交通事故伤残等级鉴定356例分析

目的探讨我市交通事故伤残等级鉴定的特点。方法对长治市人民医院人身伤害司法鉴定中心2014年度356例交通事故伤残等级鉴定案例进行回顾性分析。结果 356例伤残鉴定案例中,男性比例明显高于女性,40-50岁年龄段伤残人员最多,从季节来看,第一、四季度高于二、三季度的鉴定数量。损伤以四肢骨折、颅脑损伤最为多见,达到四级以上的伤残的人员不足5%,八级以下的占据了70%以上,从委托单位的主体来看,法院委托153例,其中132例属于重新鉴定,交警队及保险公司委托198例,5例为其他单位委托。结论我市交通事故伤残等级鉴定存在一定的内在规律。     

重症颅脑损伤合并胸外伤患者的救治和预后研究

目的:探讨重症颅脑损伤合并胸外伤患者的临床救治要点和预后。方法:对2006年1月至2015年12月陕西省森工医院收治的重型颅脑损伤及重型颅脑损伤合并胸外伤患者的临床资料进行回顾性研究,并随访观察其预后情况。结果:我院10年间收治单纯重症颅脑损伤患者137例及重症颅脑损伤合并胸外伤患者86例,单纯重症颅脑损伤患者死亡率为9.5(13/137),主要死亡原因为:脑内出血(36/26.3%)、脑挫裂伤(31/22.6%)、呼吸衰竭(27/19.7%)等;重症颅脑损伤合并胸外伤患者死亡率为17.4(15/86),主要死亡原因为:呼吸衰竭(18/20.9%)、脑挫裂伤(18/20.9%)、脑内出血(15/17.4%)等。单纯重症颅脑损伤患者手术时间为187.6±11.3分钟、术后住院时间为10.9±1.8天、肢体运动障碍12例(8.8%)、植物生存2例(1.5%);重症颅脑损伤合并胸外伤患者手术时间为265.4±18.9分钟、术后住院时间为14.3±2.1天、肢体运动障碍10例(11.6%)、植物生存3例(3.5%)。其中,两组间在手术时间、术后住院时间及肢体运动障碍方面有统计学差异。结论:重症颅脑损伤合并胸外伤较单纯重症颅脑损伤的致死率更高,手术时间长,术后并发症发生率更高,术后住院天数较长。对于重症颅脑损伤合并胸外伤的患者,应尽量保全肢体功能,提高患者存活率和术后生活质量。     

院前急救对重型颅脑损伤患者的预后影响

重型颅脑损伤是外伤中常见而又最严重的一种损伤 ,常见的原因以交通事故为主 ,此病来势凶猛 ,病死率高 ,且有突变、多变、易危及生命的临床特点。重型颅脑损伤由于同时存在脑水肿、脑缺血 ,使脑的损伤一直存在。因此 ,做好早期复苏急救 ,去除脑继发性损伤的因素 ,可提高抢救成功率。我院自 1 996年 1月至 2 0 0 2年 1月共接诊 2 5 0例重型颅脑损伤病人 ,其中 1 70例进行院前急救处理 ,80例由家属直接送入医院。现将两组病人入院时病情及预后报告如下。1　临床资料1 .1　一般资料　 2 5 0例重型颅脑损伤病人中 ,1 70例经过院前急救 (观察组 )…     

创伤性颅脑损伤脑脊液代谢谱改变及临床意义

目的:探讨创伤性颅脑外伤患者脑脊液中代谢谱的改变及其临床意义。方法:用高分辨率质子核磁共振代谢组学检验创伤性颅脑损伤对脑化学物质和代谢的影响。在重型创伤性颅脑损伤组(n=6),损伤后的脑脊液分析脑代谢的变化,并与轻,中型颅脑损伤组(n=6)相比较。结果:与轻型,中型颅脑损伤组相比,发现了乙酰乙酸,尿酸,3-硝基酪氨酸升高的证据。3组脑脊液中乙酰乙酸,尿酸,3-硝基酪氨酸含量有显著性差异(p<0.01)。结论:颅脑创伤后脑脊液中乙酰乙酸,尿酸,3-硝基酪氨酸值均有不同程度升高,且升高越明显则病情越严重。说明乙酰乙酸,尿酸,3-硝基酪氨酸可作为颅脑创伤病情的监测指标。     

