爆炸冲击波所致轻度颅脑损伤的诊断与处理

doi:10.3877/cma.j.issn.2095-655X.2016.01.008

中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (01) : 26 -29. doi: 10.3877/cma.j.issn.2095-655X.2016.01.008

所属专题：文献；

爆炸冲击伤诊治研究

爆炸冲击波所致轻度颅脑损伤的诊断与处理

段朝霞¹, 张洁元¹, 陈魁君¹, 李冠桦¹, 李兵仓¹^,^†(

)

^1. 400042　重庆，第三军医大学大坪医院野战外科研究所　创伤烧伤与复合伤国家重点实验室

收稿日期:2015-12-16 出版日期:2016-02-26
通信作者: 李兵仓

Diagnosis and treatment of mild brain injury induced by explosive blast wave

Zhaoxia Duan¹, Jieyuan Zhang¹, Kuijun Chen¹, Guanhua Li¹, Bingcang Li¹^,^†()

^1. State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China

Received:2015-12-16 Published:2016-02-26
Corresponding author: Bingcang Li
About author:
Corresponding author: Li Bingcang, Email: bcli1118@yahoo.com

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爆炸冲击波引起的创伤性颅脑损伤(bTBI)是战场上最常见的损伤，大多数患者是轻度的颅脑创伤(mTBI)。常规的临床影像技术如CT不能检测出mTBI的脑部变化，并且这类损伤的功能意义目前还有争议，最近几年出现的新技术能敏感地检测出脑组织的细微异常，因此在mTBI的诊断中起非常中的作用。笔者主要综述爆炸冲击波所致mTBI诊断的相关进展。

关键词: 爆炸冲击波, 颅脑损伤, 诊断

Blast-related traumatic brain injury (bTBI) induced by explosive blast wave is the most common event on the battlefield.Most of the patients are characterized as mild traumatic brain injury (mTBI). The traditional clinical imaging couldn′t detect the pathological changes in the brain.Also, the functional significance of this type of injury remains controversial.In recent years, some new technology can sensitively detect the minimal abnormality in the injured brain tissues.Thus, it is valuable in the diagnosis of mTBI.In this paper, we summarized the new advancement of diagnosis for mTBI induced by explosive blast wave.

Key words: Explosive blast wave, Craniocerebral trauma, Diagnosis

图1 创伤性颅脑损伤机制示意图。(1－7)是原始爆炸伤的脑局部效应；(8－9)是系统效应；(10－12)是二级爆炸性损伤；(13)是三级爆炸性损伤；(14)是四级爆炸性损伤；(15，16)是冲击波传递到脑的入口。(1)是声阻抗引起的裂解；(2)是冲击波引起的气泡相互作用；(3)剪切效应引起的弥散性轴突损伤；(4)空洞；(5)回弹引起颅骨变形；(6)冲击波在颅内的反射；(7)加速－减速引起的头部损伤效应；(8)躯体微血管损伤引起的大量出血；(9)肺冲击伤引起的空气栓塞；(10)破片穿透伤；(11)复合的颅骨骨折；(12)颅内出血；(13)对侧挫伤；(14)烧伤；(15)冲击波通过眼眶传递；(16)冲击波通过鼻窦传递。

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