亚低温辅助治疗弥漫性轴索损伤疗效观察

目的:观察亚低温辅助治疗对弥漫性轴索损伤病人的影响。方法:设置观察组27 例,对照组14例,观察组在常规神经外科治疗的同时,采取“冬眠合剂+控温毯(控温帽)+呼吸机辅助呼吸”三联法,疗程为3~14天;对照组仅采取常规神经外科治疗,观察两组近远期疗效。结果:观察组疗效明显优于对照组(P<0 .05)。结论:亚低温辅助治疗能明显降低弥漫性轴索损伤病人的病死率和致残率,疗效满意。     

亚低温治疗弥漫性轴索损伤的临床疗效

 目的研究亚低温对弥漫性轴索损伤(Diffuse axonal injury,DAI)的治疗作用及临床效果.方法53例DAI患者随机分为亚低温治疗组和对照组.亚低温治疗组26例,均于伤后24h内行亚低温治疗,直肠温度(BT)控制在32～33℃,持续1～7 d,同时监测患者的生命体征、颅内压(ICP)、血糖、血气、电解质.对照组27例,其他治疗同亚低温组.两组患者均于伤后3个月根据℃OS评估法判定疗效.结果与对照组相比,亚低温治疗组患者伤后早期的高ICP显著下降(P＜0.05);生命体征、血气及电解质差异无显著性意义(P＞0.05);无严重并发症,病死率降低,恢复良好率提高,预后显著改善.结论亚低温具有显著的脑保护作用,临床上用于治疗DAI患者,安全有效.     

重度弥漫性轴索损伤的亚低温治疗及其与颅内压和预后的关系

重度弥漫性轴索损伤(ｄｉｆｆｕｓｅａｘｏｎａｌｉｎｊｕｒｙ,ＤＡＩ)是脑损伤患者的主要死亡原因,也是造成伤后植物生存和严重致残的最常见原因。其临床诊断及治疗及时与否直接影响患者的预后。本科近年来应用亚低温等综合治疗重度弥漫性轴索损伤,取得较好疗效。现总结如下。一、资料与方法1.临床资料:80例重度脑外伤患者,其中男58例,女22例;年龄15～61岁。均在伤后6ｈ内入院,ＧＣＳ<8分,入院时经ＣＴ扫描、结合临床表现诊断为重度弥漫性轴索损伤。所有患者均给予激素、脱水剂、止血、抗炎等常规治疗。部分继发颅内血肿者行开颅手术(除外…     

亚低温治疗重度弥漫性轴索伤的临床研究

目的 旨在探讨亚低温对重度弥漫性轴索伤（DAI）的治疗作用及患者颅内压、预后的关系。方法 本组观察了80例重度弥漫性轴索伤,在常规治疗的同时,对60例亚低温治疗。80例重度DAI患者分为亚低温和常温两组,所有患者均行颅内压监护5－7天。全部患者于伤后3个月行GOS评分判断预后。结果 在亚低温组,其颅内压明显低于对照组（P＜0．05）;亚低温组的死亡率为26．7％,而常温治疗组为55％（P＜0．05）。结论 重度DAI后,不仅应及时诊断,而且要尽早应用亚低温治疗、尽早降温。亚低温治疗有明显降低颅内压的疗效。亚低温治疗可以明显提高重度DAI患者的生存率和生存质量,降低DAI的死亡率和伤残率。     

弥漫性轴索损伤行亚低温治疗的护理

弥漫性轴索损伤（diffuse axonal injury DAI）是外伤直接引起的脑白质广泛性轴索损伤，是闭合性颅脑损伤中最严重的原发性损伤之一，占重型颅脑损伤20％，占死亡病人的29％-43％。其临床特点为病情危重，昏迷时间长，并发症多，这就给临床治疗和护理提出了更高要求，早期行亚低温治疗并给予护理干预，将大大提高病人的生存率，降低死亡率，提高病人的生命生存质量。     

高压氧综合治疗弥慢性轴索损伤的效果

弥漫性轴索损伤 (diffuse axonal injury,DAI)是原发性颅脑损伤的一种特殊类型 ,其临床特点是病情危重 ,治疗困难 ,死亡率高。为了探讨高压氧 (HBO)对其疗效的影响 ,我们收集从 1992年 5月～ 1996年 5月和 1996年 6月～ 2 0 0 0年 12月收治的两组 DAI临床资料进行总结 ,发现应用 HBO治疗可取得满意的结果 ,现报告如下 ,供同道们参考。一、临床资料1.一般资料 :本组患者 76例 ,我们将 1992年 5月～1996年 5月收治的 DAI 36例 ,由于未用 HBO治疗 ,定为对照组 ;而将 1996年 6月～ 2 0 0 0年 12月收治的 DAI 40例 ,由于应用 HBO治疗 ,…     

