32例弥漫性轴索损伤诊治分析

目的　探讨弥漫性轴索损伤的有效治疗措施 ,提高其救治成功率。方法　回顾分析 32例弥漫性轴索损伤患者的受伤方式、年龄、格拉斯哥昏迷 (GCS)评分、CT、并发症及治疗方法和预后。结果　 32例弥漫性轴索损伤患者按格拉斯哥预后 (GOS)评分 ,良好 5例 ,中残 6例 ,重残 7例 ,植物生存 2例 ,死亡 1 2例。结论　弥漫性轴索损伤是弥漫性脑损伤的主要病理类型。交通事故常致弥漫性轴索损伤 ,入院时GCS评分越低 ,预后越差。高龄患者因其并发症较多 ,病死率较高。CT示组织撕裂出血则确诊的把握性大。早期气管切开、呼吸机辅助呼吸、亚低温治疗、防治并发症、钙离子拮抗剂应用可显著改善预后。出现颅高压危象时可考虑手术治疗。

DIAGNOSIS AND TREATMENT OF DIFFUSE AXONAL INJURY IN 32 PATIENTS

Objective To approach effective therapeutic methods for Diffuse Axonal Injury (DAI) and to improve their curative effect. Methods Clinical data of 32 patients with DAI were analyzed retrospectively,such as traumatic mechanism,age,glasgow coma score (GCS),findings in computer tomography,complications,therapeutic method and prognosis. Results According to glasgow outcome score (GOS),the prognosis of the patients with DAI was divided into five grades:good recovery (n=5),moderate disability (n=6),severe disability (n=7),persistent vegetative state (n=2) and death(n=12). Conclusion DAI is the most common type of diffuse brain injury.Patients injured in traffic accidents often suffer from DAI,and the lower glasgow coma score on admission the worse prognosis.High death rates occur in elder patients because of complex complication.Findings of laceration and hemorrhage by CT examination show helpful evidences to make final diagnosis.Incision of windpipe in early stage,assistant of mechanical ventilation,mild hypothermia,prevention of the occurrence of complication and the application of calcium antagonist could improve the prognosis significantly.And operation should be considered when intracranial hypertension crisis occurs.