超高龄老年人脑损伤致伤因素分析及护理对策

Analysis of wound factors for brain injury in the elderly and the nursing countermeasure

目的探讨老年人颅脑损伤的发病因素和护理措施。方法对1999～2003年在解放军总医院定点就医的一组老年人群（年均18492人）共210例颅脑损伤患者发病时的身体状况，发病率及受伤特点，病程及治疗和护理等临床资料进行回顾性总结。该组老年人在建档案时已被分为2个亚组：超高龄组年龄限（平均年龄79．75岁，1978例）和老年组年龄限（平均年龄69．42岁，16514例）。以同期其他人群的脑损伤187例作为对照组，并进行2组回顾资料的比较。结果按意向处理分析397例均进入结果分析。发病率及受伤特点：超高龄组发病率明显高于老年组，多为摔伤；老年组和对照组均为交通伤占主要伤因。治疗及病程：对照组和老年组中均有超过80％患者接受手术治疗，而超高龄组仅有53．40％的患者接受手术治疗。预后：各组的死亡率和重残比率均无明显差别。结论老年人群的脑损伤致伤原因主要是摔伤，同时多患有单器官或多器官的疾病；老年人脑损伤占用医疗资源多，但经积极治疗和采取有效的护理措施，仍可获得较好的疗效；回顾性资料记载超高龄组是能够检索到的国内外老年人脑损伤平均年龄最高的一组，时超高龄脑损伤的相关分析是有临床借鉴意义的。

Objective To investigate the epidemic factors of traumatic brain injury （TBD of aged people and the nursing countermeasure. Methods In a group of old people designated to General Hospital of PLA during 1999/2003 （on an average of 18 492 cases per year）, the condition, the incidence rate, the injury feature, the course of diseases, the clinic materials of treatment and nursing of 210 cases with TBI were retrospectively reviewed. These people had been divided into two subgroups when their medical records were established, i.e. the hyper-old group with an average age of 79.75 （1 978 cases） and the early-old group with an average age of 69.42 （16 514 cases）. 187 cases with brain injury in the same period from other peoples were used as the control group. The retrospective materials of the two groups were compared, Results The 397 cases were all entered into the result analysis according to the intent process analysis. The incidence rate in the hyper-old group was much higher than that in the early-old group. The main injury was tumbling injury in the hyper-old group, while the traffic injury in the early-old group and the control group. More than 80% of the patients received the surgery treatment in the control group and the early-old group, while 53.40 % in the hyper-old group. The mortality rate and the disability rate had no significant differences in each group. Conclusions The main reason of brain injury is tumbling injury in the elderly. At the same time, most of the patients have single-organ diseases or multiple-organ diseases. The brain injuries in the elderly occupy many medical resources, but the better therapy effect can be obtained through the active treatment and the effective nursing countermeasure. The retrospective materials record that the group is the group with the highest average age among the groups of aged people with traumatic brain injury searched out over the world. The analysis onthe correlativity of the hyper- aged people with traumatic brain injury has a clinical significance for refer- ence.