婴幼儿急性颅脑损伤临床分析

Clinical analysis of acute craniocerebral injuries in infants and children

目的探讨3岁以下婴幼儿急性颅脑损伤的特点。方法回顾性分析49例3岁以下婴幼儿急性颅脑损伤资料，临床主要表现为：抽搐、呕吐、前囱门隆起紧张，意识障碍，局灶性神经系统体征，贫血及呼吸紊乱窘迫。分为三组：轻度颅脑损伤（19例），中度颅脑损伤（22例），重度颅脑损伤（8例），头颅CT显示：①均有颅内出血，包括急性、亚急性硬膜下血肿（SDH）和蛛网膜下腔出血（SAH），最常见出血部位为大脑镰，小脑幕及大脑凸面；②伴局灶性或弥漫性（大面积）脑实质低密度。多发生在6个月以下的婴幼儿，伴大面积低密度灶患儿多预后不良。结果按COS预后评级，良好39例，中残6例，重残2例，死亡2例。结论婴幼儿生理特点有其特殊性，依据婴幼儿急性颅脑损伤的特点，早期采取积极有效的治疗措施，可降低病死率及致残率，婴幼小儿经系统修复能力强，与成人相比多预后良好。

Objective To explore the clinical characteristics of traumatic craniocerebral injury in children before 3 years old. Methods The clinical data of 49 children younger than 3 years with craniocerebral trauma were retrospectively analyzed. The clinical manifestations mainly included seizure, vomiting, bulging fontanel, decreased level of consciousness, focal neurological signs, anemia and respiratory distress. According to the severity of injury, the 49 patients were divided into 3 groups： mild injury group （19 cases）, moderate injury group （22 cases） and severe injury group （8 cases）. Cranial CT demonstrated that： acute or subacute subdural hematoma （SDH） and subarachnoid hemorrhage （SAH） occurred in all patients; hematomas located in the parafalcine and tentorial regions and over the brain convexity; some patients, especially infants younger than 6 months, had focal or diffuse parenchymal hypodensities, which indicated unfavorable prognosis. Results According to Glasgow outcome scale （GOS）, most patients （39 cases） had a good outcome except 6 moderately disabled, 2 severely disabled and 2 died. Conclusions Craniocerebral anatomy and physiology and pathophysiology of craniocerebral trauma in children were distinct from those in adults. Therapeutic plan should be made on these distinct characteristics. For children＇s good neurologic repairing capability, pediatric patients with craniocerebral trauma usually have favorable prognosis.