目的 分析丁苯酞对外伤性蛛网膜下腔出血患者脑循环及血清炎症因子水平的影响.方法 60例外伤性蛛网膜下腔出血患者,按照治疗方式不同分为对照组和观察组,每组30例.对照组应用常规方案治疗,观察组在对照组基础上应用丁苯酞氯化钠注射液治疗.比较两组患者治疗前后血清炎性因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、脑循环参数[脑血流量(CBF)、脑血容量(CBV)以及平均通过时间(MTT)]及并发症发生情况.结果 治疗后,两组患者IL-1β、IL-6以及TNF-α水平均较本组治疗前降低,且观察组患者IL-1β(2.01±0.36)pg/ml、IL-6(96.34±10.24)pg/ml、TNF-α(5.14±1.17)ng/ml明显低于对照组的(4.15±0.28)pg/ml、(151.24±13.25)pg/ml、(16.35±2.29)ng/ml,差异具有统计学意义(P<0.05).治疗后,两组患者的CBF、CBV较本组治疗前明显升高,MTT较本组治疗前明显缩短,且观察组患者CBF(43.63±1.29)ml/(100 g·min)、CBV(2.29±0.17)ml/100 g均高于对照组的(37.24±1.26)ml/(100 g·min)、(1.86±0.19)ml/100 g,MTT(2.74±0.26)s短于对照组的(3.91±0.27)s,差异具有统计学意义(P<0.05).两组患者并发症发生率比较差异无统计学意义(P>0.05).结论 对外伤性蛛网膜下腔出血患者应用丁苯酞进行治疗有助于降低其血清炎性因子水平,缓解脑循环不良情况,且并发症发生率低,值得在临床推广应用.
Objective:To discuss the efficacy of bifid triple viable capsules combined with early enteral nutrition in the patients with severe head injury. Methods:Totally 80 cases of patients with severe head injury were divided into the observation group and the control group at random. The patients in the observation group were given bifid triple viable capsules combined with early enteral nutri-tion supporting treatment, while the patients in the control group were only given early enteral nutrition supporting treatment. The oc-currence rates of alteration of intestinal flora and diarrhea in the two groups were observed after the 10-day medical treatment, and the changes of GCS,SOFA and APACHE scores,serum ALb,Hb and adverse reactions were compared before and after the medical treat-ment. Results:After the 10-day medical treatment, the GCS score of patients in the two groups was increased when compared with that before the treatment,while SOFA and APACHE scores were lower than those before the treatment (P<0. 05 or P<0. 01), and the changes in the observation group were more notable than those in the control group (P<0. 05). The occurrence rates of alteration of intestinal flora and diarrhea of patients in the observation group were much lower than those in the control group during the medical treatment (P<0. 05). After the 10-day medical treatment, ALb and Hb levels of patients in the two groups were obviously lower than those before the treatment (P<0. 05 or P<0. 01), and the declining in the control group was much higher than that in the observation group (P<0. 05). There was no statistical significance between the incidence of ADR in the two groups (P>0. 05). Conclusion:Bifid triple viable capsules combined with early enteral nutrition have favorable curative effect with good safety in the patients with se-vere head injury.
目的:探讨急性重型颅脑损伤术中出现脑膨出治疗方法及效果。方法:选取2012年5月~2013年6月于我院进行治疗的急性重型颅脑损伤术中出现脑膨出患者30例为研究对象,分析采取的治疗措施及结果。结果:脑膨出的主要原因是出现迟发性颅内血肿和弥漫性脑肿胀,经手术治疗后,死亡8例,22例存活病例出院后半年GOS评估,良好10例,重度残疾6例,中度残疾4例,植物生存2例。结论:重型颅脑损伤术中急性脑膨出患者,必须认真分析引发的原因,及时采取相应措施,可降低患者病死率,提高治疗效果。
目的:探讨急性重型颅脑损伤术中出现脑膨出治疗方法及效果。方法:选取2012年5月~2013年6月于我院进行治疗的急性重型颅脑损伤术中出现脑膨出患者30例为研究对象,分析采取的治疗措施及结果。结果:脑膨出的主要原因是出现迟发性颅内血肿和弥漫性脑肿胀,经手术治疗后,死亡8例,22例存活病例出院后半年GOS评估,良好10例,重度残疾6例,中度残疾4例,植物生存2例。结论:重型颅脑损伤术中急性脑膨出患者,必须认真分析引发的原因,及时采取相应措施,可降低患者病死率,提高治疗效果。
目的:探讨外伤性胫腓骨骨折合并血管损伤临床病例的早期诊断及处置方法.方法:回顾分析我院1996年2月至2004年8月外伤性胫腓骨骨折合并主要知名血管损伤的病例17例,分析评价其早期诊断标准及治疗效果.结果:对于小腿及足部苍白、冰冷、感觉异常、运动丧失、足背动脉搏动消失、伤口内喷射状出血及血肿形成等异常征象的准确判断有利于对所合并的血管损伤的早期诊断;急诊血管彩超检查对血管损伤情况及手术方案的制定具有重要的意义;据不同的血管及合并损伤情况选择适宜的血管重建手术,对患者的救治及肢体的保存有着重要的意义.17例患者中最终9例(52.9%)保肢成功;复合有骨折及软组织损伤的腘动脉损伤,以及胫前、胫后动脉合并损伤患者的截肢率较高;截肢患者MESS评分为6.31±1.07,而保肢患者为5.01±0.81.结论:对胫腓骨骨折合并血管损伤的病例的早期诊断与及时合理的外科处理,对于此类患者肢体的保存及预后的改善有着重要的意义.
