脑弥散性轴突损伤的临床特征与诊断治疗76例  

The Clinical Characteristics,Diagnosis and Treatment of the Diffuse Axonal Injury of Brain in 76 cases

作　　者：黄宇星[1] 李定君[1] 熊震[1] 

机构地区：[1]成都中医药大学附属医院神经外科,四川成都610072

出　　处：《世界最新医学信息文摘》2014年第15期119-120,共2页World Latest Medicine Information Electronic Version

摘　　要：目的通过对76例脑弥散性轴突损伤（OAI）的受伤原因、临床表现与CT扫描结果关系进行分析，探讨DAI的发病机制及临床诊断治疗问题。方法回顾性分析总结76例DAI患者的致伤机制，临床表现和影像学检查特点，并探讨伤后持续昏迷的时间与DAI的诊断治疗关系。结果致伤原因主要为交通事故伤59例（77．6％），发病机制是因为外伤使颅脑产生旋转加速度和／或角加速度，进而使脑组织内部产生剪力作用，造成神经轴索和小血管损伤。治疗结果为恢复良好者21例，轻残14例，中残11例，重残9例，3位患者属于植物生存，死亡18例（23．7％）。结论脑外伤之后持续昏迷时间大于6小时，临床症状程度严重，影像学检查有多发散在点状出血灶或者没有显著的脑损伤状况，没有显著性的占位效应，这样就可以判定其为DAI。此外，一般情况下，没有必要用手术治疗的方式治疗DAI。治疗DAI一般采用保守治疗，保守治疗主要是促进神经功能恢复药物及改善脑微循环，在昏迷期间保持呼吸道通畅，防止各种并发症综合治疗。Objective To analyse the relationship of the causes,clinical feature and the computed tomography （CT） results of the diffuse axonal injury （ DAI ） of brain and approach the pathogenesis,diagnosis and treatment for the disease. Method To analyse and summary the pathogenesis,feature of clinical and imageology feature in 76 cases with DAI of brain retrospectively and approach the relationship between the time of persistence coma after injury with diagnosis and treatment for the disease.Results The causes of DAI in this study were mainly traffic accident （59 cases; 77.6%）, The mechanism DAI was that injury caused to coriolis acceleration and/or angular acceleration and shear force in the brain tissue of patients, which leading injury of cylindraxile and small blood vessel.After treatment, 21 cases were recovered, 14 cases were mild maimed, 11 cases were middle maimed, 9 cases were heavy maimed, 3 cases were in the vegetative state and lg cases were dead （ 23.7% ） . Conclusion DAI may be diagnosed when patients had cerebral trauma with persistence coma for 6 hours, severe clinical manifestation, and CT shown focus hemorrhage and no occupied lesion in brain. The surgery treatment for DAI is not necessary generally. The expectant treatments for DAI are improving recover the fimction of nerve and the microcirculation in brain.In the period of coma are keeping the respiratory passages unblocked and prohibit complication and other synthetic treatment.

关 键 词：脑损伤 弥散性轴突损伤 CT扫描 诊断与治疗 

分 类 号：R651[医药卫生—外科学]