重型颅脑损伤患者继发性脑梗死的危险因素与对策

目的　探讨重型颅脑损伤患者继发性脑梗死 (DCI)的危险因素及对策。　方法　回顾近 6年收治的重型颅脑损伤患者 330例 ,分析发生DCI患者一般资料、临床特征、内环境因素和DCI防治效果。　结果　DCI者 5 1例 ,占 15 .5 % (5 1 330 ) ,其中发生在伤后低血压休克、低钠血症患者分别为 30 .2 % (16 5 3)和 2 8.6 % (14 4 9) ,是DCI发生重要的危险因素 (P <0 .0 5 ) ;损伤累及脑深部和中线基底部时 ,DCI的发生率明显增加为 2 1.6 % (40 185 ) (P <0 .0 5 ) ,预后较差 ;增容扩管 (白蛋白及尼莫地平 )和甲基强的松龙治疗组DCI发生率分别为 7.6 % (8 10 6 )和 8.6 % (3 35 ) ,发生率显著减少 ,预后较好 (P <0 .0 5 )。　结论　低血压休克、低钠血症、损伤累及脑深部和中线基底部是引起DCI的主要危险因素 ;积极清除积血压迫 ,引流蛛网膜下腔出血 ,维护正常内环境 ,白蛋白、尼莫地平及甲基强的松龙的应用 ,可较好地防治DCI。

Risk factors and countermeasures for delayed cerebral ischaemia following severe brain injury

Objective To evaluate risk factors and countermeasures for delayed cerebral ischaemia (DCI) after severe brain injury (SBI). Methods A total of 330 cases with severe brain injury in recent 6 years were analyzed in regard of general materials, clinical characteristics, internal condition and protective effect of DCI. Results There were 51 cases (15.5%, 51/330) suffering from DCI. The high attack rate of DCI after SBI was related to hypotension shock (30.2%, 16/53) and hyponatraemia (28.6%, 14/49) ( P <0.05), which were important risk factors inducing DCI. The incidence of DCI was increased significantly with a poor prognosis in cases with injury in deep, midline and base parts of brain (21.6%, 40/185) ( P <0.05). It with a favorable prognosis, could significantly reduce the morbidity of DCI to 7.6% (8/106) and 8.6% (3/35) respectively by treating with vasodilation therapy (Albumin and Nimodipine used) and high dose of Methylprednisdone ( P <0.05). Conclusions Hypotension shock, hyponatraemia and injury in the deep, midline and base parts of brain are the main risk factors for DCI following SBI. DCI can be prevented and cured by means of actively cleaning out hematoma suppression, draining SAH, sticking up for homeostasis and using Nimodipine, Methylprednisdone and Albumin.