47例脑弥漫性轴索损伤的临床诊治及预后分析(1)
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[摘要] 目的：探讨脑弥漫性轴索损伤(DAI)的临床特点及其影响预后的因素。方法：分析我科2004年12月～2007年12月收治的47例DAI患者的临床资料和影像学特点及治疗后的结果，探讨原发性昏迷时间及GCS评分与预后的关系。结果：47例DAI伤者中以交通伤较常见(70%)。CT扫描发现脑不同部位有点状高密度影32例(68%)，CT阴性而行MRI者发现病变者11例。4例CT及MRI扫描均无异常发现。共死亡11例，植物生存9例，残疾12例，预后良好15例。结论：DAI诊断主要根据临床表现，同时结合CT、MRI等影像学资料；治疗采用综合治疗；GCS评分及原发昏迷时间有助于判断预后。
[关键词] 脑损伤；弥漫性轴索损伤；影像学；预后
[中图分类号] R651.1+5[文献标识码]C [文章编号]1673-7210(2009)05(c)-039-03
Clinical diagnosis, treatment and prognosis of 47 cases of cerebral diffuse axonal injury
LIAN Zhenghua，JIAN Junjie
(Department of Neurosurgery, the First People's Hospital of Jinzhou District, Dalian 116100, China)
[Abstract] Objective: To study the clinical characteristics and prognosis of the patients with diffuse axonal injury(DAI).Methods: The clinical characteristics, the data ofimagingand the results of the treatment of 47 patients with DAI hospitalized in the department from December 2004 to December 2007 as well as the relationship between the times of primary coma, Glasgow Coma Scale (GCS) and the prognosis were analyzed. Results: Traffic accidents were the main causes (70%). Among the cases, dot high-density shadows were found in different sites of the brain of 32 patients (68%) by CT scanning. After head injury, lesions not found by CT scanning were found by MRI in 11 patients. No abnormality was found in both CT and MRI in 4 patients. Among the patients, 11 patients died, 9 cases survived in a vegetative state, 12 cases disabled, 15 cases completely recovered. Conclusion: Diagnosis of DAI mostly depended on clinical manifestation, and also on CT, MRI imagingmaterials. DAI should be integrated treatment. GCS and the continuous time of primary coma are useful for the determination of the prognosis of DAI.
[Key words] Brain injuries; Diffuse axonal injury; Imaging; Prognosis
脑弥漫性轴索损伤(DAI)多见于重型颅脑损伤，是颅脑外伤致死和致残的重要原因。我科于2004年12月～2007年12月收治47例DAI患者，下面就临床特征和影像学资料进行分析，并探讨影响预后的因素。
1 资料与方法
1.1 一般资料
收集本院神经外科2004年12月～2007年12月收治的47例DAI患者，其中，男性36例，女性11例；年龄2～74岁，平均28.7岁。
1.2 致伤原因
47例DAI患者均为闭合性损伤；其中，交通伤33例，高空坠落伤8例，其他伤6例。
1.3 临床表现
①原发意识障碍：根据意识障碍时间的长短来划分 ......
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