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应用液压冲击颅脑损伤仪建立大鼠外伤性视神经损伤动物模型

Objective　To observe whether the animal model of optic nerve injury in rats can be set up by fluid percussion brain injury device (FPI) or not.Methods　Seventyone healthy female Wister rats were randomly divided into 2 groups, inlcuding model group with 66 rats and control group with 5 rats.The rats in model group were randomly divided into 3 groups. Eight rats in group 1 were examined by flashvisual evoked potential (F-VEP) and magnetic resonance imaging (MRI) examines before and 1, 3 days,1,2,4,6,and 8 weeks after injury; 56 rats in group 2 were randomly divided into 7 subgroups with 8 rats in each subgroup，and were detected by histopathological and terminal deoxynucleotidyl transferasemediated dUTP nick end labeling (TUNEL) apoptosis examines 1, 3 days, 1,2,4,6,8 weeks after injury；2 rats in group 3 were examined by electron microscopy 4 and 8 weeks after injury.According to the degree of injury, the injured eyes were divided into 2 groups including severe injury group with the beat pressure of （699.14plusmn;60.79） kPa and mild injury group with the beat pressure of （243.18plusmn;20.26） kPa.The right and left eyes in rats in each group were in severe and mild injury group, respectively.Results　One day after injury, the latency duration of FVEP prolonged in severe injury group，wich differed much form which in the normal control group (P＜0.05)；the amplitude was gradually reduced during the first 2 weeks after injury and kept steady after that (P＞0.05). The latency duration prolonged in mild injury group,and its difference with the normal control group was statistically significant (P＜0.05)；the amplitude was gradually reduced during the first 4 weeks after injury and kept steady after that (P＞0.05). The abnormal high signal could be seen on optic nerve 1 day after injury, and was still obvious 8 weeks later. The results of histopathological examination showed ruptured capillary in ganglion cell layer 1 day after injury;retinal ganglion cells without nucleus could be seen 4 weeks after injury. The apoptosis of positive cells was found in each layer of the retina 3 days after injury.TUNEL results indicated that the number of apoptotic positive cells increased significantly 1-2 weeks after injury.Conclusion　An animal model of optic nerve injury can be successfully set up using FPI in rats.

重型颅脑损伤患者整体救治分析

目的 总结52例重型颅脑损伤患者的整体救治经验，探讨重型颅脑损伤的救治方法。 方法 2004年9月-2009年9月收治52例重型颅脑损伤患者，男性42例，女性10例；年龄11～75岁，平均年龄40.6岁。开放损伤8例，闭合损伤44例。格拉斯哥昏迷评分(Glasgow coma scale，GCS)3～5分12例，6～8分40例。采用非手术12例，予以脱水、镇静剂、早期行气管切开、鼻饲及防治并发症等治疗。手术40例，行开颅手术清除血肿或去骨瓣减压，其中行单侧手术35例，双侧手术2例，后颅窝手术3例。二次手术1例，5例与其他专科同时手术。 结果 患者获随访2~24个月。手术治疗组死亡9例(22.5%)，非手术组死亡8例(66.7%)；本组总死亡率32.7%，存活35例(67.3%)。按GCS预后分级：良好20例(38.5%)，中残9例(17.3%)，重残6(11.5%)。植物人1例。 结论 对重型颅脑损伤患者的救治，应提高院前现场救治措施，尽早开颅充分减压，维持循环、内环境稳定，尽早气管切开改善通气；控制感染，防治并发症，尽早(管喂)饮食，积极全身支持；尽早配合中医中药、理疗、体疗等，可改善患者的预后，提高救治成功率。

眼部检查在闭合性颅脑损伤患者预后判断中的作用

车祸致头部多发伤表现出远达性视网膜病变一例

急性颅脑损伤患者的临床治疗

【摘要】目的 总结急性颅脑损伤患者的外科手术治疗效果。方法 2005年1月-2009年5月,急诊外科行手术治疗158例急性颅脑损伤患者。其中男89例,女69例;年龄5～84岁,平均40岁。受伤至入院时间为1～14 h,平均6 h。CT诊断后行开颅血肿清除手术61例,开颅血肿消除及去骨瓣减压73例,钻孔引流术8例,气管切开14例,胸腔闭式引流术2例。结果 158例共存活137例(86.7%),死亡21例(13.3%)。存活患者中植物生存2例,重度残疾18例,轻度残疾57例,恢复良好60例。死亡患者gt;65岁有15例；死亡时间1周内12例,1～3周内5例,3周以上4例。结论 应深入了解急性颅脑损伤的特点,采取正确的手术治疗方式,积极防治并发症,降低患者死亡率,改善预后。

