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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。
Objective To analyze and summarize the pathogenesis of cerebral infarction complicated with traumatic brain injury and its effective preventive measures and individual comprehensive treatment plan to improve the curative effect and reduce the lethality and morbidity. Methods Twenty-three patients with cerebral infarction complicated by traumatic brain injury admitted to the Second Affiliated Hospital of Bengbu Medical College from December 2011 to November 2016 were selected as the study subjects. The group of patients, 13 cases of severe cerebral contusion, intracranial hematoma with intracranial hemorrhage or cerebral hernia who were given drilling hematoma drainage or craniotomy hematoma, including decompressive bones flap 6 Cases; 2 cases of simple cerebral infarction after trauma, timely cerebral angiography proved to be caused by embolism after trauma, the line of active thrombolytic intervention; for 8 cases of stable, mild brain contusion or intracranial Small hematoma, no significant increase in intracranial pressure in patients with cerebral infarction, the implementation of conservative medical treatment. All patients in this group were actively given calcium antagonists, free radical scavengers and other drug treatment; traumatic hemorrhagic shock with early restrictive fluid resuscitation, late active rehydration; and early hyperbaric oxygen and rehabilitation. Implementation of individual comprehensive treatment, observation of treatment. Results In 23 patients with cerebral infarction complicated with cerebral infarction, 14 cases were recovered well, 6 cases were mild residual disability, 1 case severe disability, and 2 cases died after active rescue treatment according to Glasgow Outcome Scale (GOS). One died of traumatic hemorrhagic shock in 1 case, multiple organ dysfunction syndrome (MODS) in 1 case. Conclusion Early prevention and diagnosis, timely detection of cerebral infarction after traumatic brain injury, and to give a positive and effective early individualized comprehensive treatment can effectively reduce the mortality and morbidity.