重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗

Easily Missed Injuries in Severe Craniocerebral Injury Patients with Multiple Trauma

目的探讨重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗。方法对2000年1月至2007年8月收治的432例重型、特重型颅脑损伤合并其他部位损伤患者的临床资料进行回顾性分析。所有病例均符合重型、特重型颅脑损伤合并其他部位损伤患者的诊断标准,并按损伤严重评分(ISS)和GCS评分对伤情进行评估。同时对漏诊组(50例)和非漏诊组(382例)患者进行分析比较。结果432例患者中有50例漏诊,漏诊率为11.57%。与非漏诊组比较,漏诊组患者ISS评分,GCS≤8的病例所占比例及死亡率均较非漏诊组患者高(P<0.05)。视神经、空腔脏器及脊髓损伤漏诊率较高,这些易漏诊部位损伤的致残率和死亡率也较高。结论对重型、特重型颅脑损伤应重视其视神经、脊髓等合并伤的诊断、规范其诊疗流程,降低漏诊率。

Objective To explore the regularity of the easily missed injuries in the severe craniocerebral injury patients with multiple trauma in order to prevent the misdiagnosis of them. Methods The clinical data of 432 severe craniocerebral injury patients with multiple trauma treated in our hospital from January, 2000 to August, 2007 were analyzed retrospectively. The muhiple trauma severity and craniocerebral injury severity were assessed respectively by Injury Severity Score （ISS） and GCS. Results There were 115 missed injuries in 50 of the 432 patients. ISS was significantly higher in 50 patients with missed injuries than that in 382 patients without missed injuries （P〈0.01）. The misdiagnosis rate of injuries in optic nerve, spinal cord, abdominal cavity and thoracic cavity were relatively higher in these patients. The percentage of the patients with GCS≤ 8 point was significantly higher in the patients with missed injuries than that in the patients without missed injuries （P〈0.01）. Conclusions It is necessary to make the standard of diagnosis of severe craniocerebral injuries accompanied with multiple trauma. The optic nerve, spinal cord, abdominal and thoracic injuries are easily missed and should be paid attention to in the severe craniocerebral injury patients with multiple trauma.