重型弥漫性轴索损伤的诊治

目的:探讨重型脑弥漫性轴索损伤的发病机制、临床特点、诊断、治疗和预后.方法:回顾性分析65例重型脑弥漫性轴索损伤患者的临床资料.结果:伤后6个月根据格拉斯哥预后分级:恢复良好14例(21.5%)、中残10例(15.4%)、重残7例(10.8%)、植物生存7例(10.8%)、死亡27例(41.5%).结论:重型脑弥漫性轴索损伤是重型颅脑损伤患者死亡的主要原因,致残率高;意识障碍是其典型临床表现.其诊断MRI检查优于CT;大部分采取保守治疗.格拉斯哥昏迷评分越低,患者昏迷持续时间越长,预后越差.

Diagnosis and Treatment of Severe Diffuse Axonal Injury

Objective:To study the pathogenesis,clinical characteristics,diagnosis,treatment and prognosis of severe dif- fuse axonal injury(DAI).Methods:Clinical data of 65 cases with severe DAI were retrospectively analyzed.Results:Final outcome in patientswere graded at 6 months after injury accord- ing to Glasgow Outcome Scale(GOS)categories:good recovery in 14 cases(21.5%),moderate disability in 10 cases (15.4%),severe disability in 7 cases(10.8%),vegetative state in 7 cases (10.8%) and death in 27 cases (41.5%). Conclusion:Severe DAI is the main cause of severe head injury,with high disability rate.Consciousness disturbance after head injury is its typical clinical presentation.MRI is superior to CT for the diagnosis.Most patients underwent conservative therapy.The lower the GCS,the longer the persistent time of coma and the poorer the prognosis.