无脑部外伤与骨科相关的意识障碍分析与处理  

Analysis and treatment of patients with disorders of consciousness without brain trauma but related to orthopedics conditions

作　　者：安志刚[1] 赵刚[1] 李力更[1] 郑煦光[1] 张宏伟[1] 梁卫东[1] 吴啸波[1] 

机构地区：[1]唐山市第二医院ICU科,河北063000

出　　处：《中国骨与关节损伤杂志》2015年第1期75-78,共4页Chinese Journal of Bone and Joint Injury

基　　金：唐山市科学技术研究与发展计划(09130202A-3-41)

摘　　要：目的探讨无脑部外伤与骨科相关的意识障碍原因、鉴别诊断和治疗方法。方法回顾性分析自2003-01—2014-01诊治的77例无脑部外伤骨科患者出现意识障碍的临床资料。结果本组68例获得随访6-128个月,平均67.6个月。其中脂肪栓塞综合征（FES）33例中死亡2例,植物状态1例,13例昏迷2-10周,17例表现为较轻的意识障碍,24例目前意识均恢复正常。肺栓塞（PE）21例中死亡9例,植物状态2例,4例昏迷2-5 d,6例出现短暂的意识丧失,8例目前意识恢复正常。脑梗死（CI）9例中死亡3例,植物状态1例,4例遗留部分后遗症。重度低钠血症（SHN）7例,意识均恢复正常。重症肺炎（SP）5例中死亡4例,1例意识恢复正常。颅内感染（ICI）2例,均死亡。结论无脑部外伤的骨科患者出现的意识障碍要充分认识,辨明病因,积极防治,减少死亡率和病残率。Objective To explore the etiology, differential diagnosis and treatment method of patients with disorders of consciousness without brain trauma but orthopedic-related reasons. Methods Retrospective analysis of clinical data was performed for 77 cases of disorders of consciousness without brain trauma but related with orthopedics reasons from January 2003 to January 2014. Results Sixty eight cases were followed up for 6-128 months, average 67.6 months. Among them there were 33 cases of fat embolism syndrome, 2 of death, one case in vegetative state, 13 in coma for 2-10 weeks, 17 with mild impairment of consciousness, 24 recovered to normal consciousness. There were 21 cases of pulmonary embolism, 9 of death, 2 of vegetative state, still in vegetative state, 4 in coma for 2-5 days, 6 with transient loss of consciousness, 8 cases recovered to normal consciousness. There were 9 patients with cerebral infarction, 3 died, 1 in vegetative state, 4 with partial sequelae. Severe hyponatremia of 7 cases were restored to normal consciousness. There were 5 cases of severe pneumonia, 4 died, 1 recovered to normal consciousness. Two cases of intracranial infection died. Conclusion The disorders of consciousness in orthopedics patients without brain trauma should be fully aware of, differentiated of reasons, positively treated and prevented to reduce the mortality and morbidity.

关 键 词：骨科 意识障碍 鉴别诊断 无脑部外伤 

分 类 号：R741[医药卫生—神经病学与精神病学]