Cichoński J, Moskała M, Krupa M, Uhl H, Gil T
Kliniki Neurotraumatologii CMUJ, Kraków.
Neurol Neurochir Pol. 1999 Jan-Feb;33(1):211-7.
Even with the advent of the present diagnostic possibilities, polytraumas are still a serious problem with a large mortality. Owing to the complexity of the clinical picture, severe craniocerebral injury masks other extracerebral signs and creates a risk of unnoticeable injury of another organ. We describe a case of a 63 year-old patient, who suffered a polytrauma in road accident. A typical treatment of traumatic subarachnoid haemorrhage was administered and patient's state of consciousness improved. On 5-th day after the trauma the patient's state deteriorated. The neurological examination didn't reveal intracranial hypertension signs. Increasing anaemia was detected and an extracerebral reason of deterioration was sought. The following x-ray picture of chest was taken revealing elevation of the diaphragm without any other posttraumatic lesions. The patient was selected for thoracosurgical operation because pericordial sac disruption and diaphragm contusion were found. The pericardial sac was sutured. During further treatment the patient's state improved. He was discharged walking and independent.
即使有了目前的诊断手段，多发伤仍然是一个严重的问题，死亡率很高。由于临床表现复杂，严重的颅脑损伤会掩盖其他脑外体征，并造成其他器官未被察觉损伤的风险。我们描述了一例63岁患者，他在道路交通事故中遭受了多发伤。对其进行了典型的创伤性蛛网膜下腔出血治疗，患者的意识状态有所改善。创伤后第5天，患者的状态恶化。神经系统检查未发现颅内高压体征。检测到贫血加重，并寻找脑外导致病情恶化的原因。随后拍摄的胸部X光片显示膈肌抬高，无其他创伤后病变。由于发现心包破裂和膈肌挫伤，该患者被选进行胸外科手术。心包进行了缝合。在进一步治疗过程中，患者的状态有所改善。他出院时能够行走且生活自理。
