outcome.Results: The rate of unfavorable outcome ( dead, vegetative status, severe disability ) was significantly correlated with perimesencephalic cistern narrower than 1mm (P < 0.05), especially narrower than 0.5 mm (P < 0.005), deformed midbrain (P< 0.005) or abnormal ratio ( < 0.9 or >.1) of the occipitofrontal diameter and transverse diameter of the midbrain (P < 0.01). But the patient's perimesencephalic cistern wider than 1mm and the patients without deformed midbrain got favorable outcome (moderate disability/good recovery).Conclusions: The state of the compressedperimesencephalic cistern ( < 1 mm) and the deformation of the midbrain may significantly indicate unfavorable outcome of the patients with acute craniocerebral injury.

Complications induced by decompressive craniectomies after traumatic brain injury

Objective: To find out the optimal approach to decompress externally the severe injured brain and to avoid possible complications caused by external decompression. Methods: 68 patients who underwent external decompression after traumatic brain injury were admitted into Tianjin Medical University General Hospital for cranioplasty from 1995 to 2001. Complications were retrospectively investigated and analyzed in all patients. The findings were compared between the patients who accepted the decompressive craniectomy in our hospital and in local hospitals. χ 2-test was employed for statistical analysis and complication evaluation. Results: Large craniectomy definitely caused some side effects to patients. Among various complications, several of them showed significantly high incidence (P< 0.05) in patients who underwent the decompressive operation in local hospitals such as shunt-dependent hydrocephalous, subdural fluid collection, and CSF leakage from scalp incision. The rest of the complications had no remarkable difference (P> 0.05) between the two groups including dilation or/and migration of lateral ventricle underlying the cranial defect, skin flap concavity, encephalomalacia of the decompressive area, seizure and infection. Conclusions: To reduce the incidence of iatrogenic side effects, surgical craniectomy should be performed according to the strict indication and standard and any abuse should be avoided.

Biomechanical behavior of brain injury caused by sticks using finite element model and Hybrid-III testing

Objective： To study the biomechanical mechanism of head injuries beaten with sticks, which is common in the battery or assaultive cases.Methods： In this study, the Hybrid-III anthropomorphic test device and finite element model （FEM） of the total human model for safety （THUMS） head were used to determine the biomechanical response of head while being beaten with different sticks. Total eight Hybrid-III tests and four finite element simulations were conducted. The contact force, resultant acceleration of head center of gravity, intracranial pressure and von Mises stress were calculated to determine the different biomechanical behavior of head with beaten by different sticks.Results： In Hybrid-III tests, the stick in each group demonstrated the similar kinematic behavior under the same loading condition. The peak values of the resultant acceleration for thick iron stick group, thin iron stick group, thick wooden stick group and thin wooden stick group were 203.4 g, 221.1 g, 170.5 g and 122.2 g respectively. In finite element simulations, positive intracranial pressure was initially observed in the frontal comparing with negative intracranial pressure in the contra-coup site. Subsequently the intracranial pressure in the coup site was decreasing toward negative value while the contra-coup intracranial pressure increasing toward positive values.Conclusions： The results illustrated that the stiffer and larger the stick was, the higher the von Mises stress, contact force and intracranial pressure were. We believed that the results in the Hybrid-III tests and THUMS head simulations for brain injury beaten with sticks could be reliable and useful for better understanding the injury mechanism.