亚低温对大鼠脑创伤性非断离轴突损伤继发断离的影响

目的 研究亚低温对创伤性非断离轴突损伤(nondisruptive axonal injury,NDAI)继发断离的影响,探讨其治疗价值.方法 将16只雄性SD大鼠采用随机数字表法分为亚低温组(32℃,持续6 h)和对照组(37.5℃)各8只,液压冲击致大鼠脑弥散性损伤,非磷酸化神经丝蛋白(NF68)免疫组化显示肿胀轴突及轴突球,比较两组伤后24 h、72 h胼胝体区、间脑中脑区、桥脑延脑区和小脑区肿胀轴突及轴突球最大密度变化.结果 伤后24 h,亚低温组各计数区肿胀轴突及轴突球明显减少(P<0.05),间脑中脑区、桥脑延脑区、小脑区尤为显著(P<0.01);而伤后72 h,亚低温组仅在距冲击部位较远的桥脑延脑区、小脑区减少(P<0.05,P<0.01),距冲击部位较近的胼胝体区、间脑中脑区不明显(P>0.05).结论 亚低温早期无论对损伤轻或重的NDAI均可延滞其继发断离的进程,但随着时间推移,这种效应逐渐减弱,仅对损伤较轻的NDAI有效,亚低温可能阻断部分损伤较轻的NDAI的继发断离.     

原发性脑干损伤的早期亚低温治疗

原发性脑干损伤是一种严重的颅脑损伤 ,有效的治疗方法不多 ,死亡率高[1 ] 。近年来 ,采用以亚低温为主的早期综合治疗使患者的预后有一定改善。本院 1999年 1月～ 2 0 0 1年 12月收治原发性脑干损伤 96例 ,均早期使用亚低温治疗。报告如下。临　床　资　料1.一般资料 :本组 96例 ,男 6 0例 ,女 36例 ;年龄 12～ 5 6岁 ,平均 38岁。其中交通伤 6 6例 ,坠落伤 30例。2 .入院时的症状与体征 :本组患者伤后 2～ 12ｈ入院。均呈昏迷状态 ,格拉斯哥昏迷评分 (ＧＣＳ) <8分。其中 2 5例有心率、呼吸节律或频率的变化 ;6 0例出现瞳孔时大时小或形状…     

弥漫性轴索损伤的临床诊疗进展

弥漫性轴索损伤是神经外科常见的疾病之一,其发病机制复杂,原发性损伤和继发性损伤成连琐样反应,临床症状重,伤后多有昏迷没有明确的神经定位体征,诊断主要依靠CT和MR,目前缺乏有效的治疗手段,本文就DAI的发生机制、国内外主要临床诊疗措施进行综述。     

镁离子对大鼠弥漫性轴索损伤超微结构的影响

目的探讨镁离子(Mg^2 )对脑弥漫性轴索损伤(diffuse axonal injury，DAI)脑干超微结构的影响。方法选健康成年雄性SD大鼠36只，体重350～450g，将其随机分为实验组、对照组、空白组，每组为12只。采用改良Marmarou模型制作DAI模型，伤后30min分别给予MgSO4 250μmol／kg、等渗盐水0．2ml，伤后24h处死。用透射电镜分别检测脑干超微结构，并行综合组织损伤评分。结果伤后24h，对照组髓鞘分离，线粒体嵴明显肿胀；实验组未见髓鞘分离，线粒体轻度肿胀。实验组脑干综合组织损伤程度评分明显轻于对照组。结论Mg^2 可在超微结构水平阻止DAI轴索的继发性损害，对DAI具有一定的保护作用。     

56例脑弥漫性轴索损伤的临床分析

目的 探讨脑弥漫性轴索损伤（ＤＡＩ）与脑挫裂伤、原发性脑干伤和脑震荡的关系。方法 分析５６例ＤＡＩ病人的临床资料和影像学特点,与原发性脑损伤的特征进行比较。结果 ５６例ＤＡＩ伤者中６６％为交通伤,多次暴力致伤比较常见（６１％）。伴脑挫裂伤者４０例（７１％）。ＣＴ／ＭＲＩ发现出血灶者４５例。结论 ＤＡＩ是常见的弥漫性脑损伤,脑震荡和原发脑干伤被包含其中,且常常与脑皮质挫裂伤伴发。将原发性脑损伤分为局     

