脑震荡病理机制探讨

Pathological mechanism of cerebral concussion

目的 观察脑震荡昏迷期患者的临床体征、症状和脑干听觉诱发电位（ Ｂ Ａ Ｅ Ｐ） 变化的关系， 研究脑震荡可能的病理生理基础。方法 从１８６０ 例急性颅脑损伤患者中选出受伤后５ 分钟内送院， 昏迷时间２０ ～３０ 分钟的脑震荡患者及弥漫性轴索损伤（ Ｄ Ａ Ｉ） 患者各１５ 例进行意识、瞳孔、生命征等指标的对照及 Ｂ Ａ Ｅ Ｐ的动态观察。结果 脑震荡患者昏迷期各临床指标和 Ｂ Ａ Ｅ Ｐ 的变化与弥漫性轴索损伤患者相近。结论 脑震荡由于头部外伤尤其是剪应力的作用 而引起中线结构如脑干、间脑等受损而导致昏迷及植物神经功能失调， 符合轴索损伤的病理生理变化。

Objective To research the pathological changes of cerebral concussion through the observation of the relationship between clinical manifestation and BAEP changes of these patients at coma stage. Methods Fifteen cases of cerebral concussion patients were selected from 1860 cases of head injured patients, who were transferred to hospital within 5 min after injury and with coma lasting 20～30 min. The alternation of BAEP, consciousness level, size of pupils and vital singnas were monitored and then compared with those of diffuse axonal injury patients. Results The above monitored clinical parameters and the alterntion of BAEP in cerebral concussion patients at coma stage are similar to those of axonal injury patients. Conclusions Concussion patients who have injury (trauma, especially shearing stress ) of mid line structure, such as brainstem and diencephalon brain may lead to coma and functional dystarbance of autonomic nervous system.