CAJ | 학술논문

目的探讨弥漫性轴索损伤(DAI)患者的临床特点、治疗及预后.方法广东省揭阳市人民医院神经外科自1999年1月至2009年12月共收治280例DDI患者,其中76例予以双侧开颅减压术治疗,204例保守治疗,回顾性分析患者的临床资料及治疗效果.结果本组患者恢复良好122例(43.6%),轻残或遗留部分并发症86例(30.7%),重残37例(13.2%),植物性生存2例(0.7%),死亡33例(11.8%).结论脑肿胀,一侧或双侧瞳孔散大DAI患者应及早行开颅去骨瓣减压术,昏迷时间长者及早行气管切开保持呼吸道通畅,早期脱水治疗选用20%甘露醇+速尿+白蛋白模式,辅助甲强龙冲击及亚低温治疗.
목적 탐토미만성축색손상(DAI)환자적림상특점、치료급예후.방법 광동성게양시인민의원신경외과자1999년1월지2009년12월공수치280례DDI환자,기중76례여이쌍측개로감압술치료,204례보수치료,회고성분석환자적림상자료급치료효과.결과 본조환자회복량호122례(43.6%),경잔혹유류부분병발증86례(30.7%),중잔37례(13.2%),식물성생존2례(0.7%),사망33례(11.8%).결론 뇌종창,일측혹쌍측동공산대DAI환자응급조행개로거골판감압술,혼미시간장자급조행기관절개보지호흡도통창,조기탈수치료선용20%감로순+속뇨+백단백모식,보조갑강룡충격급아저온치료.
Objective To discuss the clinical features and pathological changes of diffuse axonal injury (DAI), and explore the treatment and prognosis of patients with DAI. Methods Two hundred and eighty patients with DAI, admitted to our hospital from January 1999 to December 2009,were enrolled in our study; bilateral decompressive craniotomy was performed in 76 patients and conservative treatment in 204 patients; the clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Good recovery was achieved in 122 patients (43.6%), mild disability in 86 (30.7%), severe disability in 37 (13.2%), persistent vegetative state in 2 (0.7%) and death in 33 (11.8%). Conclusion Decompressive craniotomy is needed as early as possible for patients with brain swelling, unilateral or bilateral mydriasis; early tracheotomy should be performed for patients in coma for a long time to maintain airway smooth; 20% mannitol plus furosemide plus albumin, together with methylprednisolone and mild hypothermia therapy, can be employed to treat patients with early dehydration.