Yanagawa Youichi
Department of Traumatology and Critical Care Medicine, National Defense Medical College (NDMC), Japan.
J Emerg Trauma Shock. 2011 Jul;4(3):355-8. doi: 10.4103/0974-2700.83863.
Characteristics of extracranial injury in patients with diffuse axonal injury (DAI) have not been clarified.
This retrospective study reviewed medical records from January 2003 to December 2007. Subjects comprised 35 patients meeting the following criteria: 1) head injury without mass lesion; 2) Glasgow coma scale (GCS) on arrival <15; and 3) magnetic resonance imaging (MRI) examination including T2*-weighted imaging. Subjects were divided into two groups: severe traumatic brain injury (TBI) group (patients with GCS ≤8, n=19) and moderate TBI group (patients with GCS >8, n=16).
Shock index (heart rate/systolic blood pressure) was significantly higher in the severe TBI group than in the moderate TBI group, while base excess on arrival was significantly lower in the severe TBI group than in the moderate TBI group. The abbreviated injury scale (AIS) for the face, thorax, extremities and external structures showed no significant differences between the severe TBI group, but AIS for the abdomen and the sum of extracranial AIS was greater in the severe TBI group than in the moderate TBI group. Duration of hospitalization was longer and outcomes were worse in the severe TBI group than in the moderate TBI group.
Because patients with severe TBI are more likely to have abdominal injury than patients with moderate TBI, physicians should be aware of the potential for such complications when treating severe TBI.
弥漫性轴索损伤（DAI）患者的颅外损伤特征尚未明确。
这项回顾性研究回顾了2003年1月至2007年12月的病历。研究对象包括35例符合以下标准的患者：1）头部损伤无占位性病变；2）入院时格拉斯哥昏迷量表（GCS）评分<15；3）进行了包括T2*加权成像在内的磁共振成像（MRI）检查。研究对象分为两组：重度创伤性脑损伤（TBI）组（GCS评分≤8的患者，n = 19）和中度TBI组（GCS评分>8的患者，n = 16）。
重度TBI组的休克指数（心率/收缩压）显著高于中度TBI组，而入院时的碱剩余在重度TBI组显著低于中度TBI组。重度TBI组和中度TBI组面部、胸部、四肢及体表结构的简明损伤定级（AIS）无显著差异，但重度TBI组腹部的AIS及颅外AIS总和高于中度TBI组。重度TBI组的住院时间更长，预后比中度TBI组更差。
由于重度TBI患者比中度TBI患者更易发生腹部损伤，医生在治疗重度TBI时应意识到此类并发症的可能性。
