摘要
目的 研究重型颅脑创伤后持续昏迷与脑缺血的关系。方法 将研究期内的 4 2例重症脑外伤患者分为昏迷时间大于 10d的持续昏迷组和昏迷时间小于 10d的对照组 ;持续昏迷组患者32例 ,入院时GCS =5～ 8分 ;对照组患者 10例 ,入院时GCS =5～ 8分。两组患者伤后接受了昏迷期和苏醒期单光子发射计算机摄影 (SPECT)扫描检查 ,同时进行临床评估 ;将SPECT所检测的脑区分为额、颞、顶、枕及丘脑 5个部位。结果 昏迷期SPECT扫描时两组患者均显示多脑区脑缺血 ,持续昏迷组则全部患者 (10 0 % )有双侧丘脑缺血 ,对照组则无丘脑缺血的迹象。持续昏迷组患者在苏醒期SPECT扫描结果单侧丘脑缺血率为 17/2 5 (6 8% ) ,提示一旦双侧丘脑区缺血改善 ,大多数患者的意识恢复清醒或接近苏醒。结论 本研究结果表明患者重症颅脑创伤后持续昏迷状态可能与双侧丘脑区的缺血有关 ;长时间持续的多脑区缺血与颅内压和脑灌注压关系不大。
Objective To assess the relationship between persi st ent coma after severe head injury and brain ischemia.Methods Fo rty-two patients with severe head injury during the period of this research wer e divided into two groups: the persistent coma group in which patients were unconscious for more than ten days and the control group in which patients were unconscious for less than ten days. In the persistent coma group, 32 patients h ad an admission with coma score of 5～8 and 10 patients were included in the control group, where their admission GCS was 5～8. Single photon emission comput e d tomography (SPECT) were carried out in all patients. The brain areas meas ured by SPECT were divided into 5 areas: frontal, parietial, temporal, occipital lobes and the thalami. Results In the first SPECT, multiple areas of cerebral ischemia were documented in all patients in both groups, wher eas bilateral thalamic ischemia presented in all patients in the persistent coma group and was absent in the control group. In the second SPECT taken during the period of analepsia, with an indication that unilateral thalamic ischemia p ersisted in 17 of 25 patients in persistent coma group (17/25, 68%), once the bi lateral thalamic ischemia improved, consciousness regained in most patie nts. Conclusion Persistent coma after severe head injury is associated with bilateral thalamic ischemia. Multiple areas of cerebral isc haemia is independent of intracranial pressure (ICP) and cerebral perfusion pr essure (CPP).
出处
《中华神经外科疾病研究杂志》
CAS
2005年第1期34-36,共3页
Chinese Journal of Neurosurgical Disease Research
基金
国家自然科学基金资助项目 (30 370 51 2 )
