重型颅脑损伤患者行去骨瓣减压术预后分析  

Initial Rotterdam CT score may predict prognosis of the patients after unilateral decompression craniectomy for treating severe traumatic brain injury

作　　者：王建莉[1] 金国良[1] 袁紫刚[1] 

机构地区：[1]绍兴市人民医院浙江大学绍兴医院神经外科,浙江省绍兴312000

出　　处：《中华急诊医学杂志》2014年第2期168-173,共6页Chinese Journal of Emergency Medicine

基　　金：绍兴市科技局公益性技术应用研究计划项目（2012B70075）

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增大的相关因素及与预后的关系.方法 本研究为前瞻性研究：对2008年1月至2011年12月期间浙江省绍兴市人民医院神经外科收治的行去骨瓣减压术的重型颅脑损伤患者（共291例,其中56例因缺乏头颅CT数据等情况不纳入分析,最终研究对象为235例）进行随访观察,收集记录性别、年龄、致伤原因、术前情况（GCS评分,瞳孔状态,实验室检查和头颅CT数据）、术后血肿增加量、预后（GOS评分）指标,比较血肿增大组与血肿未增大组各参数差异（视数据特性进行t检验,x2检验和秩和检验）,同时采用分类和回归树预测血肿是否增大,并进行Rotterdam CT评分与GOS相关性分析.结果 235例患者中血肿增大组120例,血肿未增大组115例,组间比较显示,年龄（t=2.034,p=0.043）、首次Rotterdam CT评分（Z=4.838,P＜0.01）、GCS评分（Z =4.440,P＜0.01）、瞳孔状态（Z=3.235,P=0.001）、外伤到开颅时间（Z=3.874,P＜0.01）、血糖值（Z=3.880,P＜0.01）和疝出幅度（Z=2.529,P=0.012）差异具有统计学意义；分类和回归树分析结果表明：最初头颅CT的Rotterdam评分、血糖值和外伤到开颅间隔时间是强有力的预测因子,年龄和骨瓣大小也对挫伤性脑出血是否增大产生有意义的影响,分类和回归树预测准确率为83.3％；相关性分析结果说明Rotterdam CT评分与GOS呈负相关（r=-0.333,P＜0.01）.结论 重型颅脑损伤患者头颅CT的严重程度、血糖值和外伤到开颅间隔时间可以预测去骨瓣减压术后脑挫伤出血增大的风险；Rotterdam CT评分与预后密切相关.Objective To identify the factors enhancing the contusive brain hemorrhage following unilateral decompression craniectomy in patients with severe traumatic brain injury （TBI）,and to explore the relationship between the initial Rotterdam CT score and clinical outcomes.Methods A prospective study of 291 consecutive patients with TBI admitted from Jan 2008 through Dec 2012 was carried out.Patients treated with unilateral decompression craniectomy were enrolled for study.Patients without preoperative or postoperative cranial CT imaging were excluded.Of them,235 patients were followed up.Gender,age,the causes of injury,preoperative general condition including Glasgow Coma Scale （GCS） score,pupillary response,laboratory data and the initial CT scans before operation,contusion hematoma size in CT scans following operation and Glasgow Outcome Scale （GOS） score were recorded.With t test,x2 test and nonparametric rank sum test,differences in the above listed variables were compared between patients with enlarged hematoma size group and those without change in hematoma size.A Classification And Regression Tree （CART） was used to predict the size of hematoma.Correlation analysis was used to find the relationship between the Rotterdam CT scores and GOS scores.Results The differences in age （t =2.034,P =0.043）,first Rotterdam CT score （Z =4.838,P ＜ 0.01）,GCS score （Z =4.440,P ＜ 0.01）,pupillary response （Z =3.235,P =0.001）,the length of time elapsed between the trauma occurred and the decompressive craniectomy （Z =3.874,P ＜ 0.01）,glucose level （Z =3.880,P ＜ 0.01） and cerebrum hernia magnitude （Z =2.529,P =0.012） were significant between the patients with hematoma expanded （n =120） and those without change in hematoma size （n =115）.The results of the CART indicated that Rotterdam score got from the initial head CT,glucose level and the length of time elapsed between trauma occurred and decompressive craniectomy were strong predictors of the risk for expanded hemorrhagic

关 键 词：创伤性脑损伤 创伤性脑出血 外伤性蛛网膜下腔出血 ROTTERDAM CT评分 去骨瓣减压术 预后 分类和回归树 Glasgow预后评分 

分 类 号：R651.15[医药卫生—外科学]