重型颅脑损伤患者凝血纤溶标志物动态观察

Objective To investigate the dynamic changes and the clinic significance of coagulation and fibrinolysis markers in patients with severe craniocerebral trauma. Methods Thirty three consecutive patients [Glasgow coma scale (GCS) ≦8 and APACHE II >10] including 10 women and 23 men with age of (46. 3 ± 16. 3) years old and with severe craniocerebral trauma were enrolled in this study. Endothelin(ET),alpha-granular membrane protein-140( GMP-140) and D-dimer(DD) were measured at 1st day ,3rd day and 7th day of admission, head computerized tomography (CT) was performed on each patient.Twenty healthy people with similar age were as control. ET was determined by the reagent kit which from Shanghai Shenjia company and GC-1200 -γ radiatory counter. GMP-140 was determined by the reagent kit which from Suzhou university and PEKINEINMER WIZARD-1470 γ radiatory counter. DD was determined by the reagent kit Shanghai sung biological product company limited and measured by latex agglutination.Results ET,GMP-140 and DD levels were significantly increased at the time of admission [(75. 24 ± 26. 44)pg/ml,(26.43 ± 13. 94) ng/ml, (3. 20 ± 0. 97) μg/ml, respectively ] ,then gradually decreased. ET and DD levels were significantly higher than control group even after 7 days[ (44. 66 ± 15. 25)pg/ml, (1. 35±0.55) μg/ml, respectively ], but not for GMP-140. All of the coagulation and fibrinolysis abnormalities markers were negatively correlated with GCS,P<0. 05. There were 18 survivors including 8 vegetables and 15 dead including 1 case suffered from disseminated intravascular coagulation (DIC) in this investigation.Conclusions Coagulation and fibrinolysis abnormalities markers were occurred at the very early stage in the patients with severe craniocerebral trauma. The levels of ET, GMP-140 and DD levels were negatively correlated with GCS.

早期不同营养支持对重型颅脑损伤患者康复的影响

1 Subjects and method 1.1 Choice of cases All cases should match the following condition.⑴ The patients were admitted in 6 h after trauma and diagnosed originally head injured with Glasgow Coma Scale(GCS)≤ 8;⑵ The patients whose age from 18 to 60;⑶ The patients had no diabetes mellitus or the other endocrinism that had influence on nutrition and metabolism;⑷ The patients had no severe complicated trauma of important organs,no external hemorrhage or internal hemorrhage and no more than 800 ml blood transfused if operated.We had carried out this study from October 1998 to June 2000.140 cases,89 males and 51 females.

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.

Objective:　To explore a way of guiding diagnosis and treatment of blunt and penetrating diaphragm injuries. 　　Methods:　According to injury violence, 46 chest trauma patients with diaphragm rupture were divided into two groups: a blunt injury group and a penetrating injury group. The injury condition and trauma scores between the two groups were compared and analyzed.　　Results:　The incidence of blunt diaphragm injuries was lower than that of penetrating injuries (1.78% vs 8.53%, P<0.05). In the blunt injury group most patients had multiple injuries. Penetrating injuries developed more quickly than blunt injuries, and resulted in hemorrhagic shock in the early period. Trauma scores showed that there was no significant difference in the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups (P>0.05), but the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS than the penetrating group (P<0.05).　　Conclusions:　Blunt and penetrating diaphragm injuries have different clinical characteristics. So they should be dealt with differently to reduce the incidence of complication and improve prognosis.

西学东渐——新译“Glasgow coma scale”

西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐.格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的“Glasgow coma scale”多种多样,容易造成初学者和使用者的迷惑.本文复习有关“Glasgow coma scale”的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版.结合英式英语、美式英语和汉语的语言文化特点,新译了“Glasgow coma scale”,以方便医护人员使用.