本文關(guān)鍵詞： 顱腦損傷 腦內(nèi)血腫 彌漫軸索損傷 預(yù)后　出處：《中華神經(jīng)外科疾病研究雜志》2016年06期 　論文類(lèi)型：期刊論文

【摘要】：目的分析腦彌漫軸索損傷(DAI)治療及預(yù)后。方法選擇經(jīng)CT證實(shí)腦中線(xiàn)區(qū)域有出血灶的重型顱腦損傷住院患者50例,測(cè)算血腫體積、血腫距中線(xiàn)距離、首次腰穿腦脊液壓力。Glasgow預(yù)后量表(GOS)評(píng)估預(yù)后。結(jié)果本組經(jīng)治療30~70 d后清醒45例;在最長(zhǎng)90 d治療期內(nèi),死亡3例,植物生存2例,重殘2例、輕殘4例、恢復(fù)良好39例。預(yù)后不良組(重殘、輕殘)和預(yù)后極差組(死亡、植物生存)在血腫容積和首次腰穿壓力上的差異未達(dá)到統(tǒng)計(jì)學(xué)顯著水平;而預(yù)后不良組和預(yù)后極差組在血腫距中線(xiàn)距離上均明顯短于恢復(fù)良好組,預(yù)后極差組的血腫距中線(xiàn)距離長(zhǎng)于預(yù)后不良組,但差異未達(dá)到統(tǒng)計(jì)學(xué)顯著水平。預(yù)后良好患者占本組78%。結(jié)論創(chuàng)傷性腦中軸區(qū)域出血是DAI的關(guān)鍵病理改變,傷后早期深度、長(zhǎng)程、昏迷是DAI典型臨床特征,血腫距中線(xiàn)距離與DAI患者預(yù)后密切明顯相關(guān)。對(duì)DAI患者,盡管沒(méi)有實(shí)施手術(shù),運(yùn)用密切的生命體征監(jiān)控和肺部管理措施,結(jié)合脫水、抗炎、神經(jīng)營(yíng)養(yǎng)藥物等綜合手段,恰當(dāng)處理存在的合并傷,有效地控制可能繼發(fā)的多器官功能衰竭,將可能收到良好的治療效果。
[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.
【作者單位】： 陜西省康復(fù)醫(yī)院神經(jīng)外科;
【分類(lèi)號(hào)】：R651.15
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本文編號(hào)：1525188