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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. 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. 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:
引用本文:

段朝霞, 张洁元, 陈魁君, 李冠桦, 李兵仓. 爆炸冲击波所致轻度颅脑损伤的诊断与处理[J]. 中华诊断学电子杂志, 2016, 04(01): 26-29.

Zhaoxia Duan, Jieyuan Zhang, Kuijun Chen, Guanhua Li, Bingcang Li. Diagnosis and treatment of mild brain injury induced by explosive blast wave[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(01): 26-29.

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。

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.

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。
[1]
Nakagawa A,Manley GT,Gean AD, et al.Mechanisms of primary blast-induced traumatic brain injury:insights from shock-wave research[J]. J Neurotrauma, 2011, 28(6): 1101-1119.
[2]
DePalma RG,Burris DG,Champion HR, et al.Blast injuries[J]. N Engl J Med, 2005, 352(13), 1335-1342.
[3]
Wolf SJ,Bebarta VS,Bonnett CJ, et al.Blast injuries[J]. Lancet, 2009, 374(9687): 405-415.
[4]
Blennow K,Hardy J,Zetterberg H. The neuropathology and neuro biology of traumatic brain injury[J]. Neuron, 2012, 76(5): 886-899.
[5]
Bryant R. Post-traumatic stress disorder vs traumatic brain injury[J]. Dialogues Clin Neurosci, 2011, 13(3): 251-262.
[6]
Smith DH,Johnson VE,Stewart W. Chronic neuropathologies of single and repetitive TBI:substrates of dementia?[J]. Nat Rev Neurol, 2013, 9(4): 211-221.
[7]
Vasterling JJ,Verfaellie M,Sullivan KD.Mild traumatic brain injury and posttraumatic stress disorder in returning veterans:perspectives from cognitive neuroscience[J]. Clin Psychol Rev, 2009, 29(8): 674-684.
[8]
Goldstein LE,Fisher AM,Tagge CA, et al.Chronic traumatic en cephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model[J]. Sci Transl Med, 2012, 4(134): 134-160.
[9]
Rosenfeld JV,McFarlane AC,Bragge P, et al.Blast-related traumatic brain injury[J]. Lancet Neurol, 2013, 12(9): 882-893.
[10]
Chapman JC,Diaz-Arrastia R. Military traumatic brain injury:a review[J]. Alzheimers Dement, 2014, 10(3 Suppl): S97-104.
[11]
Jorge RE,Acion L,White T, et al.White matter abnormalities in veterans with mild traumatic brain injury[J]. Am J Psychiatry, 2012, 169(12): 1284-1291.
[12]
Coldren RL,Kelly MP,Parish RV, et al.Evaluation of the Military Acute Concussion Evaluation for use in combat operations more than 12 hours after injury[J]. Mil Med, 2010, 175(7): 477-481.
[13]
Wilk JE,Herrell RK,Wynn GH, et al.Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U. S. soldiers involved in combat deployments:association with postde ployment symptoms[J]. Psychosom Med, 2012, 74(3): 249-257.
[14]
Bazarian JJ,Donnelly K,Peterson DR, et al.The relation between posttraumatic stress disorder and mild traumatic brain injury acquired during Operations Enduring Freedom and Iraqi Freedom[J]. J Head Trauma Rehabil, 2013, 28(1) : 1-12.
[15]
Wolf G,Cifu D,Baugh L, et al.The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury[J]. J Neurotrauma, 2012, 29(17): 2606-2612.
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