老年急性颅脑损伤颅内血肿演变分析

Analysis of intracranial hematoma progression of acute traumatic brain injury in elderly patients

目的探讨老年急性颅脑损伤颅内血肿演变及其对预后的影响。方法回顾性分析112例青年(<40岁)和104例老年(>60岁)急性颅脑损伤患者入院后颅内血肿演变在程度和时间方面的异同,并分析其对预后的影响。结果两组血肿进展程度无显著性差异(P>0.05);Ⅰ型血肿进展稳定期,青年患者在伤后24h内(88.2%),而老年患者则分布相对延长,在48h(82.5%);Ⅱ型血肿进展峰值期,青年患者在伤后12h内(75.0%),老年患者为24h(73.9%);老年组Ⅱ型血肿进展与血肿未进展比较对预后影响存在显著差异(P<0.01)。结论老年急性颅脑外伤的患者颅内血肿进展达到稳定或峰值时间相对较长,有必要在急性期常规定时复查CT以监测颅内血肿进展,并适当放宽手术指征,尽量在尚未出现临床情况恶化时采取积极措施,有利于改善预后。

Objective To study the features and prognostic influences of intracranial hematoma progression（ICHP） of acute traumatic brain injury（TBI） in elderly patients.Methods One hundred and twelve young（45 years） and one hundred and four TBI elderly patients were included in this retrospective study.The similarities and differences of the time and level of ICHP between two groups were compared,and the prognostic influences of different types of ICHP were analyzed.Results The level of ICHP was not significantly different between the young and elderly patients;the stable time of type-Ⅰ ICHP was 24 hours after injury in young patients（88.2%） while 48 hours in elderly（82.5%）;the peak time of type-Ⅱ ICHP was 12 hours after injury in young patients（75.0%） while 24 hours in elderly（73.9%）;the prognostic influences were significantly different（P0.01） between type-Ⅱ ICHP and none ICHP in elderly patients.Conclusion It is necessary for elderly patients to repeat routine scheduled CT scanning in acute phase of TBI for monitoring the ICHP and properly expand the range of surgical indication in order to take aggressive treatment before clinical deterioration,which may help to improve the prognosis.