切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2016, Vol. 02 ›› Issue (04) : 245 -247. doi: 10.3877/cma.j.issn.2095-9141.2016.04.013

所属专题: 文献

专题笔谈

重视对重型颅脑损伤后沉默的30%的研究和治疗
陈前伟1, 谭亮1, 尹怡1, 冯华1,()   
  1. 1. 400038 重庆,第三军医大学西南医院神经外科,全军神经外科研究所,全军神经创伤防治重点实验室,重庆市脑科学协同创新中心
  • 收稿日期:2016-01-23 出版日期:2016-08-15
  • 通信作者: 冯华
  • 基金资助:
    国家重点基础研究发展计划(973计划(2014CB541606)

Pay attention to the 30% silent after severe traumatic brain injury

Qianwei Chen1, Liang Tan1, Yi Yin1, Hua Feng1,()   

  1. 1. Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
  • Received:2016-01-23 Published:2016-08-15
  • Corresponding author: Hua Feng
  • About author:
    Corresponding author: Feng Hua, Email:
引用本文:

陈前伟, 谭亮, 尹怡, 冯华. 重视对重型颅脑损伤后沉默的30%的研究和治疗[J/OL]. 中华神经创伤外科电子杂志, 2016, 02(04): 245-247.

Qianwei Chen, Liang Tan, Yi Yin, Hua Feng. Pay attention to the 30% silent after severe traumatic brain injury[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(04): 245-247.

颅脑损伤大多数为轻型伤与中型伤。伤后过程,轻型伤无颅骨骨折者约有0.2%~0.7%的患者加重;有颅骨骨折者3.2%~10%病情转恶化。中型伤有一部分脑挫裂伤患者,数日内出现迟发性颅内血肿。这两类患者如有明显症状,宜住院观察治疗避免发生意外。重型颅脑损伤约占颅脑伤的20%,死亡率很高,是救治的重点。颅脑创伤患者的死亡率下降了50个百分点,具有明显的进步。另外一个有意思的发现是1885~1930年,颅脑创伤死亡率以每10年3个百分点的速度下降,而在1930~1970年期间死亡率无明显增减,1970~1990年出现了死亡率的迅速下降,达到了平均每10年9.2个百分点,而1990~2006年间颅脑创伤死亡率再次出现了平台期,约占病例总数的30%。可以很明显地看到脑外伤死亡率的两次明显下降之后又处在平台期。分析了这种变化趋势背后所采取的救治策略的价值,提出未来应该重视对于救治这沉默的30%颅脑创伤死亡患者的研究和治疗。

Most of the head injuries were light and medium-sized injuries. After injury, about 0.2% to 0.7% of the light injury without skull fracture patients will be aggravated; 3.2%~10% of the patients with skull fracture will be worse. One part of the middle injury patients were brain contusion, and the symptoms of delayed intracranial hematoma occurred several days later. If these two categories of patients with obvious symptoms, then it should be hospitalized for treatment to avoid accidents. If these two categories of patients with obvious symptoms, then it should be hospitalized for treatment to avoid accidents. Severe brain injury accounts for about 20% of the brain injury, the mortality rate is very high, so it is the focus of our treatment. The death rate of patients with traumatic brain injury has been reduced by 50 percentage points, which has made remarkable progress. Another interesting discovery is that, during 1885 to 1930, the mortality of craniocerebral trauma at a rate of 3 percent for every 10 years of decline; and in 1930~1970 years mortality did not increase or decrease obviously; from 1970 to 1990, mortality decreased rapidly to average every 10 years 9.2 percentage points; and in 1990 to 2006, the platform of craniocerebral trauma mortality appears again, accounting for about 30% of the total cases. We can clearly see that there is a plateau in the mortality of brain injury after the two significant decline. After analyzing this trend, we should pay more attention to the research and treatment of 30% patients with brain trauma.

