重型脑弥漫性轴索损伤的诊断与治疗

Diagnosis and treatment of severe diffuse axonal injury.

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200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30例(15%)、中残30例(15%)、重残38例(19%)、植物生存12例(6%)、死亡90例(45%)。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MR I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。

Objective To study the pathogcnesis,clinical characteristics,diagnosis,treatment and prognosis of severe diffuse axonal injury （ DAI ）. Methods Clinical data of 200 cases with severe DAI were retrospectively analyzed. Results Final outcome in patients were graded at 6 months after injury according to Glasgow Outcome Scale （COS） categories： good recovery in 30 cases （15%） ,moderate disability in 30 cases （15%）, severe disability in 38 cases （ 19%） ,vegetative state in 12 cases （6%） and death in 90 cases （45%）. 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 persistenttime of coma and the poorer the prognosis.