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目的 :探讨重型颌面外伤导致钝性颈内动脉损伤后脑梗死的治疗策略。方法 :回顾性复习2008年1月—2013年12月本院收治的8例颌面外伤引起颈内动脉损伤后脑梗死患者的临床资料。结果:男6例,女2例;年龄19~54岁,平均36±11.95岁;受伤至我院收治时间5~8 h,平均(6.31±1.00)h;伤后均清醒,入院时6例嗜睡,2例昏睡,其中1例次日进展为昏迷,6例偏瘫;8例颌面部CT显示面部骨折,2例合并颅底骨折,1例合并下颌骨骨折;头颅CT发现颈内动脉供血区低密度缺血病灶,无颅内出血。治疗均给予阿司匹林300 mg/d,口服2周,然后改为100 mg,维持6个月,1例行开颅减压手术。6个月后GOS评价,恢复良好6例,轻残1例,重残1例,死亡0例。结论 :颌面骨折合并颈内动脉钝性损伤的患者早期出现缺血导致的中枢神经系统损害表现时,应积极使用抗血小板治疗,以降低卒中引起的病患伤残与死亡率。
Objective: To discuss the treatment strategy of cerebral infarction after blunt internal carotid artery injury caused by maxillofacial trauma. Methods: The clinical data of 8 patients with cerebral infarction after carotid artery injury caused by maxillofacial trauma admitted in our hospital from January 2008 to December 2013 were retrospectively reviewed. Results: There were 6 males and 2 females, aged from 19 to 54 years (average 36 ± 11.95 years). The patients were admitted to our hospital for 5-8 h (average 6.31 ± 1.00 h) Drowsiness, and drowsiness in 2 cases. One case developed coma in the next day and 6 cases were hemiplegia. Eight cases of maxillofacial CT showed facial fracture, two cases of skull base fracture and one case of mandibular fracture. Area of low-density ischemic lesions, no intracranial hemorrhage. All patients were given aspirin 300 mg / d orally for 2 weeks and then 100 mg for 6 months. One patient underwent craniotomy and decompression surgery. 6 months after GOS evaluation, good recovery in 6 cases, 1 case of light residue, 1 case of severe disability, 0 cases of death. CONCLUSIONS: In patients with maxillofacial fractures complicated with blunt internal carotid artery injury, early manifestation of central nervous system damage caused by ischemia should be actively treated with antiplatelet to reduce the disability and mortality caused by stroke.