高海拔地区重型颅脑交通伤特点分析

Analysis of characteristics of heavy head injuries caused by traffic accidents in highland

目的 探讨高海拔地区重型颅脑交通伤的特点和救治。 方法 对 1992～ 1998年收治的 392例颅脑交通伤病人进行回顾性分析。 结果 本组病例占同期颅脑损伤的 6 8.9%(392 5 6 9) ,其中重型或特重型颅脑伤占 79.8% (313 392 )。CT检查有颅内血肿占 41.3% (16 2 392 ) ;颅内压 (ICP)监测≥ 2 .6 7kPa占 92 .6 % (87 94) ;血氧饱和度 (SaO2 ) <0 .90占 83.7% (2 31 2 76 ) ;血红蛋白 (Hb)≥ 180g L占 42 .3% (16 6 392 )。非手术治疗 2 0 7例 ,死亡 33例 ,死亡率 15 .9% ;手术治疗185例 ,死亡 98例 ,死亡率 5 3.0 %。随访 189例 ,15 8例 0 .5～ 6年无明显后遗症 ,恢复原工作。 结论 高海拔地区颅脑交通伤多属重型或特重型 ,因低氧环境因素影响 ,具有ICP增高出现早、SaO2低、Hb高、术后死亡率高等特点 ,加上交通不便 ,伤后院外滞留时间长 ,使救治难度增加。

Objective To explore the characteristcs and treatment of heavy head injuries caused by traffic accidents in highland. Methods The data of 392 cases of brain traffic accidents injuries treated in our hospital between 1992 to 1998 were retrospectively reviewed and analyzed. Results The group of the cases accounted for 68.9% of all the brain injuries in Qinghai province (392/569), among which patients with heavy head injuries took up 79.8%(313/392). CT examination revealed that patients with intracerebral haematoma covered 41.3%(162/392), patients with ICP≥2.67 kPa 92.6%(87/94), patients with SaO 2<0.90 83.7%(231/276),and patients with Hb≥180 g/L 42.3% (166/392). Non-surgical treatment was performed in 207 cases, surgical treatment was done in 185 cases, among whom 98 cases died with death rate of 53.0% ( 98/185 ). The follow-up of 189 cases showed that 158 cases were able to work without sequelae 0.5 - 6 years after treatment. Conclusions Most head injuries caused by traffic accidents in highland are heavy head injuries. Because of the low oxygen, early increase of ICP, low SaO 2, high Hb, and poor traffic conditions all these factors make it difficult to treat the injuries immediately as a result the death rate is high.