多发部位重型颅脑损伤的临床研究

Clinical study of multiple severe craniocerebral injury

目的研究多发部位重型颅脑损伤的临床特点及救治策略。方法回顾性分析128例多发部位重型颅脑损伤的病例资料。根据CT扫描结果,对损伤进行分型:1型32例,2型13例,3型27例,4型24例,5型16例,6型16例。结果根据GOS判断预后:良好46例(35.9%),中残39例(30.5%),重残18例(14.0%),植物生存8例(6.3%),死亡17例(13.3%)。不同CT损伤分型的病例,预后存在差别(P<0.05)。颅内压监测组病死率明显低于未监测组(P<0.05)。结论根据病人具体情况,采取个体化治疗及监护,特别是术后颅内压监护,是提高多发部位重型颅脑损伤救治成功率的关键。

Objective To study the clinical characters and surgical strategy of multiple severe craniocerebral injury and improve its treatment efficacy. Methods The clinical data of 128 patients with multiple severe craniocerebral injury were analyzed retrospectively. According to CT scan results, the injury was type 1 in 32 patients, type 2 in 13, type 3 in 27, type 4 in 24, type 5 in 16 and type 6 in 16. Results According to the Glasgow Outcome Scale （GOS）, the patients were recovered well in 46 cases （35.9%）, moderately disabled in 39 （30.5%）, severely disabled in 18 （14.0%）, vegetative state in 8 （6.3%） and died in 17 （13.3%）. There was significant difference between various types according to CT features （P〈0.05）. Mortality in intracranial pressure （ICP） monitoring group was significantly lower than that in non-ICP monitoring group （P〈0.05）. Conclusions According to the individual status, the corresponding treatment and monitoring, especially ICP monitoring are the key point to raise the success rate of salvage for multiple severe craniocerebral injury.