大鼠外伤后癫痫动物模型研制方法的探讨

目的:探讨大鼠外伤后癫痫(PTE)动物模型模型的制作方法和稳定性。方法:将50只成年雄性SD大鼠随机分为2组,液压损伤组40只,手术对照组10只。液压损伤组的大鼠在清醒状态下给予液压打击造成其重度颅脑外伤,于致伤后6个月内观察大鼠的行为、脑电图改变,并进行组织病理学分析。结果:液压损伤组在致伤后约有42.86%的大鼠出现典型的癫痫发作症状和脑电图上痫样放电。病理检查见伤侧脑皮质有局部挫伤,蛛网膜下腔及脑实质有出血灶和胶质结节形成等改变。液压损伤组其发作形式、脑电图特征和病理学改变与人类的PTE特征基本一致。结论:颅脑液压冲击伤可建立起清醒状态下大鼠的PTE动物模型,操作简单、稳定性及可靠性较好,有望为PTE的深入研究提供一种更为有效的实验动物模型。     

针灸联合中药汤剂治疗颅脑外伤后头痛的效果分析

探究通窍活血汤联合针灸对颅脑外伤后头痛的改善效果。方法:选择2011年4月-2015年12月我院就诊的60例颅脑外伤后头痛患者,随机分为两组,对照组采用常规西医治疗,观察组采用通窍活血汤联合针灸治疗;比较两组患者治疗疗效及治疗前后头痛vas评分。结果:治疗后,观察组vas评分(1.33±0.34)分,低于对照组(3.22±0.87)分,差异有统计学意义(p0.05);观察组总有效率(86.7%)高于对照组(66.7%),差异有统计学意义(p0.05)。结果:通窍活血汤联合针灸治疗颅脑外伤后头痛可一定程度缓解疼痛程度,提高治疗效果,好于常规西医治疗。     

上海浦东新区浅部真菌病及其致病菌种的分布特征分析

目的了解浦东新区浅部真菌病的致病病种、菌种构成及其分布特征。方法对疑似浅部真菌病患者的标本进行显微镜直接镜检及培养鉴定,并作临床资料登记及统计学分析。结果确诊的895例浅部真菌病患者中体、股癣337例(37.65%),生殖器念珠菌病227例(25.36%),手、足癣168例(18.77%),甲真菌病93例(10.39%),花斑癣70例(7.82%)。患者男性多于女性,20～39岁年龄组的患病人数(48.72%)明显多于其他年龄组(P<0.05),但甲真菌病患者女性则普遍多于男性,且以50～59岁患病人数最多(P<0.05)。分离的797株菌种中红色毛癣菌379株(47.55%),念珠菌属293株(36.76%),须癣毛癣菌62株(7.78%)。结论上海浦东新区浅部真菌病的病种以体、股癣最多见,男性青壮年多见,而甲真菌病则以中老年女性多见。浅部致病真菌的分布以红色毛癣菌占首位,念珠菌属次之,须癣毛癣菌位于第三位。     

急诊绿色通道提高颅脑外伤患者救治效果的体会

目的:评价建立急诊绿色通道对救治颅脑外伤患者的价值.方法:采用回顾性分析方法,收集我院2007年1月～2012年1月救治的颅脑外伤患者199例,其中急诊绿色通道组111例(A组)和非急诊绿色通道组88例(B组)的救治情况进行比较,分析两组救治的疗效、死亡率及预后.结果:199例颅脑外伤患者中,绿色通道组(A组)111例(55.78％),死亡26例(23.42％),对照组88例(44.22％),死亡30例(34.09％).A组的有效治疗时间较B组明显缩短,差异有统计学意义(0.01＜P＜0.05);A组硬膜外血肿(33例)的术前血肿量少于B组(30例),预后较B组好,差异有统计学意义(0.01＜P＜0.05);A组的中重型颅脑外伤的死亡率明显低于B组,差异有统计学意义(0.01＜P＜0.05),两组特重性颅脑外伤的死亡率仍较高,差异无统计学意义(P＞0.05).结论:急诊绿色通道可缩短颅脑外伤患者救治等待时间,改善中重型颅脑外伤患者的预后.     

糖尿病患者重型颅脑外伤术后脑梗死发生的预防性治疗研究

目的:观察分析糖尿病患者重型颅脑外伤术后脑梗死发生情况.方法:重型颅脑外伤共112例,糖尿病患者31例,非糖尿病患者81例,糖尿病患者按术后血糖控制水平分为血糖控制良好组(＜16.0)和血糖控制不良组(＞16.0),分别为13例、18例;所有病人均采用常规去骨瓣开颅术清除血肿减压,术后早期行脱水治疗,糖尿病组患者给予胰岛素治疗,术后1天、3天、7天复查CT.结果:糖尿病组患者15例(48.4%)出现脑梗死,血糖控制良好组和血糖控制不良组分别为3例(23.1%)、12例(66.7%),非糖尿病组患者9例(13.2%)出现脑梗死.结论:通过术后早期控制血糖水平于合适状态(＜16.0),可有效降低糖尿病患者重型颅脑外伤术后脑梗死发生,明显改善患者预后.     

