电击伤后并发脑损伤的临床分析

Clinical analysis of brain injury in patients injured by high voltage electricity

目的 探讨电击伤后并发脑损伤的发病特点及诊治方法。 方法 收集笔者单位近年收治的 138例电击伤患者的临床资料 ,根据临床表现及影像学检查结果 ,判断其是否并发脑部损伤 ,并将受损程度分为轻、中、重、特重度 4类。分析电流出入口部位及电压高低与脑损伤的关系 ,提出可能的致病原因。根据诊断结果 ,选择合适的治疗方案。 结果 本组患者中 ,有 10 6例并发脑损伤 ,4例为重度 ,其余为轻、中度 ,影像学检查可见脑部阳性病变。致伤电压的高低、电流出入口部位与脑损伤发生率关系不大 ,但二者与脑损伤程度有密切关系。本组患者经治疗 ,131例治愈 ,7例死亡 ,但无1例因脑损伤而致死。 结论 高压电击伤后脑损伤的发生率较高 ,其原因可能与电流对脑部的直接损害、机械性损伤、电流所致心肺疾病、大面积烧伤均有关 ,早期、正确地诊断、治疗 ,是减少死亡率、致残率的关键。

Objective To explore the pathogenic characteristics and management of brain injury in patients injured by high voltage electricity. Methods One hundred and thirty eight patients injured by electricity were enrolled in this study. Postburn brain injury was diagnosed by clinical sighs and imaging analysis. The brain injury was graded as mild, moderate, severe and most severe. The relationships among the inlet of the electric current and the electric voltage and the degree of brain injury were analyzed, and the causes and pathogenesis of the brain injury were suggested. Treatment modality was optimized for the patients according to the diagnostic data. Results In this group of patients, brain injury was identified in 106 cases, mostly rated as mild and moderate. Only 4 cases were ranked as severe degree with positive imaging findings. The electric voltage seemed to be not correlated with the incidence of postburn brain injury. But the intensity of electric current and the locations of electrical current inlet and outlet were closely related to the degree of brain injury. Among all the patients in this group, 131 survived and 7 died after treatment. But there was no death due directly to brain injury. Conclusion There was high incidence of postburn brain injury in patients injured by high voltage electricity. The injury might be related to the direct effect of electrical current on the brain tissue, to mechanical injury, to the cardio-pulmonary lesions caused by electrical current, or to massive skin burn. Early and accurate diagnosis of the injury was of key importance for lowering both mortality and disability.