AIM To evaluate the clinical significance of early nutrition support in severe head-injured patients.METHODS One hundred and forty cases (GCS≤8) were randomly divided into 5 groups: each one had 28cases with similar data in age, sex, GCS or prognosis (P>0.05, x2= 0.43). Group A were given earlyparenteral nutrition (PN) and enteral nutrition (EN); group B were given early PN and EN after 1 week;group C were given PN only for more than 2 weeks; group D were given early PN only and group E weregiven traditional delayed EN. The clinical nutritional data, the rate of complication and the progrosis wereobserved and statistical comparison (t test and Chi-square test) was made.RESULTS The severe head-injured patients could get nourishment from different ways at early stage.Groups A and B had better outcomes and their clinical data such as blood glucose, blood total goblin, bloodalbumin, lymphocyte amount were superior to that of groups D and E (P<0.05, t = 2.12) and were thesame as that of group C (P>0.05, t = 0.98), the rate of complication and the prognosis of patients werebetter than that of the other groups. Group C had similar nutritional data in early stage, but had higher rateof complication and infection after 2 weeks than group A or B ( P<0.01, x2 = 7.38). Group A had lowerrate of gastric hemorrhage.CONCLUSION Early rational nutritional support had significant effect in the severe head-injured patients.The nutritional support of early PN and EN could afford nourishment, protect and improve the gastroentericfunction, reduce the rate of complication. So it is a rational nutritional support.

新生动物及其缺血性脑损伤神经干细胞移植的研究现状

新生儿缺血缺氧性脑病(HIE)是导致脑性瘫痪(脑瘫)的主要原因,至今缺乏有效疗法.近年有关缺血性脑损伤以及新生动物神经干细胞(neural stem cells, NSCs)移植的实验研究为治疗新生儿HIE带来了新的希望.现有研究表明在移植条件相同的情况下,受者年龄、脑发育成熟度、脑内微环境是NSCs移植成功的决定因素.但总体来讲,与成年人(动物)NSCs移植相比,儿科相关研究甚少.因此,了解新生动物NSCs移植的独特优势,将有助于推动新生儿HIE神经干细胞移植的研究与应用.

脑损伤后康复医疗的基本原则

随着神经康复学的发展,扭转了神经系统损伤后"不可恢复"和"无所作为"的宿命论观点,为神经系统损伤后功能的恢复开创了新局面[1-5].神经损伤中为常见和对功能后果影响大的是脑损伤,如卒中、脑外伤、脑手术后等.由于它们都是脑部的损伤,有着许多共同的病理生理学过程.因此,在它们的康复医疗方面,也有着一些基本相同的处理原则.

神经特异性烯醇化酶血清浓度与重型脑外伤预后的相关性研究

AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS: 30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a close relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.

肢体高能量火器伤后脑病理生理变化机制

AIM: To study the mechanism of cerebral pathological and pathophysiological changes after extremity gunshot wounds at molecular level. METHODS: M-193, 5.56 mm bullets were used to shoot the most plentiful part of the hind extremities of the dogs. C-fos gene expression in neurons of cerebral tissues of different time intervals after gunshot in the subject and control groups were detected with immunohistochemistry. RESULTS: No C-fos gene expression was detected in the cerebral cortical neurons in the control group. But in the subject group, C-fos expression increased in the cerebral neurons 30 min after injury, reached the peak 6 houre(P＜0.05), and began to decrease 10 hours post-injury. CONCLUSION: After extremity gunshot wound C-fos expression in neurons of distal parts is the early response of the body to the injury, which might be caused by Leao' s spreading depression(SD), and correlated to extracellular transduction and cell apoptosis.

