目的 探讨影响双额脑挫伤临床症状恶化和预后的相关危险因素。方法 回顾性研究2011-03到2013-03医院收治的双额脑挫裂伤患者,收集并分析患者年龄、性别、受伤机制,入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)、影像学表现等临床信息,分析影响临床症状恶化出现的相关危险因素;并对患者进行伤后1年随访,格拉斯哥结局量表(Glasgow outcome scale, GOS)评价临床预后并分析影响患者预后的相关因素。结果 入组患者共112例,17例出现临床恶化,预后不良者(GOS分级,Ⅰ~Ⅱ级)15例,预后良好者(GOS分级,Ⅲ~Ⅴ级)95例。患者性别(P=0.0039)、GCS评分(P=0.0063)、环池闭塞(P=0.0426)、血肿体积(P<0.0001)与临床症状恶化显著相关,年龄(P=0.0004)、GCS评分(P=0.0424)、鞍上池闭塞(P=0.0047)、血肿体积(P<0.0001)、SAH(P=0.0145)显著影响患者临床预后。结论 GCS评分及影像学表现是影响双额脑挫伤患者预后和临床症状恶化的重要评价指标。
Abstract
Objective To investigate the risk factors of clinical deterioration and post-traumatic outcomes in patients with bilateral frontal contusion.Methods Retrospective analysis was performed of the clinical data about patients with bilateral frontal contusion treated between March 2011 and March 2013. Clinical factors for analysis included age, gender, mechanisms of injury, Glasgow coma scale (GCS) and imaging information. Statistical analysis was performed to find the predictors of clinical deterioration. These patients were followed up for 1 year after injury.Glasgow outcome scale (GOS) was used to evaluate the clinical outcome and to analyze the factors that affected the prognosis of the patients.Results 112 patients with bilateral frontal contusion were enrolled in this study and 17 of them suffered clinical deterioration. 95 patients achieved good outcomes (GOS,Ⅲ-Ⅴ) while 15 patients did not recover favorably. Gender(P=0.0039), GCS scores (P=0.0063), compression of basal cisterns(P=0.0426), hematoma volume (P<0.0001) were significantly correlated with clinical deterioration. Additionally, age (P=0.0004), GCS (P=0.0424), suprasellar cistern compression (P=0.0047), hematoma volume (P<0.0001), SAH(P=0.0145)and clinical deterioration (P<0.0001) were obviously correlated with post-traumatic outcomes.Conclusions Comprehensive evaluations of CGS and imaging performance are important for predicting clinical deterioration and post-traumatic prognosis.
关键词
颅脑创伤 /
双额脑挫裂伤 /
临床症状恶化 /
预后
Key words
traumatic brain injury /
bilateral frontal contusions /
clinical deterioration /
outcome
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参考文献
[1] 张继武,程金凤,苑国华,等. 进展型额叶脑挫裂伤开颅手术救治体会[J]. 中国临床神经外科杂志, 2014,11(19):675-676.
[2] 孟庆虎,孟 华,丁 璇, 等. 持续颅内压监测在额叶挫裂伤患者治疗中的作用[J]. 中华神经创伤外科电子杂志, 2015, 1(2): 17-20.
[3] 陈克非,董吉荣,王玉海, 等. 双额叶脑挫裂伤的治疗策略及进展恶化的相关危险因素分析[J]. 中华神经外科杂志, 2015, 31(9):903-904.
[4] 陈麟声,甄 云,胡少杰. 双侧额叶脑挫裂伤手术治疗[J]. 中国微侵袭神经外科杂志,2015, 20 (6):262-263.
[5] 许信龙, 魏晓捷, 陈再丰, 等. 单侧骨窗开颅大脑镰切开治疗非对称性双额叶脑挫裂伤及其对额叶功能的影响[J]. 中华创伤杂志, 2012, 28(2): 162-163.
[6] Barthélemy E J, Melis M, Gordon E, et al. Decompressive craniectomy for severe traumatic brain injury: a systematic review[J]. World Neurosurg,2016,88:411-420.
[7] Statham P F, Johnston R A. Delayed deterioration in patients with traumatic frontal contusions[J]. J Neurol Neurosurg Psychiatry,1989,52:351-354.
[8] Eric C P, Randall M C. Talk and die revisited: bifrontal contusions and late deterioration[J]. J Trauma, 2011,71(6):1588-1592.
[9] Andrews B T, Pitts L H. Functional recovery after traumatic transtentorial herniation[J]. Neurosurgery, 1992,30(3): 462.
[10] Bullock M R, Chesnut R, Ghajar J, et al. Guidelines for the surgical management of traumatic brain injury[J]. Neurosurgery, 2006, 58 (3):2-62.
[11] Liang G, Xuehai W, Jin H, et al. Intensive management and prognosis of 127 cases with traumatic bilateral frontal Contusions[J]. World Neurosurg ,2013,80(6):879-888.
[12] Jirong D, Xuejian C A, Biao W, et al. Intracranial pressure monitoring for special patterns of frontal lobe contusions[J]. Chin J Traumatol, 2010,13(1):51-54.
[13] Zhaofeng L, Bing L, Peng Q, et al. Surgical treatment of traumatic bifrontal contusions: when and how[J]. World Neurosurg, 2016,93(3):261-269.
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