目的:通过对61例重型脑伤合并消化道应激性溃疡出血的内科综合治疗,评价其疗效在治疗中的地位。方法:对61例重型脑伤合并消化道应激性溃疡出血的患者进行内科综合治疗,分析其疗效。结果:消化道应激性溃疡出血一般发生在入院的2～6 d,占观察例数的86.9%(53例),出血后,在治疗的两周内痊愈42例(占68.9%)。结论:重型脑伤合并消化道应激性溃疡出血是临床危急重症,积极的了解和祛除病因,持续监控,积极的、有效的综合治疗,能取得满意的疗效,提高痊愈率和患者的生存质量。
Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.
目的:探讨行气管切开术抢救成功的重型颅脑损伤及高血压脑出血患者直接除管的安全性和可行性。方法:在507监护仪行SPO2监测和严密观察下,不经过试阻管而直接将气管套管拔除。结果:本组除1例患者因带管时间长,切口周围气管内炎性肉芽生长而重新插管外,其余患者呼吸平稳,呼吸道通畅,无呼吸急促、呛咳、紫绀及SPO2降低。结论:此法避免了传统除管前试阻管的繁锁和由阻管而引起的多种不良反应,有临床实用价值。
【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.
目的 探讨5例特重型胰腺炎的特点及治疗方法。方法 我院2001年8月至2003年8月共收治特重型胰腺炎患者5例。其中入院后18 h内心跳、呼吸骤停3次的重症急性胰腺炎（SAP）1例，治疗以及时血液滤过和心、肺、脑复苏为重点； SAP并发胰性脑病2例，以大剂量维生素B1的补充，或足量补给浓缩红细胞为治疗重点； 并发多个器官功能障碍的暴发性胰腺炎（FAP）2例，治疗重点是血液滤过和防治多器官功能衰竭的级联放大反应，其中1例以高渗性糖昏迷为主要表现，治疗重点是内稳态的纠正，血液滤过，重要器官功能维护。结果 5例特重型胰腺炎患者均治愈，平均住院时间为32.2 d。结论 器官功能的复苏和维护、外科ICU监护、短时血液滤过、内稳态的纠正、中西药综合治疗及病因、对症的个体化治疗是特重型胰腺炎的重要治疗措施。
目的:了解评价血浆置换(PE)治疗慢性乙型重型肝炎的临床疗效及价值。方法:观察重型肝炎患者PE前后总胆红素、白蛋白5项指标及乏力、腹胀等临床症状变化,比较治疗组和对照组治疗后好转率的差异。统计分析PE治疗及次数与患者预后的关系。检测部分患者PE前后内毒素(LPS)浓度,探讨LPS与患者预后的关系。结果:治疗组和对照组早中期患者好转率分别为54.4％和27.8％(Plt;0.01);晚期患者的好转率分别为8.3％和1.4％(Pgt;0.05)。PE治疗2到4次,患者的好转率分别为39.4％、43.6％和42.9％,但PE次数在不同组别患者的好转率之间差异无统计学意义(Pgt;0.05)。PE治疗后好转患者血清内毒素浓度下降(Plt;0.01)。结论:PE能明显改善患者肝功能指标,提高早中期患者的好转率。PE次数为2到4次时,患者的好转率较高,但不同的PE次数未显示相应患者的临床转归之间有统计学意义的差异。血清LPS浓度与患者预后有相关性,治疗前血清LPS浓度低且治疗后下降者,预后较好;相反,治疗前血清LPS浓度高且治疗后下降不明显者,预后较差。