Diagnosis and treatment of 23 cases of cerebral infarction after craniocerebral trauma
-
摘要: 目的 分析总结颅脑外伤后合并脑梗塞的发病机制及有效的预防措施和个体化综合性治疗方案,以提高疗效,降低致死率和致残率。 方法 选取蚌埠医学院第二附属医院2011年12月—2016年11月收治的23例颅脑外伤后合并脑梗塞患者作为研究对象。本组患者中,13例脑挫裂伤严重,出现颅内血肿伴有颅内压增高或脑疝者,给予钻孔血肿引流术或开颅血肿清除术治疗,其中去骨瓣减压者6例;2例外伤后单纯出现脑梗塞者,及时行脑血管造影证实为外伤后栓子形成所致,行积极的溶栓介入治疗;对于8例病情稳定,脑挫裂伤较轻或颅内血肿较小,无显著颅内压增高的脑梗塞者,实施内科保守治疗。本组所有患者均积极给予钙离子拮抗剂、自由基清除剂等药物治疗;合并创伤失血性休克时早期限制性液体复苏、后期积极补液;并早期行高压氧和康复治疗。实行个体化综合性治疗,观察治疗效果。 结果 在23例颅脑损伤后合并脑梗塞患者中,经过积极抢救按格拉斯哥预后评分(GOS)标准评价,恢复良好14例,轻残6例,重残1例,死亡2例。其中死于创伤失血性休克1例,多器官功能障碍综合征(MODS)1例。 结论 早期预防和诊断,及时发现颅脑外伤后并发脑梗塞,并给予积极有效的早期个体化综合性治疗能有效降低致死率和致残率。Abstract: Objective To analyze and summarize the pathogenesis of craniocerebral trauma complicated with cerebral infarction and effective preventive measures and individualized comprehensive treatment plan to improve the therapeutic effect and reduce the mortality and morbidity. Methods Twenty-three patients of merger of cerebral infarction after craniocerebral trauma in our hospital from December, 2011 to November, 2016 were selected as the research object. In this group, there were 13 cases of serious brain contusion, for the patients with intracranial hematoma combined elevated intracranial pressure or cerebral hernia, the drilling hematoma drainage or craniotomy hematoma removal was performed (including decompressive craniectomy in 6 cases). There were 2 cases of cerebral infarction after traumatic brain injury, the cerebral angiography was performed to confirm the cerebral infarction that was caused by thrombosis after trauma, and active thrombolysis intervention was given. There were 8 cases of cerebral infarction with stable condition, lighter brain contusion or small intracranial hematoma, without significantly elevated intracranial pressure, the conservative methods of internal medicine was administrated. All the patients in this group received calcium antagonists, free radical scavengers and other drugs; the early limited fluid resuscitation and late active fluid resuscitation, early hyperbaric oxygen and rehabilitation therapy were performed in patients with traumatic hemorrhagic shock. Individualized comprehensive treatment was carried out, and the therapeutic effect was observed. Results Among the 23 cases of craniocerebral trauma combined with cerebral infarction patients, according to Glasgow Outcome Scale (GOS) standard evaluation after active rescue, 14 cases recovered well, mild disability in 6 cases, severe disability in 1 case, and 2 cases died; of those who died, 1 died of traumatic hemorrhagic shock, 1 died of multiple organ dysfunction syndromes (MODS). Conclusion Early prevention and diagnosis, timely diagnosis of the cerebral infarction after craniocerebral trauma, and positive and effective early individualized comprehensive treatment can effectively reduce the mortality and morbidity.
点击查看大图
计量
- 文章访问数: 149
- HTML全文浏览量: 27
- PDF下载量: 0
- 被引次数: 0