颅脑创伤后脑梗死的诊断和治疗(附32例报道)

目的总结颅脑创伤后脑梗死的诊治经验。方法对收治的32例颅脑创伤后脑梗死患者的临床资料、影像学检查、治疗及结果进行回顾性总结。结果本组32例患者占同期收治的1 439例颅脑创伤患者的2.2%,车祸伤24例,坠落伤6例,打击伤2例。伤后有脑疝表现者21例,合并休克者12例,胸腹部伤者12例,多器官伤者10例。伤后首次头颅CT扫描均见占位性颅内血肿,其中中线结构偏移>10 mm者20例。本组脑梗死均经再次头颅CT扫描确诊,受伤至脑梗死确诊的平均时间为(24±12)h;临床上表现为术中脑肿胀18例,术后意识状态无好转14例。再手术减压3例。出院时死亡20例,植物状态生存7例,重残3例,中残2例。结论颅脑创伤后大脑半球梗死的预后很差,脑疝、失血性休克、合并多发伤是颅脑创伤后大脑半球梗死的危险因素,早期诊断和及时处置伤后颅内高压是改善其预后的关键。

Dagnosis and treatment of post-trauma cerebral infarction:reports of 32 cases

Objective To summarize the experience of diagnosis and treatment of post-trauma cerebral infarction.Methods A retrospective analysis of 32 patients diagnosed as post-trauma cerebral infarction.Their clinical data,neuroimaging findings,treatment and outcomes were reviewed.Results Thirty-two patients accounted for 2.2% of all patients with traumatic brain injury who were treated in our hospital during the same period.The causes of brain injure were traffic accidence(24),falling(6) and violent injury(2).The pa...