弥散性脑损伤的救治

Treatment of diffuse brain injury

目的探讨弥散性脑损伤的发生机制、影像学表现、诊断与处理方法。方法回顾性分析217例弥散性脑损伤患者的致伤原因、救治措施及预后。结果致伤原因多为交通伤及坠落伤;损伤类型多为弥散性轴索损伤、弥散性脑肿胀,可合并蛛网膜下腔出血、脑挫裂伤和颅内血肿等。入院时格拉斯哥昏迷评分(GCS)≤8分145例(66.8%);死亡69例(31.8%),其中GCS≤5分的死亡患者为43例,占死亡总数的62.3%。结论弥散性脑损伤的诊断主要依靠典型临床表现与影像学表现。治疗上采取综合方法;及时手术解除脑受压,保持生命体征平稳,积极防治并发症,是患者获得良好预后的关键。

Objective To explore the pathogenesis, imaging findings, diagnosis and treatment of diffuse brain injury （DBI）. Methods The causes,diagnosis and treatment as well as prognosis of 217 diffuse brain injury cases were retrospectively analyzed. Results The main reasons for injury were traffic accidents and fall from high, which mainly caused diffuse axonal injury and diffuse brain edema possibly complicated with subarachnoid hemorrhage, brain contusion and intracranial hematoma. On admission, there were 145 cases （66.8% ） with GCS ≤ 8 in whom 69 cases died （31.8%） ,but 43 died in the patients with GCS of ≤5 （62.3%）. Conclusion The diagnosis of DBI is mainly based on the clinical manifestation and the imaging findings. Comprehensive therapy should be adopted. Timely operation to relieve intracranial pressure,keeping life sign stable and intensive prevention of complications were the key to the better prognosis of diffuse brain injury.