急性弥漫性轴索损伤超微结构及血脑屏障改变的实验研究

目的 研究大鼠脑弥漫性轴索损伤后血脑屏障及超微结构在不同时间点的变化情况。方法 利用角加速度旋转模具制作大鼠急性弥漫性轴索损伤模型,在透射电镜下观察硝酸镧颗粒的分布情况和超微形态的改变。结果 大鼠弥漫性轴索损伤后３０ｍｉｎ血脑屏障通透性发生改变,２４ｈ通透性增加达到高峰,７２ｈ略有下降。超微结构以７２ｈ损害最为严重。结论 大鼠急性弥漫性轴索损伤后血脑屏障通透性增加是造成脑水肿的主要原因之一。超微结     

Diffusion-weighted MRI in diffuse axonal injury of the brain

The goal of this study was to identify and describe the different types and patterns of tissue injury which are encountered by diffusion-weighted imaging (DWI) in diffuse axonal injury (DAI) of the brain. The DWI data sets of 98 patients who suffered from a closed-head injury were retrospectively evaluated. Medical records were reviewed to rule out pre-existing neurological diseases. Lesions were studied for their DWI signal characteristics and lesion size or extension. Traumatic lesions were classified into three categories depending on their signal characteristica on DWI and apparent diffusion coefficient (ADC) maps: type 1, DWI- and ADC-hyperintense most likely representing lesions with vasogenic edema; type 2, DWI-hyperintense, ADC-hypointense indicating cytotoxic edema; type 3, central hemorrhagic lesion surrounded by an area of increased diffusion. According to the size and extent of lesions, injury was classified into three groups: group A, focal injury; group B, regional/confluent injury; and group C, extensive/diffuse injury. Our study showed that diffusion-weighted imaging differentiates between lesions with decreased and increased diffusion in patients with DAI. Different degrees of tissue injury extent were noticed. Future prospective studies should study if this additional information can be used as a predictor of injury reversibility, final outcome and prognosis.     

脑弥漫性轴索损伤的临床表现及CT诊断

目的探讨脑弥漫性轴索损伤(DAI)的临床表现、CT诊断。方法分析32例脑弥漫性轴索损伤的临床资料及cT图像资料。同时对所有病例进行GCS评分。结果DAI的CT征象主要为：a)弥漫性双侧脑白质水肿、脑肿胀、灰白质界限不清；b)脑室、脑池、脑沟及蛛网膜下腔变窄、消失，无中线移位；c)脑弥漫性肿胀，白质内点、片状出血，但未形成血肿，无占位效应；d)脑弥漫性肿胀伴硬脑膜下薄层出血。患者伤后昏迷时间越长，临床表现越重，GCS评分越低，cT显示脑室系统受压程度越重则预后越差。结论DAI根据临床表现及影像学检查可作出临床诊断?但DAI病情与CT表现不一致时需行CT薄层扫描或MRI检查。     

Pontine axonal injury after brain trauma and nontraumatic hypoxic-ischemic brain damage

Experimental studies have shown that diffuse axonal injury is usually induced by positive or negative acceleration mechanisms. In order to determine the reliability of axonal injury (AI) as a marker of this type of traumatic insult, we compared cases of trauma-induced focal cortical hemorrhage without dural involvement (n = 67) with cases of trauma-induced subdural bleeding without cortical hemorrhage (n = 26). Both groups exhibited a wide range of post-traumatic survival times. The injuries in the first group were caused mainly by direct impact to the head, those in the second by acceleration/deceleration mechanisms. The investigations were based primarily on immunohistochemical demonstration of antibodies targeted to β-amyloid precursor protein (β-APP) in the pons as a marker of AI and the results were assessed semiquantitatively. No significant differences were found between the two groups. In both groups AI was detected in 80–100% of cases with survival times of more than 3 h and two thirds of all positive cases showed pronounced positivity. Additional comparison of cases of brain death due to mechanical trauma (n = 14) with cases of brain death due to non-mechanical trauma (n = 18) also disclosed no significant intergroup differences. Finally, investigations of the pons in cases of non-traumatic death due to cerebral hypoxia/ischemia (n = 51) demonstrated AI with the same frequency as in the other groups, although the expression tended to be less pronounced. Our results confirm that β-APP expression in the pons is a reliable indicator of AI but does not discriminate between injuries caused by traumatic strain or shearing mechanisms and secondary damage due to cerebral hypoxia/ ischemia or edema. In the large majority of cases with prolonged post-traumatic survival, it can therefore be assumed that AI in the pons is the consequence of primary and/or secondary events or a combination of both, as is common in non-missile head injury survived for more than 90–120 min. Therefore, positive differentiation of the type of biomechanical event based on this criterion alone is not possible. Received: 19 December 1997 / Received in revised form: 1 April 1998     

