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Jingdong book

脑外伤新概念

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Jingdong book

脑外伤新概念

Name: 脑外伤新概念
Brand: Jingdong book
SKU: 3117004801
Price: 54.80 USD
Availability: OutOfStock

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《脑外伤新概念》共十三章，第一章概述性地综合介绍了最近几年脑外伤救治领域十六大概念性的更新以及一些治疗的新认识，比如迟发性颅内血肿与慢性颅内血肿、脑挫裂伤与脑弥漫性轴索损伤、脑肿胀与脑水肿、小脑幕裂孔疝与大脑后动脉梗死等；第二章从生物力学和分子生物学的角度全面介绍了脑外伤发生机制及其病理生理特征；第三至第五章介绍了颅脑外伤的现场救治及门急诊的诊断方法，尤其是现代高级生命支持在现场救治中的应用；第六章在介绍标准化手术方法的同时，重点介绍了现代神经外科手术新概念、脊髓电刺激系统植入术、神经修复治疗、脑外伤后昏迷和植物人的特殊手术治疗方法；第七章介绍了当今发展最快的神经ICU和严重感染的ICU集束化治疗：第八章较全面地介绍了颅脑损伤的并发症及其防治的现代理论与研究进展：第九章介绍了脑外伤的绿色治疗（高压氧）新概念及其临床应用的适应证和禁忌证等；第十、十一章在全面介绍脑外伤护理、康复、并发症防治基础上，特别重点介绍了当今颅脑损伤昏迷患者的人性化护理、现代康复功能训练的新概念与新技术、神经系统康复与代偿的新概念及新认知等；持续性植物状态、最小意识状态以及脑死亡在近些年来研究过程中产生了许多不同的认识、诊断标准，在治疗中会因此而产生某种困惑，因此第十二章进行了较全面的论述：另外，自从2005年10月1日《全国人民代表大会常务委员会关于司法鉴定管理问题的决定》实施后，我国司法鉴定机构的布局发生了重大变化，颅脑损伤的临床司法鉴定自然拓展成为神经外科专业新的领域，因此第十三章在论述脑外伤后伤残鉴定过程中存在问题的基础上，进一步说明了脑外伤后病理改变是随着时间推移逐渐变化的过程，将会对即将重新修订的《道路交通伤伤残等级鉴定标准》提供有意义的帮助。

Catalogue

第一章颅脑外伤某些概念的新认识
第一节颅脑外伤某些概念的新认识
一、意识障碍与昏迷的新概念
二、急性颅内血肿的早期诊断
三、格拉斯哥昏迷评分与CT结合判定脑损伤严重度
四、迟发性颅内血肿与慢性颅内血肿
五、脑挫裂伤与脑弥漫性轴索损伤
六、脑肿胀与脑水肿
七、颈项强直与强迫头位
八、小脑幕裂孔疝与大脑后动脉梗死
九、去大骨瓣减压在手术中的应用
十、脑灌注压和颅内压的监护与控制
十一、脑保护和并发症的防治
十二、颅脑外伤后高血糖与补液原则
十三、糖皮质激素治疗创伤性脑水肿的疗效评价
十四、脑外伤的预后
十五、植物生存状态与“植物人”
十六、重型颅脑损伤的预后因素与救治中的注意点
第二节创伤性脑水肿的新认识
一、分类及发生机制
二、诊断
三、治疗方法
第三节弥漫性轴索损伤的新认识
一、弥漫性轴索损伤的病理学特征
二、弥漫性轴索损伤的发生机制
三、临床诊断
四、治疗方法
第四节双额叶脑挫裂伤的新认识
一、受伤机制
二、临床诊断
三、治疗方法
第五节甘露醇的认识误区及规范化临床应用
一、甘露醇的认识误区
二、药理作用
三、并发症
四、临床应用原则
五、注意事项

第二章脑外伤的发生机制与病理学特征
第一节脑外伤的生物力学机制及其病理学特征
一、颅脑损伤的力学原因
二、颅脑损伤的生物力学机制
三、颅脑损伤发生机制
四、脑损伤的伤因及病理学改变
第二节脑外伤后继发性脑损害的分子生物学机制
一、炎性细胞介质的释放
二、自由基生成和脂质过氧化
三、一氧化氮在脑外伤继发性损伤过程中的作用
四、兴奋性氨基酸的过量释放与Ca2＋失衡
五、神经元凋亡

第三章颅脑损伤的诊断
第一节颅脑损伤的分类
一、按照损伤部位与性质分类
二、解剖分类法
三、临床分类法
四、医学分级
五、定位、定性、定量分类法
第二节颅脑损伤的症状与体征
一、意识障碍
二、头痛和呕吐
三、瞳孔改变
……

