重视对重型颅脑损伤后沉默的30%的研究和治疗  

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

作　　者：陈前伟 谭亮[1] 尹怡[1] 冯华[1] 

机构地区：[1]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,重庆400038

出　　处：《中华神经创伤外科电子杂志》2016年第4期245-247,共3页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：国家重点基础研究发展计划(973计划,2014CB541606)

摘　　要：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, about0.2% 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.

关 键 词：颅脑创伤 颅内压 线粒体 微透析 

分 类 号：R651.15[医药卫生—外科学]