弥漫性轴索损伤92例临床研究

The clinical study of diffuse axonal injury among 92 patients

目的探讨弥漫性轴索损伤 (DAI)的受伤机制、临床特点及眼底检查在观察病情变化中的意义。方法对 92例弥漫性轴索损伤患者进行格拉斯哥评分、眼底检查 ,并分析其受伤机制 ;治疗结果按格拉斯哥治疗结果分极 (GOS)的 5级划分进行评定。结果 92例病人中车祸伤占 77 2 % ,格拉斯哥昏迷记分 (GCS)评分 8分以下者共 88例 ,占 88 0 % ,4分以下者 4 4例。伤后 6个月的GOS为 ,死亡 37例 ,植物生存 2 1例 ,严重伤残 2 8例 ,恢复良好 6例。 32例病人合并弥漫性脑肿胀 (DBS) ,眼底检查能及时发现颅内压增高 ,对早期发现DBS有重要意义。结论DAI死亡率和致残率均很高 ,车祸是其主要致伤原因。由于脑内出现剪力伤 ,DAI患者易并发DBS ;

Objective To study the traumatic mechanism, clinical characteristics and the implying of ocular fundus for patients with diffuse axonal injury(DAI). Methods The Glasgow Coma Score (GCS) and ocular fundus were studied on the 92 patients, and the traumatic mechanism was analyzed. The outcome was assessed according to Glasgow Outcome Score (GOS) Results The etiology of 77.2% patients were caused by traffic accidents. There were 8 cases with GOS less than 8 score, 44 cases with GOS less than 4 score. The GOS for patients Six months after trauma are as following; 37 cases were dead, 21 cases were vegetable survival, 28 cases were sever disabled and 6 cases had favourable outcome. The 32 patients simultaneously had diffuse brain swelling (DBS). The funduscopy could found high intracrainal pressure. It was valuable to early find DBS. Conclusions The DAI had a high mortality and disabled rate. The traffic accidents were major cause of DAI. Because of specific traumatic mechanism. DBS was easily caused in the patients with DAI. The funduscopy was valuable of find early DBS.