Severe Head Injury, Hypertensive Intracerebral Hemorrhage after Tracheotomy Tube Directly in Addition to 326 Cases

目的:探讨行气管切开术抢救成功的重型颅脑损伤及高血压脑出血患者直接除管的安全性和可行性。方法:在507监护仪行SPO2监测和严密观察下,不经过试阻管而直接将气管套管拔除。结果:本组除1例患者因带管时间长,切口周围气管内炎性肉芽生长而重新插管外,其余患者呼吸平稳,呼吸道通畅,无呼吸急促、呛咳、紫绀及SPO2降低。结论:此法避免了传统除管前试阻管的繁锁和由阻管而引起的多种不良反应,有临床实用价值。

癫痫的一级预防：一项来自国际抗癫痫联盟预防工作组的报告

目前导致癫痫的病因中，有些是可以预防的。该综述总结了由此类可预防病因所造成的癫痫的公共卫生负担，并提出了癫痫一级预防的重要性。系统性回顾针对癫痫的 4 种可预防病因的流行病学研究，这些可预防病因分别是围产期损伤、脑外伤、中枢神经系统感染和卒中。通过使用统一的标准，对每项研究进行质量评估，并从满足质量评级标准的研究中提取了相关风险度量的数据，并将这些结果以中位数和四分位数的方式汇总。高质量的基于人群的研究结果显示，在中低收入国家中，所有年龄段的癫痫患病率约为 1.11%，而在高收入国家中约为 0.7%。围产期脑损伤是儿童癫痫中最常见的可预防病因，在中低收入国家中占 17%，在高收入国家中占 15%。在中低收入和高收入国家中，卒中均是老年癫痫患者中最常见的可预防病因，占所有新发癫痫病例的半数及以上，在高收入和中低收入国家中约 5%癫痫是由卒中造成的。在中低收入国家，中枢神经系统感染是较常见的癫痫病因，约占所有癫痫病例的 5%。在一些低收入农村地区和中等收入国家社区中，地方性神经囊虫病所致癫痫占所有癫痫病例的 34%。可预防的病因所致癫痫占癫痫的总体公共卫生负担的很大一部分。在中低收入和高收入国家中，围产期损伤、感染、脑外伤和卒中所致癫痫占所有癫痫的 25%。母婴保健、免疫接种、公共卫生、预防脑损伤和卒中这些公共卫生干预措施有可能会显著减少癫痫负担。

Retrospective Study of Patients with Severe Traumatic Brain Injury

【摘要】 目的 探讨重型颅脑损伤的死亡原因。方法 对2002年1月—2010年1月收治的54例重型颅脑损伤死亡患者,其受伤原因、受伤至入科时间、损伤时间、临床表现、治疗情况等临床资料进行回顾性分析。结果 原发或继发性颅脑损伤严重、严重的合并伤和术后并发症是死亡的重要因素。结论 重型颅脑损伤患者死亡的原因是多方面的,对此类患者须采取综合救治措施,以降低其死亡率。

Changes of Platelet Parameters in Patients with Head Injury and Its Clinical Significance