重型颅脑损伤患者脑电监测与预后关系

重型颅脑损伤后脑组织发生出血、水肿、肿胀,大脑皮层许多维体细胞线粒体发生肿胀,影响轴突后电位释放和正常脑电活动,这可在脑电图上得到反应.而通过对重型颅脑损伤患者进行脑电图监测,可能会对判断其预后有一定帮助.本文通过对2007年1月至2008年3月收住的重型颅脑损伤患者(GCS≤8分)进行脑电图动态监测,并探讨其与预后关系,报告如下.

兔脑出血灶周围脑组织bFGF,VEGF及TNF-α的表达

Intracerebral hemorrhage frequently occurs in nervous system diseases, and le ads to secondary cerebral lesion, such as ischemia, edema of perihematomal brain r egions and the biochemical change of the cell. Recent studies have confirmed tha t cytokines such as basic fibroblast growth factor(bFGF), vascular endothelial g r owth factor(VEGF) and tumor necrosis factor(TNF-α) are involved in the pathoge n esis of cerebral hemorrhage. In nervous system, positive expressions of bFGF and TNF-α are in neurons and astrocytes, and that of VEGF is in vascula r endothelial cells. The content of bFGF protein in brain regions is different a t different time after brain injuries. There was no literature about detectin g the expressions of bFGF, VEGF and TNF-α protein in the perihematomal brain r egion s after intracerebral hemorrhage. Using immunohistochemical technique,the author detected the expressions of bFGF,VEGF and TNF-α in the perihematomal brain re g ions in order to research the pathological mechanism of intracerebral hemorrhage.

创伤性脑损伤后内源性神经干细胞的变化及作用

神经外科疾病中创伤性脑损伤发病率居高不下,其高死亡率、高致残率一直是临床上的难题.随着近20年来国内外对神经系统更深层次的研究,尤其是神经干细胞的发现,让人们对解决这一难题有了新的希望.目前对于创伤后脑损伤应用神经干细胞作为治疗措施的基础研究及临床试验主要有两方面:①体外干细胞分离培养增殖后和(或)定向诱导分化后移植;②采取措施促进内源性神经干细胞的增殖、迁移及诱导其定向分化.与外源性神经干细胞相比,内源性神经干细胞具有无免疫源性、无伦理学障碍、可自我更新、多潜能分化、成瘤性低等优点.本文就近年来关于创伤性脑损伤后内源性神经干细胞增殖、迁移和分化的研究现状进行综述.由此加深对原有疾病内在机制的认识,同时也为干细胞的综合治疗提供新的依据.

Orthodontic Treatment for a Patient with Cerebral Palsy

Cerebral palsy(CP) is a group of permanent disorders asso-ciated with the developmental brain injuries that occur during fe-tal development, at birth, or shortly after birth[1,2]. Very few of such patients had the chance to be treated their maloccluded teeth. So, many orthodontists have no experience on such cases.

42例恢复期脑外伤患者的记忆障碍

脑外伤(traumatic brain injuries,TBI)后很长一段时间内,许多患者仍主诉记忆力和(或)工作能力下降,严重影响了他们的生活质量,并造成心理上的痛苦[1-3].以往人们将这种TBI后症状归结为神经症,甚至误认为是伪病,二十世纪七十年代初,人们才逐渐认识了TBI后上述临床改变有其病理基础[2].本研究的目的是探讨TBI后患者记忆障碍的特征,为TBI患者认知能力障碍的评价与康复治疗提供参考.

去骨瓣减压术治疗重型颅脑创伤的临床应用进展

虽然院前急救、重症监护的发展及颅腩创伤救治指南的推广使颅脑创伤救治水平得到明显提高,但重型颅脑创伤的致死率和致残率仍很高.

颅脑创伤康复期应用计算机通讯促进恢复的研究进展

电子邮件通讯技术已经广泛被应用于颅脑创伤多中心医师之间、医师对患者及其家属问卷调查等研究之中,诸如利用电子邮件调查工具进行颅脑创伤患者输血指征调杳、康复治疗期间颅脑创伤深静脉血栓形成、肺栓塞形成的筛查、预防、治疗的多中心研究.

