简明损伤定级标准(AIS)与格拉斯哥昏迷计分(GCS)对颅脑损伤严重度评定的比较

Comparison between AIS and GCS in patients with severe head injury

目的比较单纯颅脑损伤病人ＡＩＳ－９０评定与ＧＣＳ分值的关系，对其中不符合的原因予以探讨，并提出改进设想。方法选择单纯颅脑损伤病人１６８例（其中施行开颅血肿清除术４９例），入院时均行ＣＴ检查，伤情分别采用ＡＩＳ和ＣＣＳ评定比较。结果ＡＩＳ５与颅脑损伤ＧＣ５＞８分不符合的１２例主要是单纯硬膜外及硬膜下血肿，且中线移位均＜ ５ｍｍ。若将 ＡＩＳ ５血肿＞ ５０ｍｍ、中线结构移位≤ ５ｍｍ列入 ＡＩＳ ４，而＞５ｍｍ仍列入ＡＩＳ５，本组颅脑损伤符合率将由６９．２％上升到９０％。ＧＣＳ １３～１５分的ＡＩＳ ３～４有８３例，两者评定的符合率仅为２１．７％。结论ＡＩＳ以解剖为基础；ＧＣＳ依临床作判断，如何将两者有机结合仍为探索课题。随ＡＩＳ进一步合理调配各部位所占的评分数值，增加临床内容，可使评分的准确性更高，并随计算机的推广而简化。

Objective The relationship between AIS-90 and GCS of simply head-injured patients was compared. The incompatible causes were discussed,and better methods were Prjected. Methods One hundred and sixty-eight pa- tients who suffered simple head injury were collected. In these cases,49 Patients were operated:The injury Severity was judged with AIS-90 and GCS on admission. Results AlS 5 and severe head-injured patients(GCS > 8)in 12 cases who suffered from simple extradural and subdural hematoma were incompatible. If AlS 4 had included distance of midline trans- ferring≤5mm and AIS 5 had included it > 5mm in these cases whose volume of hematome was more than 50ml and thick- ness of hematoma was more than 1cm,the compatible rate of score in PatientS with severe head injury would increase from 69.2% to90% .The compatible rate of eighty-three cases of AIS 3 - 4 and GCS 13 -15 only was 21 .7%.Conclusion AIS based on anatomy and GCS was judged on clinical data.The two methods should be related each other .If the value of AIS used in one region of human body was reasonably.and clinical data was added more,the scale would be gott- en exactly .It Would be simplified and applicable widely in traumatology field as computer was popularized.