严重脑外伤后弥漫性轴索损伤225例临床分析

A Clinical Study of 225 cases of DAI after Severe Head Injury

本文就1993年1月—1995年6月间220731人次急诊总数中，收治于急诊病房和EICU的重症弥漫性脑损伤225例进行了临床分析。本组病例损伤机制绝大多数为因交通意外回转加速性损伤，伤后昏迷无中间清醒期，CT表现无明显占位效应，病死率和病残率俱高。文中对弥漫性脑损伤的病理改变、诊断及治疗上的特点进行了讨论。

During a period of 2.5 years(Jan 1993 -Jun.1995), 643 patients with severe bead injury were admitted to our department.225 consecutive patients (35%) in whom DAI (diffuse axonal injury )was diagnosed by CT scan (or MRI rarely)were hereby reported. DAI was almost always related to mechanisms of injury in which the rotational acceraleration produced shear and tensile strains of high magnitude.The hallmarks of DAI were resu1ted from the onset, a very slow rate of recovery, and poor prognosis for life and mentation. Evaluation on the GCS and CT findings on admission led to an improved ability to forecast outcomes.Several studies demonstrated that many cases of DAI may remain undiagnosed by CT scan.MRI was thought to be superior to CT for visualizing these lesions, the neurofilamentous disruption was a pivotal event in axonal injury.Some therapeutic methods indicated that its beneficial physiological and metabolic effects limited secondary brain injury from DAI. The authors were able to demonstrate with this study thatDAI was an important diagnosis and that its outcome could be classified on clinical ground at 24 hours,and have proposed clinical grading of DAI on this basis.The CT picture of absent third ventricle and basal cisterus was used to identify the cases. This grading scheme could provide a useful guide for clinicians in their discussion of individual patient outcome.