CT在闭合性颅脑损伤诊治中的作用

The value of computered tomography in the diagnosis and management of acute closed head injury

420例闭合性颅脑损伤进行临床和CT资料的对照分析。其中重型颅脑损伤169例,270例(64.3％)在CT扫描中有异常发现,其中颅内血肿158例、脑挫裂伤138例、急性弥漫性脑肿胀28例。经CT和手术证实的迟发性颅内血肿共12例,占颅内血肿的7.6％。45例颅内血肿行非手术治疗,其中4例失败。本组死亡35例,重型颅脑损伤的死亡率为20.7％,与本院应用CT前资料相比,各类颅内血肿的手术死亡率都有明显下降;在GCS为6～8的病人组中CT对判断预后有很大价值,尤其是基底池和第三脑室的受压和消失提示预后不良。

Acomparative analysis of clinical appearences and CT scan was performed. It based upon 420 cases of consecutive head injury adimited from March 1983 to February 1986. The patients were classified according to the duration of primary coma, Glasgow coma score, neurological deficits and the CT findings. 169 cases were categorized into severe type of craniocerebral trauma. 270 patients (64.3%) have shown abnormal CT findings, including intracranial hematomas in 158, cerebral contutions and lacerations in 138 and acute diffuse brain swelling in 28 cases.Delayed intracranial hematomas were confirmed by CT and operations in 12 patients, accounting for 7.6% of all intracranial hematomas. Nonsurgical management was applied in 45 cases of intracranial hematomas and 4 of them were underwent operation later on. 35 patients died of severe head injury, the mortality rate was 20.7%. As compared to data before application of CT in our hospital, the operative mortality in intracranial hematomas was decreased markedly. CT is useful in prediction of the prognosis. If the patient with GCS of 6—8 and obliteration of basic cistern and third ventricle usually suggests a poor outcome.