Closed brain injury, also known as closed brain injury, is mostly caused by traffic accidents, falls, falls and other intentional injuries and birth injuries.In wartime, it is often seen in the back crush injury of fortifications or the blast injury of high-pressure air waves caused by explosions, which are all caused by the direct or indirect effect of violence on the head.
The mechanism of closed brain injury is complex, and most brain injuries are often the result of several mechanisms and many factors.The main injury factors: ① Due to the deformation of the skull,fractureCause brain damage. ②Brain injury caused by linear or rotational movement of brain tissue in the cranial cavity.
1. Direct damage
(1) Accelerated damageIt refers to the brain injury caused by the moving object hitting the head in a static state, such as stick or stone injury.
(2) Deceleration lossInjury refers to the injury caused by the moving head hitting a stationary object, such as falling and falling.
(3) Crush injuryThat is, two external forces in different directions act on the head at the same time to deform the skull and cause injury.
2. Indirect damage
(1) Transmissible damageFor example, when falling to the ground with buttocks or both feet, the external force is transmitted to the skull base along the spine to cause injury;
(2) Whiplash injuryThis injury often occurs at the craniocervical junction.
(3) Brain injury associated with thoracic crush injuryThis is because when the chest is severely squeezed, the suddenly increased intrathoracic pressure is transmitted to the brain along the jugular vein, causing injury.
Degree and change are important aspects for judging injury condition;Scalp injury, earEpistaxisAnd seepage;Changes in vital signs (respiration, pulse, blood pressure and body temperature);Intracranial hypertension；Damage of medulla oblongata function;shock；Changes in pupil size, shape and response to light;Movement and reflection changes.
2. Consciousness
The change of the state of consciousness indicates the severity of the disease, and there are different degrees ofConsciousness obstacle。Nurses can judge patients through dialogue, pain stimulation and eye openingConsciousness obstacleDegree.If the patient suddenly becomes quiet and lethargic, it indicates that the condition has worsened, or because of the use of sedativesepilepsyDrugs;If the patient in deep coma has swallowing reflex, evasive action or consciousness changes to consciousness, it indicates that the patient's condition is improved.An objective assessment can be made through the Glasgow Coma Scale (GCS).
3. Pupil changes
Pupils are one of the indicators reflecting the changes of the condition of brain injury. In the acute stage, observe once every 15 to 30 minutes, and carefully make records for observation and comparison.
4. Changes in vital signs
The observation of blood pressure, pulse, respiration and body temperature can effectively judge the changes of the condition.If the blood pressure rises during observation, the pulse is slow and powerful, and the breathing is slow and deep, it indicates thatIntracranial hypertension, be alertintracranial hematoma orCerebral herniaEarly.When the blood pressure drops, the pulse increases fast and weak, the heart rate decreases, and the breathing slows and is irregular, which indicates that the brain stem function fails.Occipital bonefractureThe patient suddenly becomes slow or stops breathing, indicatingForamen magnum herniaThe possibility of.In case of high fever and deep coma, it indicates that the hypothalamus is damaged;Central high fever or body temperature does not rise, indicating severe brain injury;The temperature gradually rises and persists, indicating the possibility of secondary infection.
5. Changes in cardiopulmonary function
Severe brain injury also has obvious effects on heart and lung functions. The more serious the injury, the earlier the ECG abnormalities occur, and the higher the mortality rate. Therefore, close observation of ECG changes and timely adoption of effective measures can protect the heart early and preventheart failureandArrhythmia。
6. Observation on the volume of body in and out
Dehydrating drugs are commonly used in patients with brain injury. Observation of urine volume can determine the effect of reducing intracranial pressure, and observe the changes of condition and whether there are complications.Nurses should accurately record the 24-hour access.If 250 mL of 20% mannitol is used, the urine volume should be 500~600 mL within 4 hours. If the average urine volume per hour is less than 60 mL, it indicates that the effect of blood pressure reduction is poor, or the patient has severe dehydration.No urine is discharged after 2~4 hours of application, whether there isUroschesisOr mergerenal failure。For patients with decreased urine volume, it is necessary to find out the cause in time and report to the doctor in time, so as to prevent excessive infusion from causing or aggravating the brainedemaAnd ensure the liquid input.
7. Limb movement change
Hemiplegia, cases with increased muscular tension, cases with cerebral denervation and tetanic seizure, and cases with positive pyramidal sign,epilepsyAttack, after injuryshockEtc.
inspect
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1. X-ray plain film of skull
As long as the condition permits, routine examination should be carried out according to the normal, lateral or special position films.
2. Lumbar puncture
To understand the changes of cerebrospinal fluid pressure and composition.
3. Ultrasonic inspection
For supratentorial hematoma, the side of hematoma can be determined by midline wave displacement, but if there is no displacement, the hematoma cannot be excluded.
It is also important for the diagnosis of brain injury.
diagnosis
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The diagnosis can be confirmed according to clinical manifestations and relevant examinations.
treatment
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1. Light
It mainly depends on bed rest and general treatment. Generally, it needs to stay in bed for 1~2 weeks. Pay attention to the vital signs, changes in consciousness and pupils, and ordinary diet.Most patients can work normally after several weeks.
2. Medium
Absolutely rest in bed, measure vital signs regularly within 48 hours, and pay attention to changes in consciousness and pupils.Conscious patients can take a regular diet or a semi liquid diet.Those who are not fully conscious are given intravenous infusion,Intracranial hypertensionDehydration treatment was given to patients withCerebrospinal fluid leakageAntibiotics (cephalosporins, ofloxacin, metronidazole) were used.
3. Heavy duty
(1) Keep the respiratory tract unobstructed.
(2) Closely observe the condition, check the breathing, pulse, blood pressure, consciousness and pupil changes at any time, and pay attention to whether there are new symptoms and signs.
(3) Prevention and treatment of brainedema, Treatment of lowering intracranial pressure.
1) Decubitus position: exceptshockAll of them have high head position.
2) Limit the intake, correct the imbalance of water and salt metabolism, and give sufficient antibiotics (cephalosporins, ofloxacin, and metronidazole).
3) Dehydration treatment: to eliminate brainedema(Mannitol), effective for reducing intracranial pressure.
4) Continuous external ventricular drainage or intermittent release of a certain amount of cerebrospinal fluid in patients undergoing intracranial pressure monitoring, or lumbar puncture to release an appropriate amount of cerebrospinal fluid when the condition is stable.
5) Hibernation hypothermia therapy: reduce brain metabolism, reduce brain tissue oxygen consumption, and prevent brainedemaIt also plays a role in reducing intracranial pressure.
6) Barbital treatment: it can reduce brain metabolism, reduce oxygen consumption, increase brain tolerance to hypoxia, and reduce intracranial pressure.
8) Auxiliary excessive ventilation: the purpose is to make CO in the bodytwoExcretion can make the cerebral blood flow decrease, so that the intracranial pressure decreases accordingly.
4. Application of neurotrophic drugs
It can be selected or combined according to the condition.
