对脑弥漫性轴索损伤的临床特征与诊断治疗的探讨

The clinical characteristics,diagnosis and treatment of the diffuse axonal injury of brain

目的探讨脑弥漫性轴索损伤(DAI)的发病机制,临床表现与CT扫描结果的关系以及诊断治疗方面问题,从而提高对DAI的诊断治疗水平。方法回顾性分析总结72例DAI患者的致伤机制,临床表现和影像学特点,并探讨伤后持续昏迷的时间与DAI的诊断治疗关系。结果致伤原因主要为交通事故伤57例(79.2%),多次暴力致伤比较常见。发病机制主要是由于外伤使颅脑产生旋转加速度和角加速度,使脑组织内部发生剪力作用,导致神经轴索和小血管损伤,CT扫描有出血灶58例。恢复良好19例,轻残13例,中残10例,重残10例,植物生存3例,死亡17例(23.6%)。结论脑外伤后持续昏迷时间超过6h,临床表现重,而影像学检查有多发散在点状出血灶或无明显脑损伤情况,又无明显占位效应者,即可诊断为DAI。治疗方面,DAI一般都不需要手术治疗,保守治疗在昏迷期间主要保持呼吸道通畅,防止各种并发症,改善脑微循环及促进脑细胞功能恢复药物等综合治疗措施。

Objective To approach tile relationship of the causes,clinical feature and the computed tomography（CT）results of the diffuse axonal injury（DAI）of brain and improve the diagnosis and treatment. Methods To analyze the feature of clinical and imageology in 72 cases with DAI of brain retrospectively .Results The causes of DAI in this study were mainly traffic accident（57 cases; 79.2% ）in 72 patients and the multiple violence were common in injury. The mechanism DAI was that injury caused to cofiolis acceleration and/or angular acceleration and shear forece on the brain tissue of patients,which leading injury of cylindraxile and small blood vessel. CT shown that 58 cases had the hemorrhagic focus in brains. After treatment, 19 cases were recovered, 13 cases were mild maimed, 10 cases were middle maimed, 10 cases were heavy maimed,3 cases were in the vegetative state and 17 cases were dead. Conclusion DAI may be diagnosed when patients had cerebral trauma with persistence coma fur 6 hours, severe clinical manifestation, and CT shown locus hemorrhage and no occupied lesion in brain.The surgery treatment for DAI is not necessary generally .The expectant treatments for DAI in the period of coma are synthetic treatment to keep improving microcirculation of brain and recover the function of brain with medicine.