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目的探讨弥漫性轴索损伤(diffuse axonal injury,DAI)的发病机制、临床特点、诊断及治疗方法 ,以提高治愈率,降低致残、致死率。方法回顾性分析2006年6月2010年3月间65例临床诊断为DAI患者的受伤机制、临床特征、影像学表现、治疗及预后。结果 DAI最常见原因为车祸伤70.7%,其次为坠落、坠物伤(10.7%),其他(18.6%)。按格拉斯哥昏迷分级(GCS)评分结果 3～5分18例,6～8分15例,9～12分32例;治愈43例,轻残15例,中残8例,重残或植物生存7例,死亡7例。结论 DAI具有诊断、治疗困难,预后差等特点,交通事故是导致DAI的主要原因,格拉斯哥昏迷分级(GCS)评分、昏迷时间和瞳孔变化是判定预后的重要指标。目前尚无特效治疗方法 ,由于80%以上患者往往是多发伤,故早期气管切开、呼吸机辅助呼吸、促醒、亚低温治疗、防治并发症、钙离子拮抗剂应用等综合治疗可显著改善预后。
Objective To investigate the pathogenesis, clinical features, diagnosis and treatment of diffuse axonal injury (DAI) in order to improve the cure rate and reduce the disability and fatality rate. Methods The clinical data, clinical features, imaging findings, treatment and prognosis of 65 patients with DAI clinically diagnosed from June 2006 to March 2010 were analyzed retrospectively. Results DAI was the most common cause of traffic accidents 70.7%, followed by falls, falling injuries (10.7%), others (18.6%). According to the Glasgow coma scale (GCS) score of 3 to 5 in 18 cases, 6 to 8 points in 15 cases, 9 to 12 points in 32 cases; 43 cases were cured, 15 cases of mild residual, 8 cases of residual, severe disability or plant survival 7 Cases, 7 cases of death. Conclusion DAI has the characteristics of diagnosis, treatment difficulty and poor prognosis. Traffic accidents are the main causes of DAI. Glasgow coma scale (GCS) score, coma time and pupil change are important prognostic indicators. At present there is no effective treatment, as more than 80% of patients are often multiple injuries, so early tracheotomy, ventilator-assisted breathing, wakefulness, mild hypothermia treatment, prevention and treatment complications, calcium antagonists and other comprehensive treatment can be significantly improved Prognosis.