弥漫性轴索损伤的临床特点与预后分析

Analysis of Clinical Characteristics and Prognosis in Diffuse Axonal Injuries

目的分析脑弥漫性轴索损伤 (Diffuseaxonalinjury ,DAI)的临床特征及其预后因素。方法按Levi分级法依据入院时格拉斯哥昏迷测量表 (GCS)评分和瞳孔情况 ,将本院 1 999年 6月至 2 0 0 2年 6月收治的 37例DAI病人分为Ⅰ～Ⅳ级 ,分析各级临床特点、入院时GCS和瞳孔变化与预后的关系。结果Ⅰ级 2例 ,Ⅱ级 5例 ,Ⅲ级 1 0例 ,Ⅳ级 2 0例。Ⅲ、Ⅳ级患者入院时GCS均明显低于Ⅱ级 (P <0 .0 5 ) ,其昏迷时间明显长于Ⅱ级 (P <0 .0 1 )。预后 :死亡组年龄分别大于中、重残组 (P <0 .0 5 )。死亡组GCS分别低于中、重残组 (P <0 .0 5 ) ,植物状态组GCS低于中残组 (P <0 .0 5 )。死亡组瞳孔改变发生率分别高于中、重残组 (P <0 .0 5 )。结论入院时GCS和瞳孔情况有助于对DAI病情判断及预后估计。

ObjectivesTo analyze the clinical characteristics and prognostic factors of diffuse axonal injuries (DAI).MethodsAccording to the Glasgow Coma Scale (GCS) and pupillary changes during admission ,37 patients conformed to the DAI forms for hospitalization from June,1999 to June,2002 were divided into four grades by means of Levi's classification. The inter relation between clinical characteristics, GCS, pattern of papillary changes and prognosis was analyzed.ResultsTwo, five, ten and twenty out of 37 patients belonged to grades Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively. The GCS scores in the patients with grade III and Ⅳ were significantly lower than those in patients with grade Ⅱ (P<0.05), while duration of primary coma in the former was longer than that in the latter (P<0.01). The prognosis of patients was divided into five grades based on Glasgow Outcome Score (GOS), including good recovery(GR),moderate disability(MD),severe disability(SD),persistent vegetative state(PVS) and death(D).The age of group D was elder than that of both disability groups (P<0.05). The GCS scores in the group D were lower than those in both disability groups (P< 0.05 ), whereas the GCS scores in group PVS were lower than those in group MD. The rate of pupillary abnormalities found in group D was higher than that in both disability groups, respectively (P<0.05).ConclusionGCS and papillary changes during admission are helpful to the judgment of disease severity and appraisal of prognosis in DAI.