颅脑枪弹伤的特点及转归的因素

Prognostic factors and characters of gunshot wounds to the head

目的分析颅脑枪弹伤的特点,探讨影响其转归的因素.方法回顾分析9例2002～2005年间收治的颅脑枪弹伤病人的临床及头颅CT等有关资料,将他们的入院GCS、瞳孔的改变、枪弹及受伤类型、CT表现等与恢复情况进行比较.结果颅脑枪弹伤病人入院GCS≤8、一侧或双侧瞳孔的散大、弹道跨越中线结构及多发性血肿与高的残废率及死亡率有关.受伤至入院时间在48h内对预后影响不大.结论入院GCS≤8分、一侧或双侧瞳孔的散大、弹道跨越中线结构及多发性血肿与颅脑枪弹伤的预后有关.

Objective To evaluate the predictive factors of morbidity and mortality in patients suffered from civilian gunshot wounds to the head. Methods We reviewed 9 patients admitted to the Port Moresby General Hospital, Papua New Guinea, and Chongqing Emergency Medical Center, between 2002 and 2005. Clinical and cranial computed tomography （CT） results are described and analysed. The initial Glasgow Coma Scale （GCS）, the presence of an unilateral or bilateral dilated pupil, different findings in the CT scan are focused. Results There was a significant correlation between low GCS scores on admission and a higher mortality. This kind of correlation was also noted with patients admitted with unilateral or bilateral dilated pupil. There was a significant correlation between the presence of crossing central type trajectory and high morbidity and mortality. The poor results also were seen in patients suffered a multiple intracranial hematoma. Conclusion We conclude that low GCS scores at admission, unilateral or bilateral dilated pupil, crossing central type trajectory, and multiple intracranial hematoma noted through CT scan are predictive factors of high morbidity and mortality in patients with gunshot wounds to the head.