[1]
Andelic N. The epidemiology of traumatic brain injury[J]. Lancet Neurol, 2013, 12(1): 28-29.
[2]
Jennett B. Epidemiology of head injury[J]. Arch Dis Child, 1998, 78(5): 403-406.
[3]
Stein SC,Georgoff P,Meghan S, et al. 150 years of treating severe traumatic brain injury: A systematic review of progress in mortality[J]. J Neurotrauma, 2010, 27(7): 1343-1353.
[4]
Rosenfeld JV,Maas AI,Bragge P, et al. Early management of severe traumatic brain injury[J]. Lancet, 2012, 380: 1088-1098.
[5]
Verchère J,Blanot S,Vergnaud E, et al. Mortality in severe traumatic brain injury[J]. Lancet Neurol, 2013, 12: 426-427.
[6]
Maas AI,Stocchetti N,Bullock R. Moderate and severe traumatic brain injury in adults[J]. Lancet Neurol, 2008, 7(8): 728-741.
[7]
Jacobs B,Beems T,van der Vliet TM, et al. Computed tomography and outcome in moderate and severe traumatic brain injury: Hematoma volume and midline shift revisited[J]. J Neurotrauma, 2011, 28(2): 203-215.
[8]
Farahvar A,Gerber LM,Chiu YL, et al. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring[J]. J Neurosurg, 2012, 117: 729-734.
[9]
Chesnut RM,Temkin N,Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury[J]. N Engl J Med, 2012, 367: 2471-2481.
[10]
Carney N,Lujan S,Dikmen S, et al. Intracranial pressure monitoring in severe traumatic brain injury in latin america: Process and methods for a multi-center randomized controlled trial[J]. J Neurotrauma, 2012, 29(11): 2022-2029.
[11]
Meyfroidt G. Intracranial pressure monitoring in severe traumatic brain injury: The time for a randomized controlled trial is now[J]. Crit Care Med, 2012, 40(6): 1993-1994.
[12]
Melhem S,Shutter L,Kaynar A. A trial of intracranial pressure monitoring in traumatic brain injury[J]. Crit Care, 2014, 18(1): 302.
[13]
Murillo-Cabezas F,Godoy DA. Intracranial pressure monitoring in severe traumatic brain injury: A different perspective of the besttrip trial[J]. Med Intensiva, 2014, 38(4): 237-239.
[14]
Sarrafzadeh AS,Smoll NR,Unterberg AW. Lessons from the intracranial pressure-monitoring trial in patients with traumatic brain injury[J]. World Neurosurg, 2014, 82(1-2): e393-395.
[15]
Hawthorne C,Piper I. Monitoring of intracranial pressure in patients with traumatic brain injury[J]. Front Neurol, 2014, 5: 121.
[16]
Nangunoori R,Maloney-Wilensky E,Stiefel M, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: A systematic literature review[J]. Neurocrit Care, 2012, 17(1): 131-138.
[17]
Rosenthal G,Furmanov A,Itshayek E, et al. Assessment of a noninvasive cerebral oxygenation monitor in patients with severe traumatic brain injury[J]. J Neurosurg, 2014, 120(4): 901-907.
[18]
Haddad SH,Arabi YM. Critical care management of severe traumatic brain injury in adults[J]. Scand J Trauma Resusc Emerg Med, 2012, 20: 12.
[19]
Timofeev I,Carpenter KL,Nortje J, et al. Cerebral extracellular chemistry and outcome following traumatic brain injury: A microdialysis study of 223 patients[J]. Brain, 2011, 134(Pt2): 484-494.
[20]
Kennedy RT. Emerging trends in in vivo neurochemical monitoring by microdialysis[J]. Curr Opin Chem Biol, 2013, 17(5): 860-867.
[21]
Nordström CH,Reinstrup P,Xu W, et al. Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional enegy metabolism[J]. Anesthesiology, 2003, 98(4): 809-814.
[22]
Hlatky R,Valadka AB,Goodman JC, et al. Patterns of energy substrates during ischemia measured in the brain by microdialysis[J]. J Neurotrauma, 2004, 21(7): 894-906.
[23]
Dienel GA. Lactate shuttling and lactate use as fuel after traumatic brain injury: Metabolic considerations[J]. J Cereb Blood Flow Metab, 2014, 34(11): 1736-1748.
[24]
Baines CP,Kaiser RA,Purcell NH, et al. Loss of cyclophilin d reveals a critical role for mitochondrial permeability transition in cell death[J]. Nature, 2005, 434(7033): 658-662.
[25]
Marechal X,Montaigne D,Marciniak C, et al. Doxorubicin-induced cardiac dysfunction is attenuated by ciclosporin treatment in mice through improvements in mitochondrial bioenergetics[J]. Clin Sci (Lond), 2011, 121(9): 405-413.
[1] 王泽华, 郭子瑊, 陈帅, 狄靖凯, 闫泽辉, 冯腾达, 毛兴佳, 向川. 线粒体质量控制在骨关节炎中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 215-224.
[2] 江雅婷, 刘林峰, 沈辰曦, 陈奔, 刘婷, 龚裕强. 组织相关巨噬素3 保护肺血管内皮糖萼治疗急性呼吸窘迫综合征的机制研究[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 353-362.
[3] 钟雅雯, 王煜, 王海臻, 黄莉萍. 肌苷通过抑制线粒体通透性转换孔开放缓解缺氧/复氧诱导的人绒毛膜滋养层细胞凋亡[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 525-533.
[4] 徐珍娥, 杨娅丽, 徐晨霞, 向巴曲西, 王家蓉. 无创脑水肿监测技术在高原地区重度窒息新生儿脑水肿中的临床应用[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 114-119.
[5] 吴沛玲, 娄月妍, 张洪艳, 陈东方, 刘雪青, 赵丽芳, 薛姗, 蒋捍东. 线粒体相关基因在特发性肺纤维化中的分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 178-184.
[6] 黄程鑫, 陈莉, 刘伊楚, 王水良, 赖晓凤. OPA1 在乳腺癌组织的表达特征及在ER阳性乳腺癌细胞中的生物学功能研究[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 275-284.
[7] 冯铭, 孙洪涛. 动脉瘤性蛛网膜下腔出血的颅内压监测与管理[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 248-253.
[8] 潘冬生, 梁国标. 颅脑创伤治疗的最新进展与未来趋势[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 193-197.
[9] 周良辅. 爆炸性颅脑创伤的诊治[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 129-131.
[10] 张晟豪, 周杰, 姚鹏飞, 李长栋, 屈晓东, 南亚强, 曹丽. 雷公藤红素在创伤性脑损伤后继发性损伤中的作用及机制研究[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 132-140.
[11] 苗楠, 宗子钰. 脑出血后继发性脑损伤与线粒体相关机制的研究进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(02): 107-111.
[12] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[13] 王绅, 王如海, 李春, 杨震, 孙菲琳. 中重型颅脑创伤患者住院时间延长的危险因素分析及预测模型构建[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 146-153.
[14] 景方坤, 李岩峰. 颅脑创伤后慢性意识障碍促醒外科治疗的现状与展望[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 129-132.
[15] 于伟伟, 张国高, 吴军, 胡俊, 黄一宁, 徐晶. 线粒体相关内质网膜相关线粒体功能障碍在阿尔茨海默病中的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(02): 223-230.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?