外伤后颈内动脉闭塞的诊治（附三例报告）

Diagnosis and treatment of post-traumatic occlusion of internal carotid artery： A report of three cases

目的 探讨外伤后颈内动脉闭塞的临床特点、诊断及救治方法.方法 回顾性分析2016年4月至2017年3月武警后勤学院附属医院神经危重症医学科收治的3例外伤后颈内动脉闭塞患者的临床资料.3例均出现大面积脑梗死,其中行保守治疗1例,行去大骨瓣减压＋内减压术2例.结果 随访时间为5-12个月.格拉斯哥预后分级Ⅳ级1例,Ⅲ级2例.结论 外伤后颈内动脉闭塞的发病率低,易误诊,常导致大面积脑梗死,预后较差.合理应用MRI、磁共振血管成像、CT血管成像以及数字减影血管造影检查有助于早期明确诊断.早期行抗血小板聚集治疗、血管内治疗以及去大骨瓣减压术是治疗本病的主要方法.早期明确诊断、早期治疗是影响本病患者预后的关键.

Objective To investigate the clinical characteristics,diagnosis and treatmnent strategies of post-traumatic occlusion of internal carotid artery.Methods The clinical data of 3 patients with posttraumatic occlusion of internal carotid artery were analyzed retrospectively who underwent treatment at neurological intensive care unit of Affiliated Hospital of Logistics University of Chinese People＇s Armed Police Forces from April 2016 to March 2017.Results Among the 3 patients with massive cerebral infarction treated successfully,1 underwent conservative treatment and the other 2 received decompressive craniectomy and internal decompression.Followed up for 5-12 months,the patients showed the GOS （Glasgow outcome scale） score of 4 in 1 case and 3 in 2 cases.Conclusions Post-traumatic occlusion of internal carotid artery is relatively rare and easy to be misdiagnosed,which often results in massive cerebral infarction and its prognosis seems to be very poor.Reasonable application of MRI,MRA,CTA and DSA could be helpful for early diagnosis.The major treatment includes early antiplatelet therapy,endovascular treatment and large decompressive craniectomy.Early diagnosis and treatment are important to its prognosis.