颅脑损伤后甲状腺功能的改变与免疫

近十年来,重症颅脯损伤与神经-内分泌-免疫系统的关系日益受到关注,神经、内分泌和免疫系统是机体中相互制约和相互协调的三大凋节系统,研究表明,神经内分泌的失调参与疾病发牛发展的病理生理过程,可直接影响垂体功能,导致垂体功能低下、糖尿病及其他内分泌疾病[1].

纳米反义寡核苷酸运载体与重型颅脑损伤的基因治疗

重型颅脑损伤是神经外科的常见病,其发生率无论在平时或战时都仅次于四肢骨折居创伤中的第二位,而其死亡率则居第一位.重型颅脑损伤可诱发多种内源性脑保护基因和脑损伤基因的表达,这些基因的相继表达及相互调控,贯穿脑损伤病理生理过程的始终,并从根本上决定了脑损伤的发展与转归.

热休克蛋白与脑损伤的研究进展

热休克蛋白(heat shock proteins,HSPs)是指热应激时细胞新合成或合成增加的一类蛋白质,首次是从热应激果蝇幼虫的唾液腺等部位分离出来并命名.后来研究发现,除热应激外,多种损伤性因素可使组织细胞HSPs合成增加,它可保护机体在严酷的环境下得以生存.HSPs是一个大家族,现已发现的成员包括HSP110、HSP90家族、HSP70家族、HSP60、低分子量HSP、HSP10和泛素(ubiquitin).

脑损伤急性期丘脑-垂体-肾上腺轴损害与应激障碍的临床意义

创伤性脑损伤(traumatic brain injury,TBI)以其高发病率、高死亡率及高致残率己成为影响人民健康的重大疾病之一~([1-3]).

重视老年人的颅脑创伤救治

随着我国社会人口构成的逐步老龄化,针对老年患者颅脑创伤的救治问题将会越来越突出.颅脑创伤在创伤患者中的发生率居第二位,且病死率高.虽然国内外众多医学机构经过不懈的努力,在颅脑创伤基础与临床研究方面取得了长足的进步,但就整体的救治状况而言,尚未取得突破性进展.

客观分析颅脑创伤患者国际多中心循证医学研究结论

循证医学(evidence - based medicine,EBM)正在逐步代替经验医学(experienced medicine)成为判断临床治疗效果的科学方法,得到绝大多数临床医师的认可,目前已经成为西方国家临床医学判断疗效的惟一标准,同样也逐步成为我国临床疗效的重要判断标准.但是,循证医学结论的科学价值必须建立在设计合理、证据确实、指标科学、结果重复性和一致性强的基础上.近年来,许多有关颅脑创伤治疗的国际多中心循证医学研究结果对全世界颅脑创伤治疗起到积极的促进作用.但是,也有部分颅脑创伤临床循证医学研究存在重大缺陷和局限性,容易引起中国临床医师的误解.为了协助中国神经外科医师正确认识与本专业密切相关的国际循证医学研究结果,现撰写该文供同行参考.

重型颅脑损伤诊治的困惑

随着国民经济高速发展,我国创伤性脑损伤(TBI)发生率逐年增高.无论平时还是战时,TBI都居创伤首位,是青壮年人群的首要死亡原因.

脑损伤后颅内压监护现状

颅内压(ICP)增高是继发性脑损伤的重要原因.自1995年至2007年,美国脑创伤基金会(Brain Trauma Foundation,BTF)前后多次出版了包含颅内压监护指征的治疗指南.大量的临床实践支持颅内压监护的应用,有助于早期发现颅内占位病变、指导治疗及评估预后.但是,迄今为止,没有一项前瞻性、随机对照研究来证实颅内压监护在颅脑外伤治疗中的意义.而在我国,由于各种因素的限制,颅内压监护尚未广泛开展.笔者总结颅内压监护在临床中的应用,同时讨论颅内压监护应用中有争议的问题.