脑弥漫性轴索损伤64例临床分析

目的探讨脑弥漫性轴索损伤（DAI）的发病机制、临床表现、CT和MRI扫描与结果的关系，从而提高对DAI的诊断治疗水平。方法回顾性分析65例脑弥漫性轴索损伤患者的临床资料。结果41例DAI伤者为交通事故。CT扫描发现脑不同部位有点状高密度影43例（66％），CT阴性而行MRI者发现病变者19例。3例CT及MRI扫描均无异常发现。共死亡15例，植物生存11例，残疾15例，预后良好24例。结论脑外伤后持续昏迷时间超过6h，临床表现重，而影像学检查有多发散在点状出血灶或无明显脑损伤情况，又无明显占位效应者，即可诊断为DAI。治疗方面，DAI一般都不需要手术治疗，保守治疗在昏迷期间主要保持呼吸道通畅，防止各种并发症，改善脑微循环及促进脑细胞功能恢复药物等综合治疗措施。GCS评分及原发昏迷时间有助于判断预后。

Analysis of clinical Characteristics of 64 patients with diffuse axonal injury

Objective To approach the relationship of the causes, clinical feature and the CT, MRI results of the difuse axonal injury（DAI） of brain for improving the diagnosis and treatment. Methods Clinical data of 65 cases DA1 were retrospectively analyzed. Results 41 cases traffic accidents were the main causes. Among the cases, tigh - density shadows were found in different sites of the brain of 43 patients（66% ）by CT scanning. After head injury, lesions not found by CT scanning were found by MRI in 19 patients. No abnormality was found in both CT and MRI in 3 patients. Among the patients, 15 patients died,11 cases survived in a vegetative state,15 cases disabled,24 cases completely recovered. Conclusion DAI may be diagnosed when patients had cerebral trauma with persistence coma for 6 hours and severe clinical manifestation. And the surgery treatment.for DAI was not necessary generally. The conservative treatments for DAI in the period of coma are synthetic treatment to keep improving microcircutation of brain and recover the function of brain with medicine. GCS and the continuous time for primary coma are useful for helping determine prognosis.