创伤性脑血管损伤的识别和治疗

Diagnosis and treatment of traumatic cerebrovascular injury

目的探讨创伤性脑血管损伤(TCVI)的危险因素、临床表现及救治方法。方法回顾性分析2012年1月至2022年12月苏州大学附属张家港医院收治的39例TCVI患者的临床资料,统计其临床表现及治疗方法。结果创伤性脑动脉狭窄或闭塞19例患者中,12例予以抗栓治疗,8例血管管腔完全恢复正常,4例未再通,7例予以支架植入开通血管,死亡1例;创伤性脑动脉瘤8例患者,均行手术治疗,死亡2例;创伤性颈内动脉海绵窦瘘9例患者,均行手术治疗,术后相关症状消失,均恢复良好;脑动脉横断3例患者中,行手术治疗后死亡1例,2例恢复良好。结论对于头颅CT无法解释的神经系统症状、格拉斯哥昏迷评分3~8分、局限性或弥漫性较厚的蛛网膜下腔出血、口鼻腔或外耳道大量出血、颈椎C1~3骨折、颈椎骨折半脱位、穿透性损伤、损伤后出现新的神经系统症状或体征的外伤患者要高度警惕TCVI的存在,可行头颈部CT血管成像或数字减影血管造影明确,针对不同类型的TCVI患者采取个体化治疗方案,有助于改善患者神经功能及预后。

Objective To explore the risk factors,clinical manifestations,and treatment of traumatic cerebrovascular injury.Methods The clinical data of 39 patients with traumatic cerebrovascular injury admitted to Zhangjiagang Hospital Affiliated to Soochow University from January 2012 to December 2022 were analyzed retrospectively.The clinical manifestations and treatment methods were analyzed.Results Among 19 patients with traumatic cerebral artery stenosis or occlusion,12 patients were treated with antithrombotic therapy,withe 8 patients with normal vascular lumen and the other 4 patients without recanalization,and 7 patients were opened with stent implantation,with 1 patient died.Among 8 patients with traumatic aneurysm who underwent surgical treatment,2 patients died.The symptoms of 9 cases of traumatic carotid cavernous fistula disappeared after surgical treatment,with all recovered well.One patient died and 2 patients recovered well after surgical treatment in 3 patients with cerebral artery transection.Conclusion The patients with neurological symptoms,which cannot be explained by head CT,GCS scores of 3-8 points,localized or diffuse thick subarachnoid hemorrhage,massive hemorrhage in the oral and nasal cavity or external ear canal,cervical vertebra C1-3 fracture,cervical vertebra fracture subluxation,penetrating injury,and new neurological symptoms or signs after injury,should be paid high attension to traumatic cerebrovascular injury,and can be identified by head and neck CT angiography or digital substraction angiography.Individualized treatment for different types of TCVI patients is helpful to improve the neurological function and prognosis of patients.