Potapov A A, Zakharova N E, Pronin I N, Kornienko V N, Gavrilov A G, Kravchuk A D, Oshorov A V, Sychev A A, Zaĭtsev O S, Fadeeva L M, Takush S V
Zh Vopr Neirokhir Im N N Burdenko. 2011;75(3):3-16; discussion 17-8.
Forty patients with severe traumatic brain injury (GCS score 8 and less) aged 16-54 years treated in our clinic were analyzed. Correlations between clinical symptoms, CT signs of diffuse and focal traumatic lesions, intracranial hemorrhage, indices of cerebral blood flow (CBF) according to perfusion CT study, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were assessed. Main mechanism of injury in 27 of 40 (67.5%) patients was acceleration-deceleration due to traffic accidents which usually leads to diffuse axonal injury (DAI) of different severity. In the other 13 (32.5%) cases injury was associated with coup-countercoup mechanism which caused focal contusions mostly. Not only GCS score but CT-signs of DAI severity, intracranial hemorrhage and minimal levels of CPP had significant prognostic value. Results of perfusion CT studies demonstrated that in 37 of 40 (92.5%) patients cerebral blood flow decreased (below 28.6 ml/100 g/min) in one or more arterial blood distribution areas. Increase of CBF was registered in 9 cases (over 69 ml/100 g/min), in 6 of them elevation of CBF in one arterial distribution area was associated with reduction in the other. Generally, mean CBF values were higher in the middle cerebral artery circulation than in the other. The lowest CBF levels (16.3 +/- 6 ml/100 g/min) were observed in cortical and subcortical hemorrhagic foci while these values were significantly higher in the same contralateral intact zones (36.0 +/- 10.0 ml/100 g/min; p < 0.01). In 3 patients with DAI the CBF in the midbrain varied from 12.5 to 30.1 ml/100 g/min with the lowest levels in hemorrhagic focus in cerebral peduncle. It corresponded to cystic-atrophic alterations found on subsequent follow-up MRI. Thus, reduction of CBF and episodes of low CPP were the leading pathophysiological phenomena of diffuse and focal brain damages.
对我院收治的40例年龄在16 - 54岁、重度颅脑损伤（格拉斯哥昏迷评分8分及以下）患者进行了分析。评估了临床症状、弥漫性和局灶性创伤性病变的CT征象、颅内出血、灌注CT研究的脑血流量（CBF）指标、颅内压（ICP）和脑灌注压（CPP）之间的相关性。40例患者中27例（67.5%）的主要损伤机制是交通事故导致的加速 - 减速伤，通常会导致不同严重程度的弥漫性轴索损伤（DAI）。另外13例（32.5%）病例的损伤与对冲伤机制有关，主要导致局灶性挫伤。不仅格拉斯哥昏迷评分，而且DAI严重程度的CT征象、颅内出血和最低CPP水平都具有显著的预后价值。灌注CT研究结果显示，40例患者中有37例（92.5%）在一个或多个动脉血供区域脑血流量下降（低于28.6 ml/100 g/min）。9例患者（超过69 ml/100 g/min）脑血流量增加，其中6例在一个动脉血供区域脑血流量升高与另一个区域降低相关。一般来说，大脑中动脉循环的平均CBF值高于其他区域。在皮质和皮质下出血灶观察到最低的CBF水平（16.3±6 ml/100 g/min），而在对侧相同的完整区域这些值显著更高（36.0±10.0 ml/100 g/min；p < 0.01）。3例DAI患者中脑的CBF在12.5至30.1 ml/100 g/min之间变化，最低水平出现在脑桥出血灶。这与后续随访MRI发现的囊性萎缩性改变相符。因此，CBF降低和低CPP发作是弥漫性和局灶性脑损伤的主要病理生理现象。
