婴幼儿颅脑损伤临床分析

Clinical characteristics in infant with traumatic craniocerebral injury

目的总结分析婴幼儿颅脑损伤的临床特点。方法回顾性研究婴幼儿颅脑损伤患者的致伤原因、损伤类型、临床表现、救治方法和预后状况。结果本组年龄15d^2岁婴幼儿150例,其中坠落伤79例,跌伤35例,共占76.0%;闭合性颅脑损伤126例;开放性颅脑损伤24例。合并颅内血肿62例(41.30%),并发颅骨骨折62例(41.30%)。伤后所有婴幼儿均有不同程度的呼吸、心率变化;伤后意识障碍147例(98%);16例(10.70%)有大面积脑缺血表现。本组手术治疗54例,保守治疗96例。格拉斯哥预后评级(GOS):恢复良好131例(87.33%);中残8例(5.33%);重残6例(4.0%);植物生存1例(0.67%);死亡4例,死亡率2.67%。结论婴幼儿颅脑损伤以坠落伤和跌伤较多见,加强监护是避免损伤的重要途径;婴幼儿颅脑损伤的主要临床特点是:生命体征紊乱明显;临床症状与病情不符;颅骨凹陷骨折和颅缝分离多见;外伤后脑缺血多见,且损害较重;组织修复能力强,预后较好。

Objective To analyze the clinical characteristics of infant with traumatic craniocerebral injury.Methods The causes and types of trauma, therapy and prognosis had been studied retrospectively. Results One hundred and fifty infants aged from 15 days to 2 years included in the group including 37 cases suffering from falls and 35 cases suffering from tunbls, which accounted for 76% of the total traumatic cases. There were 126 cases with closed craniocerebral injury and 24 with open craniocerebral injury. Sixty-two patients （41.30%） combined with intracranial hematoma and 62（41.3%） with skull fracture. One hundred and forty-seven（98% ） patients were unconscious after trauma, and 16 （ 10. 70%） had apparent large area brain iscbemia. Forty-four cases were performed operation and 96 cases received medications treatment. One hundred and thirty-one patients （87, 33% ） obtained good outcomes, 8（5.33%） were moderately disabled, 6（4. 0% ） severely disabled, 1（0. 67% ） survived in a permanent vegetative state, and 4 （2.67%） died. Conclusion The main causes of traumatic cranioeerebral injury in infant are falling from high place and tumble in moving. The clinical characteristics of infant with traumatic cranioeerebral injury include abvious changes of life signs, disaccord between clinical characteristics and condition of brain injury, more depressed skull fracture and abruption in suture of skull, large area brain ischemia resulting in severe neurological deficits, and better prognosis than adults.