【摘要】 对10例外伤性脑干出血死亡病例进行了临床及病理资料的分析。发现致伤机制都属于加速性损伤。脑干出血部位均见于桥脑背部,大脑导水管周围或正中缝附近,其中3例同时伴有中脑被盖部出血。本组中半数于伤后24小时内死亡,但少数病例是尚可维持较长生存时间,最长者达58天。对脑干损伤综合征作了简单的描述。本组患者同时合并急性颅内血肿者5例,其中4例虽经血肿清除术,但未取得预期疗效,另一例钻孔探查阴性,尸检见巨大脑内血肿,并已破入脑室内。对产生脑干出血的机制作了简单的讨论。认为可根据病人(1)受伤当时的意识状态,(2)出现脑干损伤综合征的时间,及(3)致死时间,作为区别是原发性或继发性脑干损伤的标准,并提出外伤性脑干出血系脑干不可逆性损伤的一种表现,目前对脑干出血还不能找到其特征性的临床表现,因此仍是诊断中有待解决的问题。关于防治工作方面,强调提出对防止继发性脑干损伤的发生或防止其发展为不可逆性阶段的重要意义,因此应当仔细观察病情的发展动向,经常保持戒备状态,及时识别颅内血肿,迅速予以手术处理,并提出在清除血肿后尚有明显脑疝存在时的处理步骤及采用其他各种综合治疗的重要性。更多还原

【Abstract】 Traumatic hemorrhage of brain stem is a serious and irreversible brain damage.It consti- tutes one of the important causes of death in patients with acute cranio-cerebral injury.Un- fortunately,this condition is rarely diagnosed antemortemly,although much has been learnt recently regarding its clinical manifestations. In the present series of 33 fatal cases of acute cranio-cerebral injury,10 cases of brain stem hemorrhage were found on autopsy.Definite focal hemorrhages in the brain stem were seen grossly in 6 cases and microscopically in another 4 cases.The most common site of hemorrhage, was found to be on the dorsal part of the pens, periaqueductal area and median raphe.In 3 cases Hemorrhage was also found in the segmental part of the mid-brain.Bleeding might have been either petechial or massive with clot formation. Death occurred to about half of these patients within 24 hours after injury,while the rest survived for varying periods,the longest being 53 days.更多还原