CAJ | 학술논문

目的：通过对76例脑弥散性轴突损伤(dai)的受伤原因、临床表现与 ct 扫描结果关系进行分析，探讨 dai 的发病机制及临床诊断治疗问题。方法回顾性分析总结76例 dai 患者的致伤机制，临床表现和影像学检查特点，并探讨伤后持续昏迷的时间与 dai 的诊断治疗关系。结果致伤原因主要为交通事故伤59例（77.6%），发病机制是因为外伤使颅脑产生旋转加速度和/或角加速度，进而使脑组织内部产生剪力作用，造成神经轴索和小血管损伤。治疗结果为恢复良好者21例，轻残14例，中残11例，重残9例，3位患者属于植物生存，死亡18例（23.7%）。结论脑外伤之后持续昏迷时间大于6小时，临床症状程度严重，影像学检查有多发散在点状出血灶或者没有显著的脑损伤状况，没有显著性的占位效应，这样就可以判定其为 dai。此外，一般情况下，没有必要用手术治疗的方式治疗 dai，治疗dai 一般采用保守治疗，保守治疗主要是促进神经功能恢复药物及改善脑微循环，在昏迷期间保持呼吸道通畅，防止各种并发症综合治疗。
목적：통과대76례뇌미산성축돌손상(dai)적수상원인、림상표현여 ct 소묘결과관계진행분석，탐토 dai 적발병궤제급림상진단치료문제。방법회고성분석총결76례 dai 환자적치상궤제，림상표현화영상학검사특점，병탐토상후지속혼미적시간여 dai 적진단치료관계。결과치상원인주요위교통사고상59례（77.6%），발병궤제시인위외상사로뇌산생선전가속도화/혹각가속도，진이사뇌조직내부산생전력작용，조성신경축색화소혈관손상。치료결과위회복량호자21례，경잔14례，중잔11례，중잔9례，3위환자속우식물생존，사망18례（23.7%）。결론뇌외상지후지속혼미시간대우6소시，림상증상정도엄중，영상학검사유다발산재점상출혈조혹자몰유현저적뇌손상상황，몰유현저성적점위효응，저양취가이판정기위 dai。차외，일반정황하，몰유필요용수술치료적방식치료 dai，치료dai 일반채용보수치료，보수치료주요시촉진신경공능회복약물급개선뇌미순배，재혼미기간보지호흡도통창，방지각충병발증종합치료。
Objective to analyse the relationship of the causes,clinical feature and the computed tomography ( ct) results of the diffuse axonal injury ( dai ) of brain and approach the pathogenesis,diagnosis and treatment for the disease. Method to analyse and summary the pathogenesis,feature of clinical and imageology feature in 76 cases with dai of brain retrospectively and approach the relationship between the time of persistence coma after injury with diagnosis and treatment for the disease.Results The causes of DAI in this study were mainly traffic accident (59 cases; 77.6%), The mechanism DAI was that injury caused to coriolis acceleration and/or angular acceleration and shear force in the brain tissue of patients, which leading injury of cylindraxile and small blood vessel.after treatment, 21 cases were recovered, 14 cases were mild maimed, 11 cases were middle maimed, 9 cases were heavy maimed, 3 cases were in the vegetative state and 18 cases were dead(23.7%). Conclusion dai may be diagnosed when patients had cerebral trauma with persistence coma for 6 hours, severe clinical manifestation, and ct shown focus hemorrhage and no occupied lesion in brain. the surgery treatment for dai is not necessary generally. the expectant treatments for dai are improving recover the function of nerve and the microcirculation in brain.in the period of coma are keeping the respiratory passages unblocked and prohibit complication and other synthetic treatment.