重型颅脑外伤致脑疝患者的临床救治体会

目的:探讨重型颅脑外伤致脑疝的临床救治方法并总结救治体会,以提高重型颅脑外伤致脑疝患者的临床救治水平,提高其生存率。方法:回顾性分析2006年1月～2011年12月年收治的220例重型颅脑外伤致脑疝的患者的临床资料,探讨综合性救治措施对重型颅脑外伤致脑疝患者的临床意义。结果:根据格拉斯哥预后评分(GOS)评价全组预后:45例恢复良好(20.5%),34例中残(15.5%),41例重残(18.6%),25例植物生存(11.4%),75例死亡(34.1%),其中7例术中死亡,28例术后死于感染、消化道出血及多器官功能衰竭等严重并发症,40例死于脑损伤及继发脑功能严重衰竭。结论:颅脑外伤致脑疝患者致死率高,预后差,采取术前、术中、术后的综合救治措施,可显著提高患者生存率及改善预后。     

颅脑外伤致昏迷患者发生下呼吸道感染的病原学特征及防控

目的:探讨颅脑外伤所致昏迷患者下呼吸道感染的病原菌分布及耐药性,分析其相关危险因素,为临床预防该类感染提供参考。方法:选择2013年1月~2014年12月我院诊治的160例颅脑外伤致昏迷患者,对发生下呼吸道感染的80例患者采样并进行病原菌检测和药敏试验,采用Logistic回归分析探索颅脑外伤致昏迷患者发生下呼吸道感染的危险因素。结果:160例颅脑外伤致昏迷患者中,发生下呼吸道感染80例,占50.00%,共分离出病原菌85株,革兰阴性菌59株,占69.41%,革兰阳性菌20株,占23.53%,真菌6株,占7.06%。革兰阴性菌对氨苄西林和头孢曲松的耐药率较高,对左氧氟沙星和庆大霉素的耐药性较低;革兰阳性菌对氨苄西林和四环素的耐药率较高,而对万古霉素和替考拉宁的耐药率较低;多因素Logistic回归分析显示,侵入性操作、使用抗生素是颅脑外伤致昏迷患者发生下呼吸道感染的危险因素(P0.05)。结论:颅脑外伤致昏迷患者发生下呼吸道感染的主要病原菌为革兰阴性菌,临床可通过减少侵入性操作及合理使用抗生素预防该类感染。     

Bacterial meningitis after craniocerebral trauma in the community

Craniocerebral trauma is one of major risk factors for development of meningitis. We reviewed 30 cases of bacterial meningitis occurring in community after craniocerebral trauma. Alcohol abuse was significant risk factor occurring in trauma patients with meningitis present in 50% in our cohort (p=0.0001). The most common pathogen in posttraumatic meningitis was Str. pneumoniae (90% vs. 33.8%, p=0.0001). However mortality was very low, only 5% probably because of early diagnosis and treatment of patients at risk for bacterial meningitis but neurologic sequellea were significantly more common (p=0.00001) in patients after craniocerebral trauma.     

p53基因多态性和脑外伤预后及临床意义

目的:研究颅脑外伤患者中P53等位基因与基因型的频率分布,探讨其与脑损伤预后的关联性,为脑损伤患者预后提供部分参数依据.方法:选择各型颅脑损伤患者141例,正常对照者144人,患者按GCS格拉斯哥评分法进行分类;采用PCR基因型检测法检测P53等位基因,基因计数法计算等位基因频率;统计学分析等位基因和基因型在脑外伤组与正常对照组、预后良好组与预后不良组的频率分布的差异,并综合分析患者年龄、性别、GCS以及P53各等位基因等因素对脑外伤患者预后的影响.结果:在颅脑外伤患者和正常对照者中P53等位基因和基因型的频率分布,差异均无统计学意义(P＞0.05);等位基因Arg相对于Pro的OR为1.140,基因型Arg/Pro、Arg/Arg相对于Pro/Pro的OR分别为0.890和1.170.在重型脑外伤患者(3≤GCS≤8分)86例中,预后良好31例,预后不良55例,基因型对预后不良的影响:非Pro/Pro相对于Pro/Pro的OR为0417,非Arg/Pro相对于Arg/Pro的OR为0.419,非Arg/Arg相对于Arg/Arg的OR为3.667.在所有脑外伤患者中,预后良好组和预后不良组的患者年龄、性别差异均无统计学意义(P＞0.05);GCS、P53等位基因差异具有显著统计学意义(P＜0.01).结论:在重型颅脑患者中,基因型Arg/Arg有增加预后不良的风险;脑外伤预后与患者的年龄、性别无关联,与GCS、P53基因密切相关.     