大鼠创伤性轴索损伤后脑代谢质子磁共振波谱分析

目的 使用质子磁共振波谱(1H-MRS)研究大鼠创伤性轴索损伤(traumatic axonal injury,TAI)后组织代谢改变及其空间分布特征.方法 使大鼠头颅发生线加速和角加速运动制作TAI模型.于伤前和伤后24 h采用多体素MRS方法检测大鼠脑内多个部位的组织代谢状态,分析伤后N-乙酰门冬氨酸(NAA)/总肌酸(Cr)、NAA/胆碱类化合物(Cho)和Cho/Cr值变化及NAA/Cr值变化的空间分布特征.采用免疫组化标记β淀粉样蛋白前体蛋白(β-APP)观察轴索损伤情况.结果 与伤前相比,伤后24 h时NAA/Cr、NAA/Cho值显著下降(P<0.05).Cho/Cr值轻度升高(P>0.05);NAA/Cr值出现较大降低幅度的部位依次为脑干、海马、内囊、胼胝体和丘脑.病理学检查示这些部位出现轴索损伤.结论 TAI后脑组织出现严重代谢紊乱,以脑干、海马等部位变化最为显著.

Abstract：

Objective To investigate the brain metabolic changes and evaluate their spatial distributions after traumatic axonal injury (TAI)in rats by using proton magnetic resonance spectroscopy(1H-MRS).Methods The TAI model was made by subjecting the head of the rats to the linear and angular accelerations.The multi-voxel MRS was employed to detect the tissue metabolic state at the levels of hippocampus-caudate and pons prior to injury and at 24 hours after injury.The alterations of NAA/Cr,NAA/Cho and Cho/Cr values as well as the spatial distribution of NAA/Cr reduction were accessed. Immunohistochemical staining for β-APP was used to observe the injured axons. Results A siguificantdecrease in NAA/Cr and NAA/Cho(P<0.05)and subtle increase in Cho/Cr(P>0.05)were observed in rats at 24 hours after TAI in comparison to the pre-injury levels.Notable decrease in NAA/Cr value was observed in the areas including the brain stem,hippocampus,internal capsule,corpus callosum and thalamus,where axonal injuries were confirmed by the histological examination. Conclusion Metabolic imbalances Occur in the brains of rats with TAI.with notable changes in the brain stem and the hippocampus.     

磁敏感加权成像在弥漫性轴索损伤中的应用

目的：探讨磁敏感加权成像（SWI）技术在弥漫性轴索损伤（DAI）中的临床应用价值。方法收集临床诊断为DAI的患者25例,均行常规T1WI、T2WI、液体衰减反转恢复（FLAIR）、弥散加权磁共振成像（DWI）及SWI。结果25例患者中SWI较常规序列能清楚地显示脑内微小出血灶。结论在DAI患者中,SWI可提供更多的影像信息,在诊断DAI和治疗方案的制定中具有重要的临床应用价值。     

临床征象对弥漫性轴索损伤患者预后判断的价值

目的 研究弥漫性轴索损伤(diffuse axonal injury,DAI)患者临床征象与预后的关系,寻找能准确判断预后的指标,建立预测DAI患者预后的模型. 方法 对98例DAI患者资料进行回顾性分析,利用SAS 8.1进行Cochran - Mantel - Haenszel x2检验或Student - Newman -Keuls单向方差检验,分析各项指标与预后分级的关系.再将筛选出的与预后相关的指标与预后行多元累积逐步分析,建立Logistic回归模型. 结果 (1)入院时GCS、合并其他类型脑损伤、生命体征紊乱、瞳孔异常、去脑强直、影像学有DAI特征性征象、肢体瘫痪情况和意识障碍持续时间的长短与患者预后有关;而性别、年龄、致伤机制、病理征和去皮质强直与患者的预后无关.(2)回归模型显示,患者入院时的GCS、肢体瘫痪程度、瞳孔异常和合并脑损伤是预测DAI患者预后的最好指标. 结论 Logistic回归模型可较准确地预测患者的预后.GCS越高的患者预后更好,肢体瘫痪程度越轻、无瞳孔变化、未合并其他类型脑损伤的患者预后良好.