重型颅脑损伤并发脑梗塞原因分析.docVIP

重型颅脑损伤并发脑梗塞原因分析[摘要] 目的 探讨重型颅脑损伤并发脑梗塞的影响因素。方法 对我院56例并发脑梗塞的病例进行回顾性分析。结果 本组恢复良好24例、中残13 例、重残10例、死亡9例。结论 重型颅脑损伤并发脑梗塞一般出现在伤后72h -10天。重型颅脑损伤患者出现脑梗塞手术治疗多余非手术治疗，与手术、器械的刺激损伤相关，出血过多、血液的粘稠度增高、脑循环的改变，代谢产物的毒性作用有关 [关键词] 重型颅脑损伤； 脑梗塞； 原因 [中图分类号] R743.33 [文献标识码] A [文章编号] 1005-0515（2011）-12-017-01 Severe Head Injury Complicated Cerebral Infarction Reasons Analysis Chen Ben Zhang Junwei Yang Dingjun (The Trauma Surgery of the People’s Hospital in Dujiangyan,Sichuan,611830) [Abstract] Objective To discuss the influence factors of the severe head injury complicated with cerebral infarction. Methods In our hospital 56 cases complicated with cerebral infarction were studied retrospectively. Results The good recovery were 24 cases, moderate disability were 13,heavy were 10 cases,9 cases were dead. Conclusion Severe head injury complicated with cerebral infarction generally appear after injury in 72 h-10 days. Severe head injury patients experienced cerebral infarction surgery is related with non-operative therapy, and surgery, the stimulation of equipment damage, excessive bleeding; the clotting of blood and cerebral circulation increased the change, are related with the toxicity of the metabolic products. [Key words] Severe head injury; Cerebral infarction; Reasons 脑梗死(DCI)是常见的脑血管疾病，也是重型颅脑损伤后的严重并发症，其发生率2%-20%左右。给患者造成较高的死残率，重型颅脑损伤后发生脑梗塞因素众多，了解这些危险因素，对防DCI具有重要作用，本文对这些重要因素进行分析 1 临床资料 1.1 一般临床资料 我院2000年10月-2011年10月收治重型颅脑损伤56例。男,38例,女,18例,平均年龄为40±2岁,最小11岁,最大67岁,致伤原因,车祸伤36例,打击伤14例,坠落伤6例，其中53例为手术治疗，3侧为非手术治疗，做头部CT检查，首次CT未发现脑梗死 1.2 临床表现 入院后GCS平分 3-5分者15例，6-8分者41例，3例未行手术治疗。余53例因颅内占位明显，脑疝形成而手术治疗。入院时昏迷患者18例，再度昏迷者3例，双侧瞳孔散大13例，一侧瞳孔散大34例，针尖样瞳5例，无瞳孔散大4例 1.3 影像学检查 入院时均行头部CT检查，硬膜外血肿 8例，髓内血肿6例，硬膜下血肿26例，蛛血发展形成髓内多发，散在出血灶脑内血肿16，入院后3例非手术治疗患者一周内复查头部CT时发现脑梗塞，其余患者均在手术后72小时-10天复查头部CT发现脑梗塞，梗塞部位：基底节9例，额叶3例，颞叶23例，顶叶10例，枕叶6例，小脑2例，多发梗塞3例 2 结果 除3例保守治疗外，均行手术治疗，单纯血肿清除6例，血肿清除+部分脑组织切除+去骨瓣减压47例。手术后发生脑梗塞病人多于非手术病人，手术后出现梗塞多位于手术侧，颞、顶、枕部多见，脑梗塞常伴有弥漫性脑肿胀，脑水肿，弥漫性轴索损伤，侧裂血肿和广泛性蛛网膜下腔出血。手术以后给与常规临床治疗，解除血管