弥散性轴索损伤(附97例临床分析)  

Clinical analysis on 97 cases with diffuse axonal injury

作　　者：刘传杰[1] 隗世波[1] 卢武[1] 雷丹[1] 

机构地区：[1]武汉科技大学附属汉阳医院神经外科,湖北430050

出　　处：《中国中西医结合耳鼻咽喉科杂志》2008年第4期264-265,275,共3页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的分析总结脑弥漫性轴索损伤(DAI)的临床特征、诊断要点和治疗方案。方法回顾性分析近年收治的97例DAI患者临床资料和影像资料,总结其临床特点和诊疗经过,提炼诊断要点和治疗经验。结果经积极治疗,本组DAI患者存活54例(55.67%),其中16例恢复良好,14例中残,15例重残,植物生存9例;死亡43例(44.33%)。本病临床特征主要为头部暴力外伤史,伤后原发性意识障碍且持续时间较长,临床症状重却无明确神经系统定位体征,影像学表现;治疗以防治脑缺氧、控制颅高压、降低脑代谢及防治各种并发症为主要措施。结论DAI是影响颅脑损伤病死率、致残率的重要因素,准确诊断、有效应用综合治疗措施,是提高救治成功率的关键。Objective To analyze the clinical features, diagnostic procedures and therapies for diffuse axonal injury （DAI） to sum up clinical experience with this lesion based on a clinical analysis made on a group of cases. Methods A retrospective study was carried out among 97 patients diagnosed as such a condition and treated in recent years in our Hospital, with their clinical data and imaging findings analyzed carefully to look into their whole course of diagnosis and treatment for them to sum up the key steps for the diagnosis of DAI and the therapeutic experience with this lesion. Results With great efforts in the therapeutic course for these patients, 54 were survival （55.67%）, with 16 cases recovered well, 14 being moderately disabled, 15 severely disabled and 9 survived but in a permanent vegetative state, and 43 （44.33%） died. The typical clinical features of DAI should be a medical history of violence in head, immediately got into coma in a consistent way for a longer period following the injury, no localized neurological signs found in spite of most cases presented many much severed general symptoms, and special findings in imaging. The commonly used therapeutic procedures for DAI were to reduce the degree of ischaemia in the cerebral tissue, to control the abnormal increase in the intracranial pressure, to decrease metabolism rate in brain and to prevent complications from occurring in the pathological progress. Conclusions DAI is one of the most important factors to give rise influences on the fatality rate and the mutilation rate from brain injury. Comprehensive diagnosis and therapy are crucial in clinical practice for such a condition.

关 键 词：弥漫性轴索损伤 诊断 治疗 

分 类 号：R651.15[医药卫生—外科学] R741.044[医药卫生—临床医学]