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目的总结颅脑创伤后脑梗死的诊治经验。方法对收治的32例颅脑创伤后脑梗死患者的临床资料、影像学检查、治疗及结果进行回顾性总结。结果本组32例患者占同期收治的1 439例颅脑创伤患者的2.2%,车祸伤24例,坠落伤6例,打击伤2例。伤后有脑疝表现者21例,合并休克者12例,胸腹部伤者12例,多器官伤者10例。伤后首次头颅CT扫描均见占位性颅内血肿,其中中线结构偏移>10 mm者20例。本组脑梗死均经再次头颅CT扫描确诊,受伤至脑梗死确诊的平均时间为(24±12)h;临床上表现为术中脑肿胀18例,术后意识状态无好转14例。再手术减压3例。出院时死亡20例,植物状态生存7例,重残3例,中残2例。结论颅脑创伤后大脑半球梗死的预后很差,脑疝、失血性休克、合并多发伤是颅脑创伤后大脑半球梗死的危险因素,早期诊断和及时处置伤后颅内高压是改善其预后的关键。
Objective To summarize the diagnosis and treatment of cerebral infarction after traumatic brain injury. Methods The clinical data, imaging examination, treatment and results of 32 patients with cerebral trauma after cerebral trauma were retrospectively reviewed. Results 32 patients in this group accounted for 2.2% of the 1 439 cases of traumatic brain injury admitted in the same period, 24 were injured in traffic accidents, 6 were injured in crashes and 2 were injured in injuries. There were 21 cases with brain herniation after injury, 12 cases with shock, 12 cases with chest and abdomen injuries and 10 cases with multiple organ injuries. After the first craniocerebral CT scan showed space-occupying intracranial hematoma, in which the midline structure offset> 10 mm in 20 cases. This group of cerebral infarction were diagnosed again by cranial CT scan, the average time from injury to cerebral infarction diagnosis (24 ± 12) h; clinical manifestations of intraoperative brain swelling in 18 cases, postoperative consciousness without improvement in 14 cases. Reoperation decompression in 3 cases. 20 cases were discharged from hospital, 7 cases were in vegetative state, 3 cases were severe disability, 2 cases were disability. Conclusions The prognosis of cerebral hemisphere infarction after traumatic brain injury is very poor. Brain hernia, hemorrhagic shock and combined multiple trauma are the risk factors of cerebral hemisphere infarction after traumatic brain injury. Early diagnosis and prompt treatment of intracranial hypertension after traumatic brain injury is to improve its prognosis The essential.