醉酒后重型颅脑损伤54例临床特点及治疗分析

CLINICAL FEATURES AND TREATMENTS OF SEVERE TRAUMATIC BRAIN INJURY AFTER ETHANOL INTOXICATION

目的总结醉酒后重型颅脑损伤的临床特点及治疗。方法回顾性分析醉酒后重型颅脑损伤患者的临床资料。结果本组54例,年龄18～46岁。车祸伤31例;摔伤12例;殴打伤11例。闭合伤41例,开放伤13例。合并颅内血肿23例;并发颅骨骨折35例,其中凹陷性骨折16例;不同程度脑挫裂伤41例;迟发性颅内血肿9例。GCS计分:3～5分23例,6～8分31例。全组均有不同程度的意识障碍:昏迷者29例、昏睡者9例、烦躁不安者16例。39例施行血肿清除、去骨瓣减压、凹陷骨折复位术等手术治疗,另外15例保守治疗。气管切开者29例。GOS预后评分:恢复良好者24例(44.4%),中残者10例(18.5%),重残者12例(22.2%),植物状态生存2例(3.7%),死亡6例(11.1%)。其中延误诊断5例(9.3%),出现并发症21例(38.9%)。结论避免延误诊断的关键在于提高医务人员对醉酒与颅脑损伤之间相互关系的认识,同时使用纳洛酮消除急性乙醇中毒对神志判断的影响,加强呼吸道的管理、早期气管切开及使用制酸剂可以减少并发症的发生。

Objective To investigate the clinical features and the treatments of severe traumatic brain injury after ethanol intoxication. Methods 54 patients with the severe traumatic brain injury after ethanol intoxication were analyzed retrospectively. Results 54 patients were assessed according to the GOS： 24 cases with a goof recovery（44. 4%）, 10 cases were left with moderate disabilities（18.5 %）, 12 cases were severely disabilities（22.2 %）, 2 cases were left in a persistent vegetative state（3.7%）, 6 cases died（11.1%）. 5 cases were delayed diagnosis（9.3%）and 21 cases had occurred complications（38. 9%）. Conclusion The key to avoid delayed diagnosis is that the doctors should understand the correlations between ethanol intoxication and traumatic brain injury. Injecting Naloxone can depress the influence of the acute intoxication on the level of consciousness. Furthermore, intensive management of airway ,early incision of trachea and antiacid therapy should be utilized to prevent the occurrence of complications.