1116例轻型颅脑损伤回顾分析

A retrospective study of 1116 patients with mild head injury

目的 评价ＧＣＳ１３～１５分的轻型颅脑损伤病人的伤情及预后，提出对其再分型建议。方法 收集我院５年期间收治的１ １１６例轻型颅脑损伤病例，应用ＧＣＳ评分、早期放射学检查、神经外科处理及ＧＯＳ分级进行回顾性分析。结果 ２０．８％的ＧＣＳ１３～１５分的轻型颅脑损伤病人有严重的放射学异常，ＧＣＳ评分愈低异常愈明显。早期放射学异常、神经外科处理及预后都与ＧＣＳ评分密切相关。把ＧＣＳ １５分、且无早期放射学异常者分归甲组；把有意识障碍（ＧＣＳ１３分和１４分）及ＧＣＳ１５分且有早期放射学异常者分归乙组。再分组后，甲组８０４例均无需神经外科处理，预后良好率１００．０％；而乙组３１２例９．３％需神经外科处理，且中、重残及死亡率分别为７．１％，１．３％，０．３％。两组需神经外科处理及预后均相差显著（Ｐ＜０．００１）。结论 ＧＣＳ评分及早期放射学异常对病人危险性判断有意义。按ＧＣＳ评分及早期有无放射学异常将甲组定义为单纯轻型颅脑损伤和把乙组定义为潜危轻型颅脑损伤是合适的。

Objective To evaluate the current definition of mild head injury and introduce a new classfication. Methods 1 116 head injured patients with GCS scores ranging from 13 to 15 admitted to our neurosurgical department during 1996～2000 were collected, their GCS scores, acute radiographic findings and GOS scores were analyzed retrospectively.Results The 20.8% of patients with GCS scores ranging from 13 to 15 suffered from serious anatomical injuties.The lower the GCS scores,the more serious the injury.There was a statistical significance among GCS scores for percentage of patients with positive acute radiographic findings,percentage receiving neurosurgical interventions,and percentage with poor outcome.The patients with GCS score of 15 without acute radiographic abnormalities were as the first group, whereas those of GCS scores of 13 or 14,or a GCS scores of 15 with acute radiographic abnormalities were as the second group.After newly grouped,804 patients in the first group had not received neurosurgical interventions,and had a good outcome,whereas 9.3% of 312 patients in the second group underwent neurosurgical interventions,and outcome of patients in this group was as follows:moderate disability,7.1%; severe disability,1.3%;death,0.3%.There were statistically significant differences between two groups(P<0.001).Conclusion GCS scores and acute radiographic findings are significant to estimate the risk of patients with GCS scores ranging from 13 to 15.Therefore,it is appropriate to define the patients with GCS scores of 15 without abnormal radiographic findings as simple mild head injury and define ones with GCS scores of 13 or 14,or a GCS scores of 15 with acute radiographic abnormalities as potential mild head injury.