【摘要】 目的：探讨急性酒精中毒合并颅脑损伤的临床特点和急诊诊疗措施。方法：回顾性分析116例急性酒精中毒合并颅脑损伤的临床资料。结果：轻度酒精中毒合并轻度脑损伤的患者，78例治疗后0.5～2 h左右酒醒，恢复良好。重度酒精中毒或/和重度脑损伤38例中18例在治疗2～4 h内清醒，恢复良好;另20例出院时均留有不同程度的残疾，无死亡病例。结论：避免急性酒精中毒合并颅脑损伤误诊的关键在于重视现场急救、提高诊断认识、 严密观察病情变化以及动态头颅CT检查以明确脑损伤类型，并采取相应的治疗措施。
【关键词】 酒精 中毒 颅脑 损伤 处理
Study on head injury coexisting acute alcoholism
ZHU Baofeng, CHEN JianRong, WANG Fang, CHEN Yang, GU Li
1.The Second Affiliated Hospital of Nantong University
2.Nantong Emergency Medical Center Nantong 226001, China
[ABSTRACT] Objective: To investigate the clinical features and emergency management of head injury coexisting acute alcoholism. Methods: Clinical data of 116 patients with head injury coexisting acute alcoholism were studied retrospectively. Results: Seventyeight patients with mild alcoholism combined with mild brain injury recovered conscience well after treatment in 0.5～2 h. 18 cases out of the 38 patients with severe alcoholism and / or severe head injury recovered conscience well after treatment in 2～4 h, 20 cases of them discharged with different degree of disability, no death. Conclusion: The key to avoid misdiagnosis of head injury coexisting acute alcoholism are the first aid, awareness of diagnosis, closely observation of the changes of patient s condition, necessary head CT scan, the identification of types of brain injury, and appropriate managements.
[KEY WORDS] Alcohol; Poisoning; Brain; Injury; Treatment
近年来急性酒精中毒合并颅脑损伤的发生率有不断增多趋势。其发生率可达44.8%～62%[1]，占同期急性重型颅脑外伤的37.6%[2]。本文对我院急诊科在2000年8月～2006年12月收治的116例急性酒精中毒合并颅脑损伤患者的临床资料进行回顾性分析，总结救治体会报告如下。
1 资料和方法
1.1 临床资料
本组116例醉酒后颅脑外伤患者，男性102例，女性14例，年龄20～66岁，平均年龄42岁，均有过量饮酒史，呼气有酒精气味。损伤原因：跌伤79例，车祸伤22例，打击伤15例。损伤类型：头皮裂伤68例，硬膜下血肿18例，硬膜外血肿13例，脑挫裂伤7例，颅底骨折5例，脑震荡4例，开放脑伤1例。其中休克15例。
1.2 方法
对116例患者实施现场急救和安全运输，对昏迷患者立即使用纳络酮0.4～0.8 mg静脉注射并每天0.4 mg/kg持续静脉滴注，对无意识障碍者使用纳络酮0.4 mg静脉注射。严密观察病情变化，包括生命体征、神志、瞳孔等，并且进行动态头颅CT监测和血、尿、血气分析、
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