平时颅脑火器伤108例预后分析

Prognosis analysis on 108 patients with craniocerebral firearm wounds

目的 分析影响颅脑火器伤预后的因素 ,确定颅脑火器伤的预后。 方法 对第二军医大学附属长征医院神经外科等军内 5家医院 2 1年收治的 10 8例平时颅脑火器伤进行回顾性分析。 结果 对 71例行头颅CT检查表明 ,非穿透性颅脑火器伤占 11.3 % ( 8 71) ,其预后良好 ;穿透性颅脑火器伤占 88.7% ( 63 71) ,其中脑室穿透伤和双侧半球损伤预后较差 ;颅内血肿的发生率为 4 6.5 % ( 3 3 71) ,其中脑内血肿、硬膜下血肿和蛛网膜下腔出血明显增加颅脑火器伤的死亡率。结论 非穿透性颅脑火器伤一般预后较好 ;格拉斯哥昏迷评分 (GCS) <5分的穿透性颅脑火器伤、GCS <8的双侧半球损伤和脑室穿透伤一般预后较差 ;伴有硬膜下血肿。

Objective To analyze the influencing factors so as to improve the prognosis of the patients with craniocerebral firearm wounds. Methods The data of 108 patients with craniocerebral firearm wounds admitted in 5 hospitals for almost 21 years were analyzed retrospectively. Results The patients with non-penetrating wounds accounted for 11.3%, who had good prognosis. The patients with penetrating wounds accounted for 88.7%, among whom, the patients with ventricular penetrating wounds or the patients with injury in the bilateral cerebral hemispheres had poor prognosis. The morbidity of intracranial hematoma was 46.5%. Intracerebral hematoma, subdural hematoma and subarachnoid hemorrhage increased significantly the mortality. Conclusions The patients with non-penetrating craniocerebral firearm wounds generally have good prognosis. The patients (GCS<5) with penetrating craniocerebral firearm wounds, the patients (GCS<8) with ventricular penetrating wounds or the patients (GCS<8) with injury in the bilateral cerebral hemispheres have poor prognosis. And the patients combined with intracerebral hematoma, subdural hematoma and subarachnoid hemorrhage also have poor prognosis.