Objective To collect the clinical data of victims with traumatic brain injury (TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake, and to analyze their clinical characteristics and effects of early rehabilitation, so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue. Methods A total of 392 victims admitted in the hospital from April 20th, 2013 to May 3rd, 2013 were screened, of which the TBI victims were clinically assessed and treated with early rehabilitation. Then both the activities of daily living (ADL) and the Rancho Los Amigos Cognitive Recovery Scale (RLA) before and after the treatment were analyzed. The data were input by Excel software, and the statistical analysis was performed by SPSS softwar. Results A total of 51 TBI victims at age from 3 to 84 years old were included finally. The categories of TBI included subarachnoid hemorrhage (41.2%), intracranial hematoma (33.3%) and mixed type (33.3%), and the severity were associated with the type of TBI. The GCS score of cerebral concussion was higher (13.25 ± 0.62) while that of the diffuse axonal injury was lower (4.50 ± 0.71). All victims (100%) had limited ADL, 74.51% had cognitive dysfunction, 9.80% had speech disorder, and 7.84% had dysphagia. After the early rehabilitation treatment, both ADL (before treatment: 34.82 ± 58.29, after treatment: 69.63 ± 22.29) and RLA (pre-treatment: 4.16 ± 1.24, treatment: 7.20 ± 1.69) were obviously higher than those before treatment, with statistical differences (both P lt;0.05). Conclusion The TBI categories of Lushan earthquake victims are various and mixed, and the severity associated with the type of TBI. All TBI victims are accompanied with more clinical problems and functional limitation. Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
目的 探讨颅脑损伤急性期血小板（PLT）参数与外伤性脑梗死（TCI）的关系。 方法 选取2010年9月－2012年1月符合纳入除标准的颅脑损伤患者191例。将伤后14 d内发生脑梗死的患者划入观察组，余为对照组。分别于伤后第24、48小时，第3、7、14天，采集肘静脉血对PLT计数、PLT平均体积（MPV）、PLT体积分布宽度（PDW）；伤后24 h行格拉斯哥昏迷评分（GCS），伤后6个月随访行格拉斯哥结果评分（GOS）。分别分析脑梗死与上述PLT参数的关系、PLT参数与颅脑损伤病情轻重的关系以及与预后的关系。 结果 观察组PLT计数降低、MPV升高、PDW升高；观察组患者GCS/GOS与PLT计数呈正相关，与MPV、PDW呈负相关。 结论 PLT计数、MPV、PDW均与TCI有关，三者中PLT最具临床意义。PLT计数越低、MPV和PDW越高，脑梗死可能性越大，颅脑损伤可能越严重，预后可能越差。
【摘要】 目的 探讨重型颅脑损伤的临床特点和救治经验。 方法 回顾性总结2002年1月-2008年12月所诊治重型颅脑损伤96例的临床资料。 结果 96例重型颅脑损伤患者，其中手术治疗59例，非手术治疗37例。按GOS评分，出院时恢复良好33例（34.4%），中残15例（15.6%），重残16例（16.7%），植物生存8例（8.3%），死亡24例（25.0%）。 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，早期气管插管或气管切开并呼吸机支持治疗及其它积极恰当的综合治疗措施是抢救治疗成功的关键；后期加强护理注重防治并发症，可以最大可能挽救患者生命。【Abstract】 Objective To explore the clinical characteristics of severe cranio-cerebral injury and its treatment experience. Methods The clinical data of 96 patients with severe cranio-cerebral injury from January 2002 to December 2008 were retrospectively analyzed. Results In 96 patients with cranio-cerebral, 59 had undergone the surgeries and the others had undergone the conservative treatment. According to the Glasgow outcome scale (GOS), 33 (34.4%) had a good outcome, 15 (15.6%) had moderate disability, 16 (16.7%) had severe disability, 8 (8.3%) had vegetative persistent and 24 (25.0%) died. Conclusion The mortality and morbidity rate of the patients with severe cranio-cerebral injury are high, we should clean out the intracranial hematoma and relieve cerebral herniation in time, performed early tracheal intubation or tracheotomy with respirator therapy, and other active and appropriate general therapies, and avoid complications via rehabilitation time intensify nursing to rescue the patients.