p53基因多态性和脑外伤预后及临床意义

目的：研究颅脑外伤患者中P53等位基因与基因型的频率分布,探讨其与脑损伤预后的关联性,为脑损伤患者预后提供部分参数依据。方法：选择各型颅脑损伤患者141例,正常对照者144人,患者按GCS格拉斯哥评分法进行分类;采用PCR基因型检测法检测P53等位基因,基因计数法计算等位基因频率;统计学分析等位基因和基因型在脑外伤组与正常对照组、预后良好组与预后不良组的频率分布的差异,并综合分析患者年龄、性别、GCS以及P53各等位基因等因素对脑外伤患者预后的影响。结果：在颅脑外伤患者和正常对照者中P53等位基因和基因型的频率分布,差异均无统计学意义（P〉0.05）;等位基因Arg相对于Pro的OR为1.140,基因型Arg/Pro、Arg/Arg相对于Pro/Pro的OR分别为0.890和1.170。在重型脑外伤患者（3≤GCS≤8分）86例中,预后良好31例,预后不良55例,基因型对预后不良的影响：非Pro/Pro相对于Pro/Pro的OR为0.417,非Arg/Pro相对于Arg/Pro的OR为0.419,非Arg/Arg相对于Arg/Arg的OR为3.667。在所有脑外伤患者中,预后良好组和预后不良组的患者年龄、性别差异均无统计学意义（P〉0.05）;GCS、P53等位基因差异具有显著统计学意义（P〈0.01）。结论：在重型颅脑患者中,基因型Arg/Arg有增加预后不良的风险;脑外伤预后与患者的年龄、性别无关联,与GCS、P53基因密切相关。     

The Journey from Traffic Offender to Severe Road Trauma Victim: Destiny or Preventive Opportunity?

Background

Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences.

Methodology and Principal Findings

Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02–1.05), severe trauma (OR 1.13, 95%CI 1.14–1.15), and ICU admission or death (OR 1.10, 95%CI 1.08–1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death—all in a ‘dose-related’ fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6) compared to before the trauma event.

Significance

Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.     

Pneumococcal meningitis in community is frequent after craniocerebral trauma and in alcohol abusers

Aim of this short communication was to assess risk factors and outcome of community acquired pneumococcal meningitis and compare it to all cases of community acquired meningitis. Univariate analysis was used for comparison of 68 pneumococcal to 201 CBM within a Slovak nationwide database of CBM. Significant risk factors for pneumococcal meningitis were previous craniocerebral trauma within 7 days (39.7% vs. 14.9%, p=0.00002), splenectomy (10.3% vs. 3.5%, p=0.03) and alcohol abuse (36.8% vs. 15.4%, p=0.0001). Concerning outcome, mortality was similar (8,8% and 12,4%, NS), proportion of those with neurologic sequellae after CBM due to Str. pneumoniae was insignificantly higher (20.6% vs. 15.4%, NS) in comparison to all CBM. All but 2 strains Str. pneumoniae were susceptible to penicillin and macrolides (3.3% resistance).     

Nosocomial meningitis caused by Enterobacteriaceae: risk factors and outcome in 18 cases in 1992-2007

Nosocomial neuroinfections due to Enterobacteriaceae represented 9.5% in our cohort of 171 cases of paediatric meningitis within last 15 years. Commonest etiologic agents was E. coli - 9 (50%) followed by Klebsiella pneumoniae - 3 (16,7%) and Enterobacter cloacae. Citrobacter freundii, Proteus mirabilis and Salmonella enteritidis (1 each). Commonest risk factors were neonatal age 13 - (72.2%), very low birth weight 5 (27.8%), craniocerebral trauma - 4 (22.2%) and neurosurgery - 5 (27.8%). All but 1 case were treated with antibiotics: 8 with III-rd and 3 with IV-th generation cephalosporins (ceftazidim, cefotaxim and cefepim) 2 with meropenem and 4 with ciprofloxacin: Nosocomial meningitis due to enterobacteriaceae was associated with significantly high mortality (29.9% vs. 15.1% in all cohort of pediatric meningitis - p<0.02).     

Post-traumatic metabolic shifts and epileptogenic plasticity in the CNS

Metabolic and ultrastructural disturbances in the brain tissues, which developed within a remote period after light craniocerebral trauma, and their dependence on the dynamics of formation of a post-traumatic epileptic nidus (EN), were studied in the experiments on rabbits. Manifestations of disturbances in energy metabolism (tissue respiration, oxidative phosphorylation, and ATP synthesis), activation of the antioxidant glutathione system, modification of the membrane phospholipid composition, and marked activation of epileptogenic-type plastic processes were revealed in the EN tissues.