颅脑损伤患者单侧去骨瓣减压术后挫伤性脑出血扩大的相关因素及与预后的关系  

Relevant factors of contusive cerebral hemorrhage expansion and their association with prognosis after unilateral decompressive craniectomy in patients with craniocerebral injury

作　　者：王建莉[1] 金国良[1] 

机构地区：[1]绍兴市人民医院神经外科,312000

出　　处：《中华创伤杂志》2012年第8期680-685,共6页Chinese Journal of Trauma

摘　　要：目的探讨重型颅脑损伤患者单侧去骨瓣减压术后挫伤性脑出血扩大相关因素及与预后的关系。方法161例单侧去骨瓣减压术的颅脑损伤患者进入前瞻性研究，记录伤后首次、术前和术后首次头颅CT数据。以死亡或外伤后6个月GOS评分为预后评价标准。结果单侧去骨瓣减压术后挫伤性脑出血量增加（18．66±22．69）ml。伤后首次头颅CT的Rotterdam评分与去骨瓣减压术后挫伤性脑出血量是否扩大及增加的血肿量显著相关；去骨瓣减压术后挫伤性脑出血增加量超过20m1与死亡率和6个月后的预后不良显著相关；术后首次头颅CT的脑疝出幅度（externalcerebralherniation，ECH）与预后相关。结论重型颅脑损伤患者首次头颅CT的严重程度可以预测去骨瓣减压术后挫伤性脑出血增加的风险，挫伤性脑出血增加的量和疝出幅度与死亡率及预后不良相关。Objective To identify the relevant factors of expansion of contusive cerebral hemor- rhage following unilateral decompressive craniectomy in patients with severe craniocerebral injury and dis- cuss their relation with prognosis. Methods A total of 161 consecutive patients with craniocerebral in- jury undergoing unilateral decompressive craniectomy were prospectively studied. Their initial cranial CT data （data after injury, data before operation, and data after first operation） were recorded. Mortality or Glasgow Outcome Scale （GOS） at 6 months after injury was used as the criteria for evaluation of progno- sis. Results The volume of increased contusive cerebral hemorrhage among the patients after craniec- tomy was （ 18.66 ± 22.69 ） ml. The Rotterdam score of their initial cranial CT after injury was signifi- cantly associated with the occurrence or not of expanded contusive cerebral hemorrhage following decom- pressive eraniectomy and the expanded hematoma volume. The expanded volume of contusive cerebral hemorrhage （ 〉 20 ml） after craniectomy showed significant relevance to mortality and poor prognosis six months later. The magnitude of external cerebral herniation （ECH） on the initial post-operative CT was associated with the prognosis. Conclusions The severity of patients with craniocerebral injury manifes- ted by the initial cranial CT may predict the risk of expansion of contusive cerebral hemorrhage following decompressive craniectomy. The expansion volume of contusive cerebral hemorrhage and ECH are correla- ted with mortality and poor prognosis.

关 键 词：脑损伤 减压术 外科 脑出血 预后 

分 类 号：R651.15[医药卫生—外科学]