脑组织弥漫性轴索损伤的临床诊断和治疗探讨

目的:总结58例脑组织弥漫性轴索损伤(DA I)患者的特点,拟对其损伤机制、诊断和治疗要点进行分析和探讨。方法:经过分析病史,伤后临床表现,全身及神经系统检查,脑CT及M R I影像学特点等,其中58例确诊为脑组织弥漫性轴索损伤。结果:本组病例占同期重型颅脑损伤的29.29%,按Jennett和Boond提出的治疗结果分类法,Ⅰ级12例,Ⅱ级5例,Ⅲ级10例,Ⅳ级14例,Ⅴ级17例。结论:脑组织弥漫性轴索损伤是一种广泛性脑实质损害,临床表现严重。要严格观察病情变化,随时调整治疗方案,相当一部分患者有望得到较好的效果。急性期后,注意功能锻炼,促进功能恢复。

Diffuse axonal injury a discussion of clinical diagnosis and treatment

Objective:Difust axonal injury(DAI) has the features of bad wounds,progressive deterio-ration,troublesome treatments and poor outcome.The author analyzed fifty-eight cases of DAI and disc-ussed the main points of its mechanisms,diagnosis and treatments.Methods:A total of 198 cases of severe craniocerebral injury received treatments in the author′s department.After the data collection of their histories,clinical situations,physical examinations and neuroimaging features(including CT and MR scan),58 cases of them were diagnosed as DAI.Results:There were 198 cases of severe craniocerebral injury,and 58 cases of them diagnosed as ADI(29.29%).According to Jennett-Boond Outcome Classifi-cation,there were 12 cases(20.68%) of death in Grade Ⅰ,5 cases in Grade Ⅱ,10 cases in Grade Ⅲ,14 cases in Grade Ⅳ and 17 cases in Grade Ⅴ.Conclusion:DAI is a kind of extensive damage in brain tissue and presentic a critical clinical situation.Closely monitoring and promptly therapeutic adjustment will give quite a few patients the benefits of better outcome.After the acute stage of injury,the author suggests paying more attention to functional exercises in order to achieve a better condition.