Search

This paper summarized the rehabilitation nursing management of a patient with severe traumatic brain injury complicated with multiple rupture of thoracic-abdominal organs based on the concept of enhanced recovery after surgery. Based on the enhanced recovery after surgery, a multidisciplinary team for rehabilitation management was set up. Comprehensive treatment and nursing interventions including postoperative management of intracranial pressure, management of traumatic liver injuries, exercise rehabilitation, postoperative thromboembolism prevention, enteral nutrition support and management of antiepileptic drug were carried out to prevent postoperative complications and improve the rehabilitation. (本文总结1例基于加速康复外科(ERAS)理念的重型颅脑创伤伴肝脾破裂、肋骨骨折、肺、肾挫裂伤危重症患者的康复护理经验。基于ERAS理念, 组建多学科康复管理团队, 制定全面的康复治疗方案, 包括术后颅内压管理、创伤性肝损伤康复、运动康复管理、术后血栓预防管理、术后肠内营养管理、术后抗癫痫等详细的康复方案, 有效预防相关并发症, 促进患者康复。)

Objective To investigate the effect of static pushing speed of mannitol on the intracranial pressure. Methods Totally 70 children with acute intracranial pressure increase were divided into two groups: 35 cases in the control group received routine rate of mannitol injection and 35 cases in the observation group received the slow first and then fast injection of mannitol. The effect of two mannitol injection rates was compared. Results The effective time to response of intracranial pressure reduction in the observation group was slightly longer than that in the control group , but with no significant difference(P > 0. 05). The duration of effective intracranial pressure in the observation group was longer than that in the control group (P < 0. 05), and the incidence of adverse reactions in the observation group was lower than that in the control group (P < 0. 05). Conclusion The fast first and then slow injection of mannitol is helpful to maintain the stability of intracranial pressure and reduce the incidence of adverse reactions caused by the drug. (目的 探讨甘露醇静脉推注对颅内压的影响。方法 采用随机数字表法将70例急性颅内压增高症患儿分为2组, 各30例。对照组患儿静脉注射甘露醇时采用常规推注速度, 观察组采取先慢后快的静脉推注速度, 对比2组应用效果。结果 观察组颅内压降低显效时间长于对照组, 但差异无统计学意义(P＞0. 05)。观察组有效颅内压持续时间长于对照组, 差异有统计学意义(P＜0. 05); 观察组不良反应发生率较对照组低, 差异有统计学意义(P＜0. 05)。结论 采取先慢后快的静脉推注速度更有助于维持颅内压的平稳, 降低由该药物所致的不良反应发生风险。)

目的 了解颅内静脉窦狭窄（cerebral venous sinus stenosis，CVSS）患者眼部特征，分析静脉窦支架置 入术后眼底改变情况，探讨与视盘水肿程度相关的可能因素。 方法 回顾性纳入2014年1月-2018年8月在首都医科大学附属北京天坛医院神经介入中心确诊，并 行静脉窦支架置入术的CVSS患者，收集患者一般资料、病程、视力、眼底检查、视野情况、颅内压、 DSA检查、静脉窦内压测定及患者术后的眼部变化等临床资料。总结CVSS患者的眼部特征和静脉窦 支架置入术后的眼底改变情况，应用Kendall’s tau-b相关分析探讨与视盘水肿程度相关的可能因素。 结果 共纳入125例CVSS患者，存在视功能损害者101例（80.8%），包括视物模糊、视力下降、视 物变形、阵发性黑蒙、视野缺损、复视等，其中65例（52.0%）眼部症状为首发症状，35例（28.0%）仅 表现出眼部症状。视盘水肿115例，共223只眼。视盘水肿等级中位值3（2～4）级（Fri sén分级）。部分 患者可见视盘周围出血、渗出、棉绒斑，视网膜皱褶及静脉迂曲扩张，视盘色淡或苍白等。视盘水 肿等级与颅内压正相关（Kendall’s tau-b=0.271，P =0.029），与病程负相关（Kendall’s tau-b=-0.261， P =0.002）。其中79例经内科治疗无效患者接受了静脉窦支架置入术，术后患者视盘水肿均有减轻， 术后1个月视盘水肿等级降为2（1～3）级；术后6个月时视盘水肿完全消退比例达94.4%（135/143）。 结论 对双眼视盘水肿患者要除外CVSS可能性；眼底检查是CVSS诊疗评估及判断颅内压情况的 一项重要无创检查，同时也是CVSS患者治疗后随访观察的必要检查。视盘水肿程度与颅内压正相关， 与病程负相关；静脉窦狭窄合并视盘水肿经内科治疗无效患者可考虑行静脉窦支架置入术治疗，促 进视盘水肿消退，减少视神经不可逆性损害。 Abstract: Objective To understand ocular manifestations of patients with cerebral venous sinus stenosis (CVSS), analyze fundus changes after venous sinus stenting and explore possible related factors of papilledema degree. Methods Data of patients with CVSS in Neurointervention Center, Beijng Tian Tan Hospital from January 2014 to August 2018 were retrospectively analyzed. The ocular characteristics of CVSS patients and ophthalmological changes after CVSS stenting were analyzed and summarized. Results Of 125 patients, 101 (80.8%) had visual impairment, including blurred vision or decreased vision, metamorphosis, transient amaurosis, visual field defect, diplopia. 65 (52.0%) patients had ocular discomfort as the first symptom and 35 (28.0%) patients had only ocular symptom. Of 115 patients (223 eyes) with initial papilledema, the median pepilledema grade was 3 (2-4) (Frisén grades). Some patients showed hemorrhage, exudation, cotton-wool spot, retinal tissue fold surrounding the disc, dilated and tortuous retinal veins, papilla pale. There was a positive relevance between papilledema grade and intracranial pressure (Kendall’s tau-b=0.271, P =0.029), and a negative relevance between papilledema grade and duration of the disease (Kendall’s tau-b=-0.261, P =0.002). 79 patients underwent venous sinus stenting, papilledema of all patients with stenting alleviated soon after operation. At 1 month after stenting, the grade of papilledema was reduced to grade 2 (1-3). At 6 months after stenting, 94.4% eyes (135/143) with initial papilledema had no edema in the disc. Conclusions Patients with binocular papilledema should consider CVSS. The fundus examination is necessary for diagnosis and follow up of CVSS and assessing intracranial pressure. Papilledema degree had a positive relevance with intracranial pressure, and a negative relevance with duration of the disease. Patients with CVSS and papilledema who are refractory for medical treatment should consider venous sinus stenting as possible as earlier to reduce papilledema and irreversible damage of optic nerve.