摘要目的 探讨创伤性后组颅神经损伤的发生情况及胃造瘘术对于迷走神经损伤患者的治疗效果. 方法 回顾性分析45例创伤性后组颅神经损伤患者的临床资料,其中男32例,女13例;年龄(34.5±8.8)岁.致伤原因:高处坠落伤22例,交通伤15例,其他8例.舌咽神经损伤12例,副神经损伤21例,舌下神经损伤20例,均予营养神经、激素、改善微循环、活血化瘀等非手术治疗;迷走神经损伤32例,其中15例接受胃造瘘术及早期肠内营养支持治疗,17例予经鼻留置胃管并予肠内营养支持.比较胃造瘘术对迷走神经损伤患者的肺部感染和营养不良等方面的影响. 结果 胃造瘘术15例中仅2例出现肺部感染,1例营养不良;经鼻留置胃管17例中9例出现肺部感染(P＜0.05),7例营养不良(P＜0.05).胃造瘘组患者的肺部感染和营养不良均治愈;鼻胃管组7例肺部感染和5例营养不良治愈. 结论 在后组颅神经损伤中,迷走神经损伤最为常见,患者常出现饮水呛咳、吞咽困难等临床症状.胃造瘘术及早期肠内营养支持治疗,可以改善创伤性迷走神经损伤患者的营养情况、降低肺部感染率,是改善预后、提高疗效的有效方法之一.

abstractsObjective To examine the occurrence of traumatic lower cranial nerve injury and the therapeutic effect of gastrostomy on vagus nerve injury.Methods Clinical data of 45 patients sustaining traumatic lower cranial nerve injury were retrospectively analyzed.There were 32 males and 13 females,with the age of (34.5 ±8.8)years.Injury resulted from high falls in 22 patients,traffic accidents in 15 patients and other in 8 patients.Non-operative treatments,nutrition and hormone intervention,improving minicirculation,promoting blood circulation and removing stasis for instance,were performed for the patients with the injury involving the glossopharyngeal nerve (n =12),accessory nerve (n =21) and hypoglossal nerve (n =20).Vagus nerve injury was seen in 32 patients.Fifteen out of the 32 patients underwent gastrotomy and early enteral nutrition support and 17 transnasal gastric catheter indwelling and enteral nutrition support.Lung infection and dystrophy were evaluated after operation.Results Two patients had lung infection and one dystrophy after gastrotomy.In contrast,9 patients had lung infection and one dystrophy after transnasal stomach intubation surgery (P ＜ 0.05).At follow-up,the complications were cured in gastrotomy group,but only 7 lung infection and 5 dystrophy were cured in indwelling catheter group.Conclusions Vagus nerve injury is most common in lower cranial nerve injury and manifested with choking on water and dysphagia.Gastrostomy in combination with early enteral nutrition therapy is effective to improve the nutritional status and reduce lung infection in patients with traumatic vagus nerve injury.