国人轻型颅脑外伤CT检查适应证的初步研究  

Indication of CT scan for minor head injury in adult Chinese：an initial study

作　　者：朱亚男[1,2] 郑龙嵋[2] 梁煜坤[2] 郑海峰[2] 蒋士杰[2] 周和平[2] 金晨望[1] 李敏[1] 张明[1] 

机构地区：[1]西安交通大学医学院第一附属医院医学影像科,陕西西安710061 [2]安康市中心医院CT室

出　　处：《实用放射学杂志》2011年第11期1623-1628,1734,共7页Journal of Practical Radiology

基　　金：陕西省卫生厅科研基金资助项目（编号：2010D31）.

摘　　要：目的对轻型颅脑外伤（MHI）患者临床指标和CT异常结果进行相关性及多因素分析，初步探讨适合我同成年MHI的CT检查适应证。方法对860例符合纳入标准的颅脑外伤后24h以内、格拉斯哥昏迷评分（GCS）为13～15分的成年MHI患者进行前瞻性观察研究。把患者临床指标作为自变量．CT显示的急性颅脑损伤作为因变量，利用SPssl6．0软件（检验水准a-0．05）进行单因素和多因素分析，初步探讨MHI患者CT检查适应证。结果与颅脑损伤相关性最强的临床指标是神经查体阳性（OR=35．079，P=0．000）；敏感性为100％，能预测颅脑损伤的6项临床指标组合是：意识丧失、可疑颅骨骨折、危险的外伤机制、GCS评分〈15分、年龄≥65岁、锁骨上损伤体征。以此作为MHI患者CT检查适应证，可以减少27．8％的CT检查。结论本研究初步探讨了适合我国成年MHI的CT检查适应证，此临床因素组合可以敏感地预测急性颅脑损伤的发生，减少不必要的CT检查。Objective To investigate the indication of CT for minor head injury（MHI） in adult Chinese through analyzing the as- sociations between clinic and positive findings on CT scan. Methods 860 adult patients with MHI within 24 hours of incidence and 13--15 scores of Glasgow coma scale （GCS） were involved in this study. In our study, the clinical findings were as independent vari- able and the positive findings on CT were as dependent variable to tested the association between all clinical findings and the positive findings on CT scans. The most sensitive combinations for indication, and most predictive to positive findings on CT by Exhaustive CHAID decision tree. Results The most associated clinical finding with positive CT results was neurological deficit（OR=35. 079,P =0. 000）. The most sensitive results that could be predicted with positive CT findings were loss of consciousness, skull fracture, se rious injury, GCS〈15 scores, age ≥65 years and evidence of physical trauma above clavicles. This initial indication of CT was used for MHI in adult Chinese,could reduce the use of CT examination by 27.8% Conclusion This study investigated the initial indications of CT uses in MHI in adult Chinese,can be predictive to positive CT findings and reduce unnecessary CT examinations.

关 键 词：脑 颅脑外伤 体层摄影术 X线计算机 适应证 

分 类 号：R742[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]