【摘要】　目的　探讨中型和重型颅脑损伤后患者血小板（platelet，Plt）参数的变化特点及临床意义。　方法　选取2009年3月-2010年3月脑外伤后24 h内入院的颅脑损伤患者75例作为观察组，于伤后1、3、7、14 d采血测定Plt数量、血小板平均体积（mean platelet volume，MPV）、血小板体积分布宽度（platelet distribution width，PDW），并同时进行格拉斯哥昏迷评分（Glasgow coma scale，GCS）。同时选取60例健康体检者，测定Plt、MPV和PDW作为对照组。　结果　观察组伤后1、3、7 d Plt计数分别为（106.21±36.31）、（102.76±35.23）、（108.37±31.32）×109/L，较对照组[（210.41±68.56）×109/L]明显降低（Plt;0.05）；观察组伤后1、3、7 d MPV分别为（12.34±1.34）、（11.21±1.52）、（10.78±1.36） fL，PDW分别为（15.78±1.26）、（17.67±1.16）、（16.72±1.21） fL，均较对照组[MPV：（8.24±1.76） fL，PDW：（12.86±1.42） fL]明显升高（Plt;0.05）；伤后14 d Plt、MPV和PDW均较对照组差异无统计学意义（Pgt;0.05）。GCS≤8分组伤后1 d Plt计数为（96.85±36.52）×109/L，明显低于GCSgt;8分组[（123.85±35.78）×109/L]，而GCS≤8分组MPV为（12.14±1.32） fL，PDW为（18.63±1.21） fL，均明显高于GCSgt;8分组[MPV：（9.78±1.34） fL，PDW：（16.72±1.34） fL]，差异均有统计学意义（Plt;0.05）。伤后第1天Plt与随访6个月GOS评分呈正相关（r=0.625，Plt;0.05）。　结论　中型和重型颅脑损伤后Plt计数明显降低，MPV和PDW值明显升高，且与伤情及预后有关。Plt及其参数的检测有助于对伤情、预后的判断。【Abstract】　Objective　To investigate the platelet parameters changes and its clinical significance in medium and severe head injury patients. 　Methods　From March 2009 to March 2010, 75 brain injury patients hospitalized within 24 h after injury were included in this study. The platelet number (Plt), mean platelet volume (MPV), platelet volume distribution width (PDW) and Glasgow coma scale were measured on the first, third, seventh and fourteenth day after injury respectively. We also measured the Plt, MPV and PDW of 60 healthy volunteers to make comparisons.　Results　The Plt counts were (106.21±36.31), (102.76±35.23), and (108.37±31.32)×109/L in the head injury patients on the first, third, and 7th day respectively, which were significantly lower than those in the control group [(210.41±68.56)×109/L] (Plt;0.05); the MPV and PDW values measured on the first day [MPV: (12.34±1.34) fL, PDW: (15.78±1.26) fL] and the third day [MPV: (11.21±1.52) fL, PDW: (17.67±1.16)fL] were both significantly lower than those of the control group (Plt;0.05); There was no evidence of a difference in Plt, MPV and PDW between the two groups fourteen day after injury (P＞0.05); The Plt count was (96.85±36.52)×109/L in GCS≤8 group on the first day, which was significantly lower than that of GCSgt;8 group [(123.85±35.78) fL, Plt;0.05]; However, the MPV and PDW values in GCS≤8 group [(MPV: (12.14±1.32) fL, PDW: (18.63±1.21) fL] were both significantly higher than those of GCSgt;8 group [MPV: (9.78±1.34) fL, PDW: (16.72±1.34) fL, Plt;0.05]; The Plt count was correlated with GOS score positively (r=0.625,Plt;0.05).　Conclusions　Medium and severe head injury patients are significantly associated with a lower Plt count and increased MPV and PDW values. The Plt parameters changes are correlated with the prognosis of patients. Therefore, the measurement of Plt parameters may contribute to the valuation of severity and prognosis, and provide new ideas for treatment of head injury patients.

Changes of Neuron-specific Enolase and Myelin Basic Protein in the Serum and Cerebrospinal Fluid in Patients with Epilepsy after Single Episodes

【摘要】　目的　探讨单次癫痫发作是否会引起脑损伤。　方法　2007年6月-2009年11月，采用电化学发光法检测癫痫发作后24 h内40例和对照组40例患者血清和脑脊液中神经元特异性烯醇化酶（neuron-specific enolase，NSE）水平，采用ELISA法测定其血清和脑脊液中髓鞘碱性蛋白（myebin bosic protein，MBP）水平。　结果　癫痫组血清和脑脊液中NSE水平明显高于对照组（Plt;0.01）；癫痫组血清MBP水平与对照组比较差异无统计学意义（Pgt;0.05）；癫痫组脑脊液中MBP水平高于对照组（Plt;0.05）。　结论　单次癫痫患者血清和脑脊液中NSE明显升高，脑脊液中MBP升高，提示单次癫痫发作可导致神经元损伤。【Abstract】　Objective　To detect the possibility of brain damage in the epileptic patients after single episodes.　Methods　The levels of neuron-specific enolase (NSE) in serum and cerebrospinal fluid (CSF) in 40 patients with single episodes within 24 hours after seizures from June 2007 to November 2009 were determined respectively by electrochemiluminescence. Another 40 healthy individuals were enrolled as the control. The levels of myelin basic protein (MBP) were determined by enzyme-linked immunosorbent assay.　Results　The levels of NSE in the serum and CSF in epileptic group within 24 hours after seizures were significantly higher than those in the control group (Plt;0.01), and the levels of MBP in the serum in the two group didn′t differ much (Pgt;0.05). The levels of MBP in CSF in epileptic group were significantly higher than those in the control group (Plt;0.05).　Conclusion　After single episodes, the levels of NSE in serum and CSF and the levels of NSE in CSF increase,which suggests that single episodes may lead to neuronal damage.