婴幼儿颅脑损伤后大面积脑缺血的临床特征及治疗  

Clinical characteristics and treatment of ischemic brain in infants with traumatic craniocerebral injury

作　　者：王彦刚[1] 赵丽 章翔[1] 费舟[1] 刘卫平[1] 贺晓生[1] 付洛安[1] 张剑宁[1] 蒋晓帆[1] 李兵[1] 曹卫东[1] 高大宽[1] 郭庆东[1] 刘恩渝[1] 林伟[1] 

机构地区：[1]第四军医大学西京脑科医院神经外科,陕西西安710032 [2]第四军医大学口腔医院消毒供应中心,陕西西安710032

出　　处：《中华神经外科疾病研究杂志》2008年第5期451-454,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(30370512);陕西省科学技术研究发展计划项目[2007k15-01(8)]

摘　　要：目的总结分析婴幼儿颅脑损伤后大面积脑缺血的临床特点。方法回顾性研究41例婴幼儿颅脑损伤后大面积脑缺血患者的致伤原因、损伤类型、临床表现,以及救治方法和预后状况。结果41例患儿中坠落伤24例,占58.5%;新生儿产伤10例,占24.4%,二者合计占82.9%。30例(73.2%)患儿伤后症状进行性加重,11例(26.8%)患儿病情稳定后又分别出现新的症状,复查头颅CT发现大面积脑缺血。而伤后1 d内出现大面积缺血6例,1～3 d出现的23例,3 d至1 w以上出现12例。经颅多普勒(TCD)检测11例大脑中动脉血流峰速(Vm)120 cm/s<Vm<140 cm/s,5例90cm/s<Vm<120 cm/s,5例Vm>140 cm/s,2例Vm<30 cm/s。手术治疗34例,主要行颅内血肿清除术、减压术等。41例患儿均接受尼莫同、罂粟碱、丹参、低分子右旋糖酐等不同药物组合治疗。部分病例还给予静脉滴注尿激酶。格拉斯哥预后评级(GOS):恢复良好22例(53.7%);中残8例(19.5%);重残5例(12.2%);植物生存1例(2.44%);死亡5例,死亡率12.2%。结论婴幼儿颅脑损伤后大面积脑缺血的病例以坠落伤和新生儿产伤较多见,脑缺血的发生与硬膜下血肿、脑挫裂伤所致的脑血管痉挛有紧密的关系,大面积脑缺血的危害性大,致残、致死率高,早期的扩张血管和改善循环治疗,是预防和改善颅脑创伤后大面积脑缺血的最为有效的治疗方法。Objective To analyze the clinical characteristics of malignant ischemia in infants with traumatic craniocerebral injury. Methods The causes and types of trauma, clinical manifestation, therapy and prognosis had been studied retrospectively. Results Among 41 infants, 24 cases suffered from falls and tumbles and 10 cases suffered from birth trauma, which accounted for 82.9% of the total traumatic cases. The deterioration in clinical manifestation after head trauma presented in 30 cases （73.2%）. New symptoms appeared in 11 cases and series CT scan displayed large area ischemia in the brain. The infarction occurred in 6 cases 1 day after head trauma, 23 cases in 1～3 d, and 12 cases in 3 d ～ 1 w . The blood flow velocity of middle cerebral artery （MCD） was detected by transcranial Doppler （TCD）. The peak velocity （Vm） was 120 cm/s 〈 Vm 〈 140 cm/s in 11 patients, 90 cm/s 〈 Vm 〈 120 cm/s in 5 patients, Vm 〉 140 em/s in 5 patients and Vm 〈 30 ern/s in 2 patients. A total of 34 patients performed operation to evacuate the intracranial hematoma and decompression. Calcium antagonist, papaverine, salvia mihiorrhiza and dextran-40 were administered in 41 patients. Some cases received urokinase treatment. According to Glasgow Outcome Scale （GOC）： 22 patients （53.7%） showed a good outcome, 8 （19.5%） were moderately disabled, 5 （ 12.2% ） severely disabled, 1 （2.44%） survived in a permanent vegetative state and 5 （ 12.2% ） died. Conclusion The main causes of traumatic craniocerebral injury in infants are fall, tumble and birth trauma. Large area brain ischemia is closely related to subdural hematoma and brain contusion and vasospasm, which results in severe neurological deficits and high mortality. Vasodilatation and circulation amelioration are the most efficient therapy for large area brain ischemia. But infants have much better prognosis than adults.

关 键 词：颅脑损伤 婴幼儿 脑梗死 

分 类 号：R651.15[医药卫生—外科学]