脑弥漫性轴索损伤的诊断治疗及预后分析

发布时间：2018-02-22 20:02

  本文关键词： 颅脑损伤 脑内血肿 弥漫轴索损伤 预后　出处：《中华神经外科疾病研究杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的分析脑弥漫轴索损伤(DAI)治疗及预后。方法选择经CT证实脑中线区域有出血灶的重型颅脑损伤住院患者50例,测算血肿体积、血肿距中线距离、首次腰穿脑脊液压力。Glasgow预后量表(GOS)评估预后。结果本组经治疗30~70 d后清醒45例;在最长90 d治疗期内,死亡3例,植物生存2例,重残2例、轻残4例、恢复良好39例。预后不良组(重残、轻残)和预后极差组(死亡、植物生存)在血肿容积和首次腰穿压力上的差异未达到统计学显著水平;而预后不良组和预后极差组在血肿距中线距离上均明显短于恢复良好组,预后极差组的血肿距中线距离长于预后不良组,但差异未达到统计学显著水平。预后良好患者占本组78%。结论创伤性脑中轴区域出血是DAI的关键病理改变,伤后早期深度、长程、昏迷是DAI典型临床特征,血肿距中线距离与DAI患者预后密切明显相关。对DAI患者,尽管没有实施手术,运用密切的生命体征监控和肺部管理措施,结合脱水、抗炎、神经营养药物等综合手段,恰当处理存在的合并伤,有效地控制可能继发的多器官功能衰竭,将可能收到良好的治疗效果。
[Abstract]:Objective to analyze the treatment and prognosis of diffuse axonal injury (Dai). Methods 50 cases of severe craniocerebral injury with hemorrhage in the midline area confirmed by CT were selected and the volume of hematoma and the distance between hematoma and midline were calculated. Results the prognosis was evaluated by the first cerebrospinal fluid pressure. Glasgow prognostic scale (GOS). Results 45 cases were awake after 30 days of treatment, 3 cases were dead, 2 cases were vegetative, 2 cases were severe disability, 4 cases were mild disability, 3 cases died during the longest 90 days, 2 cases were vegetative, 2 cases were severe disability, 4 cases were mild disability. 39 cases recovered well. The difference of hematoma volume and first lumbar puncture pressure was not significant between poor prognosis group (severe disability, light disability) and poor prognosis group (death, vegetative survival). However, the distance from the middle line of hematoma in poor prognosis group and poor prognosis group was significantly shorter than that in good recovery group, and the distance between hematoma midline of poor prognosis group and poor prognosis group was longer than that of poor prognosis group. But the difference was not statistically significant. The patients with good prognosis accounted for 78.Conclusion traumatic hemorrhage in the midaxial region is the key pathological change of DAI. The early depth, long duration and coma are the typical clinical features of DAI. The distance from the median line of hematoma is closely related to the prognosis of patients with DAI. For DAI patients, although there is no operation, close vital signs monitoring and lung management measures are used, combined with dehydration, anti-inflammatory, neurotrophic drugs and other comprehensive means. Proper treatment of existing combined injuries and effective control of possible secondary multiple organ failure may lead to good therapeutic effects.
【作者单位】： 陕西省康复医院神经外科;
【分类号】：R651.15
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本文编号：1525188