34例脑弥漫性轴索损伤的临床特点与预后

目的　分析脑弥漫性轴索损伤（diffuseaxonalinjury,DAI）的临床特点及其与预后的关系。　方法　依据伤后昏迷的时间，将我科1997年8月～1999年月12月收治的34例DAI病人分为轻、中、重3组，分析3组病人的临床特点、CT资料及治疗后的结果；分析原发昏迷和入院时GCS与预后的关系。　结果　重度组26例（76%），伤后24h内CT扫描12例（46%）发现脑不同部位有点状高密度影，26例中死亡8例，预后良好者7例；中度组5例（15%）,CT扫描仅1例发现脑内点状高密度影，除中残1例外其余恢复良好；轻度组3例（9%），CT扫描无异常发现，全部恢复良好。中-重度组入院时GCS明显低于轻度组(P<0.05，P<0.01),原发性昏迷持续时间亦显著长于轻度组。　结论　脑外伤后持续昏迷超过6h而CT扫描无明显占位病灶者，即可诊断DAI；临床分度、GCS和原发性昏迷时间有助于判断预后。

Clinical characteristics and prognosis of 34 patients with cerebral diffuse axonal injury

Objective To analyze the clinical characteristics and prognosis of the patients with cerebral diffuse axonal injury (DAI). Methods A total of 34 patients with DAI hospitalized in the department from the year of 1997 to 1999 were divided into three groups, that is, the mild group (n=3, 9%), the moderate group (n= 5, 15%) and the severe group (n=26, 76%) according to the persistent time of coma after injury. The clinical characteristics, the materials of CT scanning and the results of the treatment were analyzed. Furthermore, the relationships between the time of primary coma, Glasgow Coma Scale (GCS) and the prognosis were also analyzed. Results In the severe group, dot high density shadows were found in different sites of the brain of 12 patients (46%) by CT scanning within 24 hours after head injury, in the end, 8 patients died and 7 had good results. In the moderate group, dot high density shadow was found in only one case and one was moderately disabled. In the mild group, no abnormality in CT scanning was found and all of the patients were found good prognosis. Conclusions It can be diagnosed as DAI if the primary coma is longer than 6 hours after head injury and no obvious occupied damage was found in the brain by CT scanning. The clinical division, GCS and the persistent time of primary coma are useful for the determination of the prognosis of DAI.