弥漫性轴索损伤患者的临床特点及治疗

目的探讨弥漫性轴索损伤（diffuse axonal injury,DAI）的发病机制、临床特点、诊断及治疗方法 ,以提高治愈率,降低致残、致死率。方法回顾性分析2006年6月2010年3月间65例临床诊断为DAI患者的受伤机制、临床特征、影像学表现、治疗及预后。结果 DAI最常见原因为车祸伤70.7%,其次为坠落、坠物伤（10.7%）,其他（18.6%）。按格拉斯哥昏迷分级（GCS）评分结果 3～5分18例,6～8分15例,9～12分32例;治愈43例,轻残15例,中残8例,重残或植物生存7例,死亡7例。结论 DAI具有诊断、治疗困难,预后差等特点,交通事故是导致DAI的主要原因,格拉斯哥昏迷分级（GCS）评分、昏迷时间和瞳孔变化是判定预后的重要指标。目前尚无特效治疗方法 ,由于80%以上患者往往是多发伤,故早期气管切开、呼吸机辅助呼吸、促醒、亚低温治疗、防治并发症、钙离子拮抗剂应用等综合治疗可显著改善预后。

Clinical Analysis of Cases with Diffuse Axonal Injury

Objective To investigate the effective treatments for diffuse axonal injury to improve its success rate and reduce disability rate and mortality rate. Methods Sixty-five cases with DAI were treated from June 2006 to March 2010. Results According to Glasgow coma scale （GCS） scores,the data showed good recovery in 43 cases （66.2%）,moderate disability in 8 cases （12.3%）,severe disability in 7 cases （10.8%）,and death in 7 cases （10.8%）. Three patients got a score lower than five,34 patients got six to nine,and 28 patients got 10 to 12.Conclusion Traffic accident is the main reason of DAI. The lower GCS score was,the worse the prognosis was worse. Early treatment,such as ventilator-assisted breathing,hypothermia treatment,preventions and treatments to complications,calcium antagonists etc,can improve the prognosis of DAI.