【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
ObjectiveTo study the effect of hyperbaric oxygen combined with nimodipine in the treatment of cerebral dysfunction resulted from traumatic brain injury. MethodWe retrospectively collected and analyzed the data of 124 patients with cerebral dysfunction induced by traumatic brain injury, admitted to the Neurosurgery Department during February 2011 to February 2014. All the patients were divided into the traditional treatment group (n=45), the traditional treatment with hyperbaric oxygen group (HBO group, n=40) and the traditional treatment with nimodipine and hyperbaric oxygen group (integrated group, n=39). The differences among the three groups in neurological injury severity evaluated by National Institute of Health Stroke Scale and the cerebral blood flow were recorded and analyzed at three time points (before the treatment, 2 and 4 weeks after treatment). ResultsThere was no significant difference in neurological injury severity and cerebral blood flow among these three groups before treatment (P>0.05). Evaluated at 2 and 4 weeks after treatments, the neurological injury severity of HBO group and integrated group were significantly less than the traditional treatment group (P<0.05); the neurological severity score of integrated group was significantly lower than the HBO group (P<0.05); the cerebral blood flow of HBO group and integrated group were significantly higher than the traditional treatment group (P<0.05); and the cerebral blood flow of integrated group was significantly higher than the HBO group (P<0.05). ConclusionsThe combination therapy of hyperbaric oxygen combined with nimodipine is effective in the treatment of cerebral dysfunction induced by traumatic brain injury, because of its attenuation of neurological injury severity and increase of cerebral blood flow.
目的:探讨颅脑损伤患者术中急性脑膨出的病因、诊断及治疗。方法:对127例术中发生急性脑膨出的颅脑损伤患者的临床资料进行回顾性分析。结果:急性脑膨出的原因为同侧脑肿胀者74例,为对侧迟发性血肿者51例,而为同侧迟发性血肿者2例。共死亡48例(37.8%),其中31例因脑疝死亡。结论:通过钻孔探查或积极的CT扫描,及时发现颅脑损伤患者术中急性脑膨出的原因,并尽早正确处理极其重要,是抢救此类患者成功的关键。
In recent years, although the mortality rate caused by traumatic brain injury has declined, the disability rate has remained high, which has a serious impact on patients and their families. Therefore, solving the complications and sequelae caused by traumatic brain injury is the focus and difficulty of current clinical research. Integration of traditional and western medicine rehabilitation is an effective method for the treatment of the central nervous system at home and abroad, and it also fully reflects its therapeutic advantages in the application of traumatic brain injury. Based on this, this paper will mainly introduce the clinical characteristics of patients with traumatic brain injury, and systematically expound the commonly used clinical rehabilitation treatment methods of integration of traditional and western medicine, aiming to provide a certain guidance for the rehabilitation treatment of traumatic brain injury.
ObjectiveTo investigate the mechanism of Semaphorin 3A (Sema3A) in fracture healing after nerve injury by observing the expression of Sema3A in the tibia fracture healing after traumatic brain injury (TBI). MethodsA total of 192 Wistar female rats, 8-10 weeks old and weighing 220-250 g, were randomly divided into tibia fracture group (group A, n=48), TBI group (group B, n=48), TBI with tibia fracture group (group C, n=48), and control group (group D, n=48). The tibia fracture model was established at the right side of group A; TBI model was made in group B by the improved Feeney method; the TBI and tibia fracture model was made in group C; no treatment was given in group D. The tissue samples were respectively collected at 3, 5, 7, 14, 21, and 28 days after operation; HE staining, immunohistochemistry staining, and Western blot method were used for the location and quantitative detection of Sema3A in callus tissue. ResultsHE staining showed that no obvious changes were observed at each time point in groups B and D. At 3 and 5 days, there was no obvious callus growth at fracture site with inflammatory cells and fibrous tissue filling in groups A and C. At 7 and 14 days, fibrous tissue grew from periosteum to fracture site in groups A and C; the proliferation of chondrocytes in exterior periosteum gradually formed osteoid callus at fracture site in groups A and C. The chondrocyte had bigger size, looser arrangement, and more osteoid in group C than group A. Group B had disorder periosteum, slight subperiosteal bone hyperplasia, and no obvious change of bone trabecula in group B when compared with group D. At 21 and 28 days, cartilage callus was gradually replaced by new bone trabecula in groups A and C. Group C had loose arrange, disorder structure, and low density of bone trabecula, big callus area and few chondrocyte and osteoid when compared with group A; group B was similar to Group D. Immunohistochemistry staining showed that Sema3A expression in chondrocytes in group C was higher than that in group A, particularly at 7, 14, and 21 day. Sema3A was significantly higher in osteoblasts of new bone trabecula in group A than group C, especially at 14 and 21 days (P<0.05). Western blot results showed that the Sema3A had the same expression trend during fracture healing in groups A and C. However, the expression of Sema3A protein was significantly higher in group C than group A (P<0.05) and in group B than group D (P<0.05) at 7, 14, 21, and 28 days. ConclusionAbnormal expression of Sema3A may play a role in fracture healing after nerve injury by promoting the chondrocytes proliferation and reducing the distribution of sensory nerve fibers and osteoblast differentiation.
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:分析重型颅脑损伤患者早期进入ICU进行监护和治疗对预后的影响。方法: 将重型颅脑损伤患者根据是否直接进入ICU分为研究组和对照组,评价3月后患者神经功能和死亡率。结果: 与对照组比较,研究组死亡率更低,3月后ADL分级法生存质量良好率也显著更高。结论: 重型颅脑损伤患者早期进入ICU监护和治疗,可降低术后病死率,改善生存质量。