轻型颅脑损伤的Fisher确切概率法分析

Fisher exact test of mild traumatic brain injury

目的分析轻型颅脑损伤的临床症状、影像诊断及转归。方法 2006年8月—2008年8月期间我院收治的224例格拉斯哥昏迷评分(GCS)13～15分患者,排除年龄<16岁、饮酒及患有精神性疾病病例。观察项目为GCS、呕吐、健忘症、CT、MRI影像所见。转归评价:(1)有无神经症状后遗症;(2)有无癫痫发作;(3)采用Awareness Questionnaire,评估受伤前后日常生活有无变化。利用Fisher确切概率法进行分析。结果 GCS13分的51例中,42例CT有脑挫裂伤表现,3例CT无脑挫裂伤表现,但MRI为脑挫裂伤表现,6例CT及MRI均无脑挫裂伤表现;51例中有33例存在神经后遗症。脑挫裂伤与神经后遗症经Fisher确切概率法χ2检验,χ2值为7.85,P<0.01。在173例GCS 14分以上的病例中有32例存在脑挫裂伤(18%),其中24例(75%)脑挫裂伤诊断需要MRI;GCS 14分以上脑挫裂伤病例中,GCS14分、呕吐、健忘症与脑挫裂伤有显著关系,χ2值为45.78,P<0.01;GCS 14分以上脑挫裂伤病例中,神经后遗症少见,脑挫裂伤与受伤前后日常生活变化无明确关系,χ2值为2.69,P>0.05。平均随访20个月,癫痫发作2例。结论 (1)轻型颅脑损伤中,GCS13分病例残留神经后遗症的危险因素为脑挫裂伤。(2)GCS14分以上病例脑挫裂伤诊断需要MRI。(3)GCS14分以上病例,GCS14分、呕吐、健忘症是诊断脑挫裂伤的危险因素。(4)GCS14分以上病例,脑挫裂伤的存在不是影响转归的影响因素。(5)轻型颅脑损伤,脑挫裂伤的存在不是癫痫发作的危险因素。

Objective To investigate the clinic symptoms,neuroimaging findings and sequelae after mild traumatic brain injury（mTBI）.Methods 224 mTBI patients with a Glasgow Coma Scale（GCS） of 13 to 15 were admitted to our neurosurgical outpatient clinic from August 2006 to August 2008.The patients with a history of drinking,cognitive deficits and an age of less than 16 did not enter this study.The neurologic symptomatology referred to GCS scores,vomiting and amnesia,while brain imaging study included CT and/or MRI.Sequelae evaluating protocols were： ⑴Whether have neurological sequelae;⑵ seizures;⑶ changes in daily life before and after injury,with Awareness Questionnaire analysis.Using Fisher exact test,P0.01 was considered statistically significant.Results Of the 51 patients with a GCS score of 13,42 cases presented intracerebral hemorrhagic contusions on brain CT scanning,3 cases had intracerebral contusions on brain MRI but not on CT scans,6 cases did not show intracerebral contusion both on repeated MRI and CT scans,and 33 cases had postconcussion syndrome.The results of Fisher exact test for cerebral contusion and neurological sequelae showed that χ2=7.85,P0.01.Among the 173 patients with a GCS score of more than 14,32 cases had cerebral contusions（18%）,of which 24 cases（75%） were diagnosed by MRI.GCS score of 14,vomiting and amnesia were significantly related to brain-contusion,χ2=45.78,P0.01;Among the patients with a GCS score of more than 14,postconcussion syndrome was rare and changes in daily life had not correlation with cerebral contusion,χ2=2.69,P0.05.Moreover,2 cases were found seizures by follow-up of 20 months.Conclusion（1）Cerebral contusion was the risk factor for postconcussion syndrome in mTBI patient with a GCS score of 13;（2）MRI scan was needed for the diagnosis of cerebral contusion in mTBI patient with a GCS score of more than 14;（3）both vomiting and amnesia were risk factors for the diagnosis of cerebral con-tusion in mTBI patient with a GCS of more than 14;（4）cerebral contusion had not effect on prognosis in mTBI patient with a GCS of more than 14;（5）cerebral contusion was not a risk factor for seizures in mTBI patients.