重型颅脑损伤去骨瓣减压术后挫伤性脑出血加重原因分析  

Analysis of the prognosis of increase of contusive cerebral hemorrhage after unilateral decompressive craniectomy in patients with severe craniocerebral injury

作　　者：王红琳[1] 王颖毅[2] 

机构地区：[1]菏泽市立医院神经外科,山东菏泽274000 [2]南京医科大学生物系第二基础室,江苏南京211100

出　　处：《中国实用神经疾病杂志》2017年第20期50-53,共4页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(81101901)

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预后情况。方法临床纳入进行单侧去骨瓣减压术的重型颅脑损伤患者235例,观察患者的性别、年龄、致伤原因、术前情况(GCS评分、瞳孔状态、实验室检查以及头颅CT等)、术后血肿增加量、预后(GOS评分)等指标,并进行Rotterdam CT评分与GOS评分的相关性分析。结果235例患者中,血肿增大组120例,血肿未增大组115例。纳入影响因素12项,性别、致伤原因、白细胞计数、C反应蛋白、骨瓣最大径与挫伤性脑出血增大无明显关联,而年龄、首次Rotterdam CT评分、GCS评分、瞳孔状态、外伤到开颅时间、血糖值以及疝出幅度等差异有统计学意义(P<0.05)。相关性分析显示,Rotterdam CT评分与GOS评分存在明显的负相关(P<0.05)。结论重型颅脑损伤患者头颅CT的严重程度、血糖水平以及外伤至开颅间隔时间可作为预测单侧去骨瓣减压术后脑挫伤出血增大的风险因素,而Rotterdam CT评分综合基底池形态、中线移位程度、蛛网膜下腔出血,根据其水平上升则GOS评分下降这一现象可知Rotterdam CT与患者的预后有较为密切的联系。Objective To investigate the related factors of increase of contusive cerebral hemorrhage after unilateral decom- press[re craniectomy in patients with severe craniocerebral iniury and prognosis. Methods Totally 235 patients with severe cranio- cerebral injury admitted for unilateral decompressive craniectomy were selected. The gender, age, the cause of injury, preoperative status （GCS score, pupil status,laboratory examination and CT of head）, the increasing volume of hematoma after the operation, prognosis （CJOS score） and other indicators of the patients were recorded. The clinical differences among the indicators of the he- matoma enlargement group and the hematoma without enlargement group were observed. The correlation between Rotterdam CT score and GOS score was analyzed. Results Among the 235 cases,there were 120 cases of patients with hematoma enlargement and 115 patients without enlarged hematoma which was absorbed in the 12 influence factors. The results showed that there was no obvious correlation between the gender, cause of injury, white blood cell count, reaction protein C, maximum diameter of bone flap and the increase of contusive cerebral hemorrhage. The differences of age, first Rotterdam CT score, GCS score, the status of pupils, time from injury to surgery,levels of blood glucose and the amplitude of hernia were significant （P〈0.05）. It showed that there was a negative correlation between the Rotterdam CT score and GOS score after the analysis of correlation （P〈0. 05）. Conclusion The severity of cranial CT of patients with craniocerebral injury, levels of blood glucose and the time between injury and craniotomy can be used to predict the risk factors of increased cerebral contusion hemorrhage after unilateral decompress[re crani- ectomy. According to the phenomenon that while the levels of Rotterdam CT scores integrated with basilar cistern form, the degree of midline shift and subarachnoid hemorrhage rises, the GOS score decreases, it can be found that there is close rela

关 键 词：重型颅脑损伤 单侧去骨瓣减压术 挫伤 脑出血 因素 预后 

分 类 号：R651.15[医药卫生—外科学]