外伤、术后出现肢体瘫痪12例的病因分析

Etiological analysis of 12 cases of limb paralysis after trauma and postoperative

目的探讨外伤、术后出现肢体瘫痪的病因、临床特点及预后。方法收集2012年1月至2017年12月河北医科大学第一医院诊治的12例临床资料进行回顾性分析,总结发病时间,腰穿、肌电图的表现特点。结果2012年1月至2017年12月河北医科大学第一医院诊治的12例外伤、术后出现肢体瘫痪的患者,发病前均无肺部、肠道感染史,无疫苗接种史;其中男性8例,女性4例,年龄(50.3±4.7)岁,2例患有糖尿病,4例患有高血压病,6例体健。发病无明显的性别及年龄差异。12例患者在外伤、术后2~3d出现肢体瘫痪,5~11d进行性加重,可伴有呼吸肌麻痹、感觉异常,腱反射减弱或引不出,无感觉平面。4例行腰穿检查:可见蛋白细胞分离。3例肌电图:提示波幅明显下降,传导速度减慢,重复电刺激未见异常。7例行头CT提示颅内血肿、蛛网膜下腔出血。12例患者经历全麻或硬膜外麻醉术,有肌松剂的应用,其中10例应用脑苷肌肽或神经节苷脂类药,7例有激素应用史,6例应用丙种球蛋白。经半年随访:5例死亡,6例遗留瘫痪,1例预后良好。结论外伤、手术的患者出现肢体瘫痪,具体病因复杂,治疗效果及预后差,因此早期认识此类疾病,做到早干预、早治疗、早康复,以减轻患者痛苦,提高生存质量。

Objective To explore the etiology,clinical characteristics and prognosis of limb paralysis after trauma and postoperative.Methods The clinical data of 12 patients were retrospectively analyzed,and the characteristics of the time of onset,waist and electromyography were summarized.Results 12 cases were in trauma,2-3 days after limb paralysis,5-11 days progression,and may be accompanied by respiratory myoparalysis,paresthesia,tendon hyporeflexia or not,4 cases of lumbar puncture protein cell separation,3 cases of electromyography tip amplitude decreases obviously,slow conduction velocity,repeated electrical stimulation did not see abnormalities.Conclusion Patients with trauma,surgery limb paralysis,the cause is complex,therapeutic effect and prognosis is poor,so early understanding of these diseases,early intervention,early treatment,early rehabilitation,to alleviate the patients′pain and improve the quality of survival.