对冲性脑挫裂伤受伤——手术的间隔时间与预后相关性分析

Relationship between time to surgery and patient prognosis in contrecoup craniocerebral injury

目的探讨对冲性脑挫裂伤患者行去骨瓣减压术受伤一手术间隔时间与预后的关系。方法回顾分析54例患者对冲性脑挫裂伤发生至去骨瓣减压手术的时间间隔及预后情况，按照3个月后的格拉斯哥预后评分（GOS）分组，分析了各组受伤一手术间隔时间的差异及其与预后的相关性。结果54例行去骨瓣减压术患者受伤一首次手术间隔时间，平均（4646）h；伤后3个月评定GOS，预后不良组25例（46％），预后良好组29例（54％）。预后不良组中，间隔时间平均（26±25）h；预后良好组，平均（72±51）h，2组间差异有统计学意义；而间隔时间不足24h者20例，GOS平均（2．7±1．3）分；24～72h者26例，平均（3．6±1．1）分；超过72h者8例，平均（4．3±1．1）分，组间统计学差异明显，显示24h组较其他组别预后差。结论预后良好的患者受伤一手术间隔时间明显长于预后不良者，提示在达到相同的手术指征的情况下，间隔越短，颅脑损伤越重预后越差，受伤一手术间隔时间能一定程度反映颅脑损伤情况，是预测患者预后更为可靠的指标之一。

Objective To investigate the relationship between time to surgery and prognosis in patients with severe contrecoup craniocerebral injury treated with decompressive craniectomy. Methods We reviewed 54 cases of severe contrecoup craniocerebral injury treated with decompressive craniectomy, and recorded the data on time to surgery and prognosis. Based on 3-month GOS scales, the correlation between prognosis and difference in time interval from injury to surgery was analyzed. Results Of the 54 patients who underwent decompressive craniectomy, the mean time to first surgery was （46 ＆#177;46）h. The prognosis at 3 months was poor in 25 （46.3%） patients and good in 29 （53.7%）, based on GOS scales. In patients with poor prognosis, the mean time interval from injury to surgery was （26 ＆#177; 25）h, compared to （72＆#177;51）h in those with good prognosis. The mean GOS score was （2.7＆#177;1.3） in patients who under-went surgery less than 24 hrs from injury （n=20）, 3.6＆#177;1.1 in those between 24 and 72 hrs （n=26）, and 4.3＆#177;1.1 in those after 72 hrs （n=8）. The differences across these subgroups were statistically significant, indicating worst progno-sis in patients undergoing surgery within 24 hrs from injury compared with the others. Conclusion As shown by the longer time interval from injury to surgery in patients with good prognosis, shorter time to surgery may be associated with a more severe condition and poorer prognosis contrecoup craniocerebral injury, given the same indications for de-compressive craniectomy. Therefore such a time interval can reflect the severity of injury and predict the prognosis in the patients.