重度颅脑外伤伴自主神经功能紊乱的临床特点  

Clinical features of severe craniocerebral trauma associated with somatoform autonomic dysfunction

作　　者：杨学[1] 张雪梅[1] 陈劲草[2] YANG Xue;ZHANG Xuemei;CHEN Jincao(The First People＇s Hospital of Zaoyang City,Hubei,Zaoyang 441200,China)

机构地区：[1]湖北省枣阳市第一人民医院,441200 [2]武汉大学中南医院神经外科

出　　处：《河北医药》2018年第20期3073-3076,共4页Hebei Medical Journal

基　　金：国家自然科学基金面上项目(编号:81373528)

摘　　要：目的探求重度颅脑外伤并且同时伴随自主神经功能紊乱(SAD)患者的症状规律和鉴别诊断依据。方法筛选2015年5月至2016年8月由于严重颅脑外伤而入住脑外科ICU病房的患者,按是否伴发SAD分为SAD组(n=9)和对照组(n=52)。收集每一位受试者的基础资料和格拉斯哥昏迷评分(GCS)、急性生理与慢性健康-Ⅱ(APACHE-Ⅱ)评分、出现的症状、相关影像检查、住ICU的天数、切开气管的天数、人工辅助呼吸天数、是否死亡等信息。结果 2组受试者的基础资料和GCS、APACHE-Ⅱ相比差异无统计学意义(P> 0. 05),有可比性。对比2组原发病:2组中对照组出现脑梗死的概率比SAD组高,差异有统计学意义(P <0. 05);对比2组影像学结果:2组中影像检查发现脑室有异常的概率对照组出现比SAD小组高(P <0. 05);试验结束后,对照组在住ICU的天数、切开气管的天数、人工辅助呼吸天数等指标要明显少于SAD组(P <0. 05)。结论脑梗患者伴随SAD患者在临床中发生的概率不是很大,但是SAD与大脑白质受损关系密切;临床上SAD多出现在颅脑外伤特别重的患者,多提示外伤已经损伤到大脑内部的白质结构。Objective To explore the regularity and differential diagnosis basis of severe craniocerebral trauma complicated by autonomic nerve dysfunction （SAD）. Methods A total of 61 patients with severe craniocerebral trauma who were admitted and treated in our hospital from May 2015 to August 2016 were enrolled in the study. According to whether they had SAD or not,ythese patients were divided into SAD group （ n =9） and control group （ n =52）.The general data, GCS scores,acute physiology and chronic health-Ⅱ （APACHE-Ⅱ） scores,clinical symptoms,related image examinarion results,days in ICU,days of tracheal trachea,manual assisted breathing days and death rate were observed and compared between two groups. Results There were no significant differences general data, GCS scores,acute physiology and chronic health-Ⅱ （APACHE-Ⅱ） scores between the two groups （ P 〉0.05）.The probability of incidence of cerebral infarction in control group was significantly higher than that in SAD group （ P 〈0.05）,and the probability of incidence of cerebral ventricles abnormality in control group was significantly higher than that in SAD group （ P 〈0.05）. Moreover the experimental results showed thatβ-receptor blocker including propranolol combined with dopamine agonists including bromocriptine could obtrain satisfactory therapeutic effects on severe craniocerebral trauma associated with autonomic nervous system dysfunction.At the end of experiment,the days in ICU,the days after tracheotomy and the days of artificial breathing in control group were significantly less than those in SAD group （ P 〈0.05）. Conclusion The probability of occurrence of SAD in patients with cerebral infarction is not great,but SAD is closely related to the damage of brain white matter.SAD appears usually in patients with severe traumatic brain injury,which suggests that and the trauma has been involved in the white matter structure of brain.

关 键 词：颅脑外伤 自主神经功能紊乱 脑白质 

分 类 号：R651.15[医药卫生—外科学]