弥漫性脑损伤的诊断与救治

目的：探讨弥漫性脑损伤（DBI）的发生机制、影像学表现、诊断与处理方法，以提高治愈率，降低残、死率。方法：回顾性总结871例弥漫性脑损伤的致伤原因、损伤类型、救治措施及预后状况。结果：致伤原因主要为交通伤和坠落伤；损伤类型多为弥漫性轴索损伤、弥漫性脑肿胀，可合并有蛛网膜下腔出血、脑挫裂伤、脑内出血和血肿等；入院时格拉斯哥昏迷评分（GCS）≤8分660例（75．8％），其中3－5分365例（41．9％）；本组治愈好转率达75．4％（657／871），死亡率为19．7％（172／871），其中GCS≤5分的死亡率高达39．2％（143／365）。结论：DBI的诊断主要是临床表现与CT、MRI影像学的结合。治疗上应采取综合疗法，注意保持生命体征稳定，及时手术解除脑受压，加强手术前后的监护和开展亚低温疗法，这些是促使患者获得康复的重要手段。

Diagnosis and treatment of diffuse brain injury

Objective To explore pathogenesis, imaging findings, diagnostic and therapeutic methods of diffuse brain injury (DBI) in order to improve the cure rate and decrease mortality and deformity. Methods A retrospective analysis was done upon injury causes and types, treatment measures and prognosis of 871 cases with DBI. Results The main causes for DBI were traffic accidents and fall from height. The main types of DBI were diffuse axonal injury and diffuse brain edema,which could be complicated with subarachnoid hemorrhage, brain contusion, intracranial hemorrhage and brain hematoma. On admission, there were 660 cases (75.8%) with Glasgow Coma Scales (GCS) of 8 or less, among whom there were 365 cases (41.9%) with GCS of 3 5. The cure rate was 75.4% (657/871), and the mortality rate 19.7% (172/871). But the mortality rate of those with GCS of 5 or less was as high as 39.2% (143/365). Conclusions The diagnosis of DBI is mainly based on the clinical manifestation and the imaging findings of CT and MRI. Comprehensive therapy should be applied to the treatment of DBI. Keeping the life sign stable, timely operation to relieve intracranial pressure, intensive care before and after operation and mild hypothermia are important measures for the patients with DBI.