[1]高进喜,郑兆聪,刘峥,等.轻中型颅脑损伤猝死原因分析(13例报告并文献复习)[J].临床神经外科杂志,2014,(01):55-57.
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轻中型颅脑损伤猝死原因分析(13例报告并文献复习)
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2014年01期
页码:
55-57
栏目:
论著
出版日期:
2014-02-28

文章信息/Info

Title:
analyse of reasons of sudden death with mild or moderate craniocerebral injury
作者:
高进喜 郑兆聪 刘峥 王守森
南京军区福州总医院神经外科
关键词:
颅脑损伤猝死减速伤坠落伤脑疝
Keywords:
craniocerebral injury sudden death deceleration injury falling injury brain hernia
分类号:
R651.1
文献标志码:
A
摘要:
目的:分析轻、中型颅脑损伤后“无明显预兆”突然死亡病人的死亡原因,增强对特殊类型的颅脑损伤的诊治预见性,减少医疗纠纷。方法:回顾性分析13例轻、中型颅脑损伤病人的伤情、诊断、治疗和死亡经过,总结死亡原因。结果:轻、中型颅脑损伤后突然死亡病人的首要致伤原因为摩托车减速伤,其次为高处坠落伤。早期死亡原因依次为:颅脑剪应力损伤引起的特殊类型弥漫性轴索损伤;颅颈交界处损伤所致的高颈段脊髓和延髓损伤;儿童突发癫痫持续状态;急性心包填塞等。中晚期突然死亡主要原因为:双侧额叶底部挫裂伤突发中央型脑疝;蛛网膜下腔出血引起脑血管痉挛;迟发性下丘脑功能损害;脑动脉瘤外伤后破裂;急性肺梗塞等。结论:对摩托车或高处坠落致伤的轻、中型颅脑损伤病人,应特别注意提防罕见的猝死现象。应注意分析受伤机制,动态观察病情变化;对有蛛网膜下腔出血、颅底骨折、颅底脑池显示不清、重要脏器合并伤等高危因素的患者要高度重视,尽早处理;为防范医疗纠纷,应重视与病人家属沟通交流。
Abstract:
Objective: To analyse the the reasons of sudden death without obvious aura in 13 patients with mild or moderate craniocerebral injury, and strenthen the foresight for special type craniocerebral injury,thus to reduce medical disputes. Methods: The severity of injury, diagnosis, treatment,and death process of 13 patients with mild or moderate craniocerebral injury were analysed retrospectively.The reasons of death were summarized too.Results: The primary cause of mild or moderate craniocerebral injury was motocycle deceleration injury,the second was falling injury.The reasons of early sudden death might be due to special type diffuse axonal injury caused by shearing craniocerebral stress, high neck segement or medulla damage caused by cranial neck border injury,status epilepticus of children,acute cardiac tamponade,and so on.The reasons of later sudden death might be due to central type brain hernia caused by double underside frontal lobes,cerebral vasospasm caused by subarachnoid hemorrhage , tardive damage of hypothalamus, rapture of cerebral aneurysm after trauma ,or due to acute pulmonary embolism.Conclusion: The craniocerebral injury patients caused of motocycle deceleration injury or falling injury must be paid more attention to prevent the rare sudden death.The mechanism of injury should be analysed combined with dynamic study of patients’ condition.Great attention shoud be paid to patients with the high risk factors such as subarachnoid hemorrhage,basal fracture and unclear display of cistern in basalis,combined injuries of important organs,and early treatment should be carried out as soon as possible.To prevent medical disputes,we must strenthen the the communication to the patients family.

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备注/Memo

备注/Memo:
[收稿日期] 2012-12-11
更新日期/Last Update: 2014-02-15