Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.
目的 探讨川芎嗪对大鼠重症急性胰腺炎（SAP）脑损伤的保护作用。方法 将72只健康Wistar大鼠按数字表法随机均分为对照组、SAP组和川芎嗪治疗组3组。对照组仅剖腹翻动胰腺后即缝合腹壁； SAP组采用胰腺被膜下均匀注射5%牛磺胆酸钠（2ml/kg体重）制备SAP动物模型；川芎嗪治疗组在SAP建模后5min于大鼠尾静脉注射川芎嗪注射液（100mg/kg体重）。各组大鼠分别于术后第6、12及24 h观察胰腺组织及脑组织的病理改变，检测血清淀粉酶、 脑组织含水量和微血管内白细胞聚集附壁计数，以及脑组织中MDA、TNF-α和IL-1β水平。结果 对照组胰腺组织无明显改变；SAP组胰腺组织腺泡细胞坏死，结构不清，间质水肿，红细胞漏出，部分腺导管扩张，有点片状出血坏死，炎性细胞浸润；川芎嗪治疗组胰腺组织病理改变较同一时相的SAP组明显减轻。对照组脑组织无明显改变；SAP组脑组织神经元细胞水肿，微血管内白细胞聚集及附壁，脑组织内有炎性细胞增生、聚集，且随时间延长上述表现逐渐加重；川芎嗪治疗组脑组织病理改变较同一时相的SAP组明显减轻。SAP组大鼠各时相脑组织含水量和微血管内白细胞聚集附壁计数，脑组织中TNF-α、IL-1β和MDA水平，以及血淀粉酶含量均明显高于对照组（P＜0.05）；川芎嗪治疗组大鼠各时相的上述指标均明显低于SAP组（P＜0.05）。结论 大鼠脑组织中的TNF-α、IL-1β及MDA参与了SAP脑损伤的病理过程，川芎嗪对SAP大鼠脑损伤具有保护、治疗作用。
ObjectiveTo explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. MethodsA retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging (44.3±15.9) years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging (40.2±10.7) years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in one-stage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. ResultsIn the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was (43.4±4.5) days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was (22.7±2.7) days. None of the 13 patients suffered intracranial infection. ConclusionMaxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for moderate craniocerebral injury
目的:探讨颅脑损伤合并视神经损伤的发病机制及治疗.方法:对23例颅脑损伤合并视神经损伤患者的临床资料做回顾性分析。结果:经过积极治疗部分患者视力有不同程度改善。结论:治疗颅脑损伤合并视神经损伤,强调神经外科和眼科协同处理,掌握治疗时机。
目的:探讨颅脑损伤后脑耗盐综合征患者的诊断与治疗策略。方法:对我科2006~2007年收治的37例CSWS患者临床资料进行回顾性分析和总结。结果:经治疗,37例CSWS患者31例血钠恢复正常,4例死亡,无1例发生桥脑髓鞘溶解症。结论:脑耗盐综合征是颅脑损伤后患者低钠血症的最主要原因。早期明确诊断,积极稳妥补液补钠是有效治疗CSWS患者的关键。
Hypoxia and other factors are related to cognitive impairment. Hyperbaric oxygen therapy can improve tissue oxygen supply to improve brain hypoxia. Based on the basic principle of hyperbaric oxygen therapy, hyperbaric oxygen has been widely used in recent years for cognitive impairment caused by stroke, brain injury, neurodegenerative disease, neuroinflammatory disease and metabolic encephalopathy. This article will review the basic mechanism of hyperbaric oxygen, and summarize and discuss the improvement of hyperbaric oxygen therapy on cognitive and brain diseases, in order to provide relevant reference for clinical treatment.
Objective To discuss the treatment of craniocerebral injuries caused by earthquake. Methods Retrospective analysis of clinical information for 256 patients with craniocerebral injury caused by an earthquake. Results The ‘Classification and Treatment’ was applied to the patients, whether or not they were operated on. A total of 146 patients were cured, 68 improved, 24 remained dependent on the care of others, and 8 died. The mortality rate was 3.13%. Conclusion Applying the ‘Classification and Treatment’ to patients with craniocerebral injury following an earthquake supported the use of medical resources and was associated with a low rate of death and disability.
目的:总结分析1387例重型颅脑损伤的救治情况，以利在今后的工作中进一步改善和提高对重型颅脑损伤的救治水平。方法:回顾性分析1983年1月～2008年1月间1387例重型颅脑损伤患者的救治情况。结果:1387例重型颅脑损伤患者，其中手术治疗857例，非手术治疗530例。按GOS评分，出院时恢复良好475例（34.2%），中残206例（14.8%），重残202例（14.5%），植物生存89例（6.4%），死亡415例（29.9%）。结论:重型颅脑损伤仍然具有较高的病死率和致残率，早期及时手术清除颅内血肿，解除脑疝以及采取积极恰当的综合治疗措施是抢救治疗成功的关键。
Objective To investigate the expression of telomerase reverse transcriptase (TERT) and cell apoptosis in neonatal rats with hypoxia ischemia brain damage (HIBD). Methods A total of 42 7-day-old SD rats (12-18 g, male or female) were randomly allocated into sham-operation group (n=6) and hypoxia-ischemia (HI) group (n=36). In HI group, the rats were anesthetized with ethylether. The right common carotid artery (CCA) was exposed and permanently l igated with a 7-0silk suture through a midl ine cervical incision. A duration of 2.5 hours of hypoxia (8%O2 / 92%N2) was used to produce HIBD model. For sham-operation group, the CCA was exposed without l igation or hypoxia. The brain tissues were harvested at 4, 8, 12, 24, 48, and 72 hours after completion of an HI insult. The expressions of TERT and CC3 were detected by immunohistochemical staining. The apoptosis cells were detected with TUNEL staining method. Results The expression of TERT was increased at 4 hours after HI injury, significantly increased at 24-48 hours and then decreased at 72 hours. The expression of CC3 was increased at 4 hours after HI injury, significantly increased at 24 hours and still maintained high expression at 48 hours and 72 hours. However, in the sham-operation group, both the expressions of TERT and CC3 were extremely low. The expression of TERT and CC3 were higher in the HI group than in the sham-operation group at different time points, and the differences were significant (P lt; 0.05). The TUNEL staining showed that the positive cells in hippocampus and cortical areas were increased at 4 hours after HI injury, significantly increased at 24-48 hours and maintained a high level at 72 hours. However, there was few positive cells in the sham-operation group. There were significant differences between the HI group and the sham-operation group at different time points (P lt; 0.05). Conclusion TERT could be induced by HI in neonatal rats, and might have a protective role in regulating the cell apoptosis in the neonatal HIBD.