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钝性脑血管损伤：治疗和结局

Authors
Walter L Biffl, MD
Clay Cothren Burlew, MD
Ernest E Moore, MD
Section Editors
Heidi L Frankel, MD, FACS
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
彭亚, 主任医师，教授

引言

钝性颈动脉和椎动脉损伤统称为钝性脑血管损伤，这种损伤虽然少见但却是潜在的毁灭性事件。在遭受钝挫伤的患者中，钝性脑血管损伤的发生率约为1%[1,2]。未经治疗的钝性颈动脉损伤的死亡率范围在23%-28%，且48%-58%的存活者会遭受永久性严重神经功能障碍[3,4]。

鉴于未经治疗的钝性脑血管损伤相关性并发症发病率和死亡率较高，除非患者存在治疗禁忌，否则期待治疗是不合适的。治疗策略包括抗血栓治疗、外科修复以及血管内介入治疗。特定患者的治疗策略取决于患者症状、损伤部位、损伤的严重程度或分级以及可能使治疗复杂化的合并损伤[1]。

钝性脑血管损伤的治疗和结局将总结在此。钝性脑血管损伤的损伤机制、筛查及诊断见其他专题。 (参见“钝性脑血管损伤：机制、筛查及诊断性评估”)

穿透性脑血管损伤和自发性脑血管夹层将在别处讨论。 (参见“颈部穿透伤的初始评估和处理”和“自发性脑动脉和颈动脉夹层：临床特征和诊断”)

损伤分级

钝性脑血管损伤分级量表是为了临床交流标准化和指导治疗而制定的[5]。对于颈动脉损伤，脑卒中发生率随着其损伤等级的增高而增加[5]。对于椎动脉损伤，脑卒中的发生率及神经系统的结局与损伤等级无关。在一项纳入171例共发现236处钝性脑血管损伤的患者的研究中，损伤的分布具有代表性：Ⅰ级(58%)、Ⅱ级(22%)、Ⅲ级(14%)、Ⅳ级(11%)及Ⅴ级(3%)[1]。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-18.
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