摘要:目的:探讨卡配因抑制剂3（MDL28170）对新生大鼠缺氧缺血性脑损伤(HIBD)神经细胞凋亡的影响。方法:建立新生SD大鼠HIBD模型,治疗组于缺养缺血后即刻、2 h、4 h腹腔内注射MDL28170,对照组及手术组同时予生理盐水。缺氧缺血后24 h用免疫组化方法观察大脑皮质及海马CA1区Caspase3 蛋白表达、TUNEL法检测细胞凋亡,观察组织病理改变并计算海马神经元死亡数,透射电镜观察细胞超微结构。结果:缺氧缺血后24 h缺血侧大脑皮质及海马CA1区Caspase3和TUNEL阳性细胞数较对照组明显增加,透射电镜证实有凋亡细胞;MDL28170可减少阳性细胞数量,抑制神经元死亡,差异有显著性(Plt;0.05)。结论:MDL28170可通过抑制神经凋亡而对新生大鼠HIBD具有一定保护作用。Abstract: Objective: To investigate the effect of (Calpain inhibitor3) MDL28170 on neural apoptosis in a neonatal model of hypoxicischemic brain damage (HIBD). Methods: A neonatal model of HIBD was established, 7dayold SD rats were divided into three groups. The treatment group received MDL28170(ip) at 0 h,2 h,4 h after HI, whereas the other two groups were administered normal saline simultaneously. The expression of caspase3 (by immunohistochemistry), neural apoptosis (by TUNEL) in cortex and hippocampus ipsilateral to the insult were observed 24 h after HI; hippocampal CA1 neural loss and electromicroscopic changes were assessed at the same time. Results: Apoptotic body was observed by electromicroscopy. Caspase3 positive cells and apoptotic cells increased significantly in the ipsilateral cortex and hippocampal CA1 region compared to the control, and MDL28170 reduced the number of positive cells, attenuated CA1 neural loss with significance (Plt;0.05). Conclusion: It is suggested that MDL28170 may protect the brain of neonatal rats after HIBD by suppressing neural apoptosis.
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。
目的:分析四川汶川地震颅脑损伤患者CT表现及其价值。方法:对地震发生后近2个月内陆续送至四川大学华西医院治疗，因地震致有颅脑损伤史的140名伤员进行颅脑CT分析总结。结果:在本组伤员中，头皮损伤97例（69％）；颅骨骨折68例（49%）；脑挫裂伤66例（47%）；硬膜外和（或）硬膜下积血、积液44例（31％）；蛛网膜下腔出血36例（26％）；脑水肿、软化灶29例（21％）；其他43例（31％）。结论:CT扫描能准确、快速、有效地对地震颅脑损伤患者进行判断，可为临床治疗方案起指导作用。
Objective To assess the results of Fluoro Jade-c (FJC) staining in brain injury after deep hypothermia circulatory arrest (DHCA). Methods First, animal model of DHCA were established. We performed DHCA on six Chinese experimental minipigs and made sure all the pigs were alive after operation. Second, pathological examination was carried out on the brain tissues of these animals. After FJC staining, we respectively took out the positive and negative tissueparts and performed Hematoxylineosin (HE) staining, Nissl staining and Terminal deoxynucleotidyl Transferase BiotindUTP Nick End Labeling (TUNEL). Finally, the results of FJC was compared with TUNEL, Nissl staining, HE staining, to verify the accuracy and reliability of FJC in assessing brain injury after DHCA. Results Postoperative FJC staining discovered positive disease focuses on the experimental pigs. The comparative results of FJC were consistent with TUNEL (Kappa=0.526, Plt;0.01), Nissl staining (Kappa=0.555, Plt;0.01) and HE staining (Kappa=0.491, Plt;0.01). However, FJC staining image was much clearer and easier in identifying brain injury. Conclusion FJC is a reliable and convenient method to assess brain injury after DHCA.
Objective To review the possible mechanisms of the mammal ian target of rapamycin (mTOR) in theneuronal restoration process after nervous system injury. Methods The related l iterature on mTOR in the restoration ofnervous system injury was extensively reviewed and comprehensively analyzed. Results mTOR can integrate signals fromextracellular stress and then plays a critical role in the regulation of various cell biological processes, thus contributes to therestoration of nervous system injury. Conclusion Regulating the activity of mTOR signaling pathway in different aspects cancontribute to the restoration of nervous system injury via different mechanisms, especially in the stress-induced brain injury.mTOR may be a potential target for neuronal restoration mechanism after nervous system injury.