额叶脑挫裂伤恶化的危险因素分析

Risk factors of deterioration in patients with traumatic frontal contusions

目的探讨不同类型外伤性额叶脑挫裂伤恶化的危险因素,首次CT表现能否预示恶化发生的风险。方法回顾性分析36例没有弥散性脑损伤或颅内血肿而CT表现额叶脑挫裂伤的头部外伤病例。分析额叶脑挫裂伤类型(根据CT扫描结果),格拉斯哥昏迷评分(GCS),病情恶化的时间和预后(GOS)。结果 20例单侧额叶脑挫裂伤的病例都恢复良好;10例局限性双侧额叶脑挫裂伤仅5例恢复良好;6例广泛性双侧额叶脑挫裂伤中的4例伤后24h病情仍恶化,其中1例死亡。结论脑水肿尤其延迟效应是额叶脑挫裂伤恶化的主要危险因素。首次CT扫描所示脑挫裂伤的类型可以用来预示恶化发生的风险,双侧广泛性额叶脑挫裂伤恶化的危险性很高。

Objective To explore the risk factors of deterioration in patients with different traumatic frontal contusions,and if patients at risk could be recognized at the time of initial CT. Methods The clinical data of 36 head injury patients in whom CT had shown frontal contusions without diffuse brain injury or intracranial hematoma were analyzed retrospectively. The type of frontal contusions （ the first computed tomography after traumatic brain injury）, Glasgow Coma Score on admission（GCS）, the time of deterioration and prognosis （GOS） were analyzed. Results Of 36 patients, 20 with unilateral frontal contusion made a good recovery,4 of 10 patients with limited bilateral frontal contusions made a good recovery. 4 of 6 patients with extensive bilateral frontal contusions deteriorated more than 24 hours after injury, and one died. Conclusions In particular, the delayed effects of brain edema is the main cause of the deterioration in patients with traumatic frontal contusions. The type of frontal contusions identified by the first computed tomography can be used to predict the risk of deterioration. Such risk is particularly high in patients with extensive bilateral frontal contusions.