儿童重型脑外伤的特点及预后分析.docVIP

儿童重型脑外伤的特点及预后分析 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：儿童重型脑外伤的特点及预后分析 1 1 资料与方法 3 1．1 一般资料 3 1．2 治疗方法 3 1．3 数据分析 3 2 结果 3 3 讨论 4 31 儿童重型颅脑损伤的临床特点 4 32 影响预后的危险因素 4 33 治疗 体会 5 文2：结肠癌根治术后转移复发的特点及预后分析 6 1 资料与方法 6 2 结果 7 3 讨论 7 参考文摘引言： 8 原创性声明（模板） 9 文章致谢（模板） 10 正文 儿童重型脑外伤的特点及预后分析 文1：儿童重型脑外伤的特点及预后分析 Abstract： Objective To analysis the clinical characteristics of severe cerebral trauma in children and their prognoses. Methods The influences of various risk facto on the prognoses were analyzed by life table, single or multiple variable analysis. Results Among the 31 children with severe cerebral trauma, eight ones (%) died. The degree of primary trauma was relative with their prognoses, whose main influencing factor was Glasgow coma score (GCS). The survival rate of those with a GCS between 5 and 8 was %, and of those with a GCS lower than 5 was %. Diffuse cerebral swelling after trauma acted as an factor with an influence on the pronoses, whereas age, cerebral fracture and intracranial hematoma had no statistical influences. According to Cox model, areflexia and acute difuse cerebral swelling before trauma acted as the main facto that exerted an influence on the prognoses. Conclusion Primary areflexia and GCS are the best indexes that predict the prognosis of severe cerebral trauma in children, which is influenced mainly by the factor of cerebral swelling or edema. Docto should lay stress on the prevention and the alleviation of cerebral swelling so as to improve the prognosis. Key words： severe cerebral trauma; prognosis; cerebral swelling 儿童重型颅脑损伤较为常见，对儿童重型颅脑损伤的救治是当今神经外科领域的重点及难点，尽管与成人相比，存活率较高，但致残率也高。2000年2月—2005年10月我科收治儿童重型颅脑损伤31例，现 总结 、分析如下。 1 资料与方法 1．1 一般资料 本组31例，男21例，女10例，年龄最小4个月，最大12岁，平均岁。 交通 事故伤19例，坠落伤8例，打击伤4例；开放伤5例，闭合伤26例；GCS 8~5分22例，GCS5分9例；单纯脑外伤16例，复合外伤15例。癫痫大发作12例，反射消失20例，有颅骨骨折13例，颅内血肿19例，脑肿胀20例，低血压2例，低氧血症4例。 1．2 治疗方法 采取综合疗法，主要有脱水疗法、亚低温疗法、大剂量激素疗法、过度通气、钙离子拮抗剂、大剂量巴比妥类药物及脑脊液外引流等；如有手术指征立刻手术治疗。全部患儿用多参数心肺功能监护仪进