第四章颅脑外伤的现场救治
第五章急诊室脑外伤的诊断与急救
第六章脑外伤的手术治疗新进展
第七章脑外伤的ICU监护与治疗
第八章颅脑损伤并发症及其防治的现在时
第九章脑外伤的绿色治疗（高压氧）新概念
第十章脑外伤护理的新理念
第十一章颅脑外伤的现代康复治疗
第十二章脑死亡与植物生存
第十三章神经外科专业新领域——脑外伤后临床法医学伤残鉴定问题

Book Abstract

二、临床表现
通常颅骨缺损直径小于3cm者多无症状；施行颞肌下减压术或枕下减压术后，有肥厚的肌肉及筋膜覆盖并在缺损区可以形成坚韧的纤维性愈合层，起到原有颅骨对脑的保护作用，在临床上亦无任何症状。颅骨缺损的临床表现：
1.直径3cm以上的缺损，特别是位于额部有碍美观和安全的缺损。
2.常见的症状，如头昏、头疼、局部触痛、易激怒、不安等。
3.患者对缺损区的搏动、膨隆、塌陷存恐惧心理，怕晒太阳、怕震动甚至怕吵闹声，往往有自制力差、注意力不易集中和记忆力下降；或有忧郁、疲倦、寡言及自卑。
4.因大片颅骨缺失造成患者头颅严重畸形，直接影响颅内压生理性平衡，直立时塌陷、平卧时膨隆，早上凹入、晚上凸出。
5.因大气压直接通过缺损区作用在脑组织上，久而久之则势必导致局部脑萎缩，加重脑废损症状，同时，患侧脑室也逐渐向缺损区扩张膨出或变形。
6.小儿颅骨缺损可随着脑组织的发育而变大，缺损边缘向外翻，凸出的脑组织也逐渐呈进行性萎缩及囊变，所以小儿更需要完整的颅骨保证脑的正常发育。四、手术治疗颅骨缺损的治疗是施行颅骨修补成形术，但对手术的时机、方法和选用的材料以及适应证与禁忌证均须认真考虑，特别是患者要求修补颅骨缺损的目的，希望解决什么问题。因为单纯的颅骨成形术对脑外伤后功能性症状神障碍和外伤性癫痫等表现的治疗效果是难以预测的。
（一）手术指征
1.颅骨缺损直径大于3cm者。
2.缺损部位有碍美观。
3.引起长期头昏、头痛等症状难以缓解者。
4.脑膜-脑瘢痕形成伴发癫痫者（需同时行痫灶切除术）。
5.严重精神负担影响工作与生活者。
（二）手术时机
对于颅骨缺损，一般教科书主张在外伤手术3个月以后再进行颅骨修补，各家医院就修补的时机说法不一，有的主张3个月后，有的主张6个月后，但目前没有外伤手术后3个月内进行颅骨修补对人体有害的确切证据。北京博爱医院神经外科更提倡早期行颅骨修补术，即在颅骨缺损处由膨起变平或凹陷时就做修补，有的在3个月内，有的甚至在1个月内，早期颅骨修补术有如下的好处。
1.早期做颅骨修补有利于患者康复颅骨缺损患者颅骨缺损处压力是不断变化的，不仅随着心跳、呼吸在不停地波动，且在睡眠、平卧时缺损处会膨起，在站立活动时会塌陷，用力大便时也会膨起，脑皮层在膨起时会卡压在颅骨缺损边缘，塌陷时会随之下陷，如同电线一样反复折动，久而久之，产生功能损害；颅骨缺损处因缺乏颅骨保护，承受外界一个大气压，皮层血运在一定程度上受到影响，血运减少该处皮层功能会受到影响，如再行高压氧治疗，有加重脑皮层受压之虞。
早期颅骨修补不仅保护大脑避免意外伤害，减轻心理压力，而且避免脑皮层折返运动，改善皮层供血，有利于高压氧治疗，有利于患者功能康复。通常认为，颅骨修补手术的目的在于恢复颅骨完整性，对患者原发病引起的认知障碍、瘫痪、失语、精神障碍无治疗作用。我们在术前谈话中也是这样向患者家属强调的，以降低患者对手术的期望值，减少纠纷。据我们观察，部分患者在修补术后，脑功能有很大程度的提高。可表现在认知障碍改善、精神状态好转、言语障碍好转、运动功能改善等方面。
有部分患者担心手术中断康复治疗，我们在围术期细节上做了改进，如术后6小时即进食水，1天拔引流管，2天后即可下床继续康复锻炼，可吸收线缝合，无须拆线等，不耽误康复治疗。
……

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