计划性CT复查在单纯脑挫裂伤的轻型颅脑损伤患者中的应用

目的：探讨入院首次行头颅CT检查发现为单纯脑挫裂伤的轻型颅脑损伤患者，有无必要行计划性CT复查。方法按标准收集病例共154例，分成计划组与非计划组，各77例。计划组指伤后无论有无神经系统症状体征变化，在首次CT检查后6h、24h、3d、5d及7d复查。非计划组则在患者出现神经系统症状体征恶化时复查，如无临床表现恶化，则在出院前1 d予以复查。比较两组入院时的基本资料、首次头颅CT检查时间、挫裂伤部位、影像学进展及神经外科专科干预比例、住院天数、出院及预后情况。结果两组入院时基本情况、首次头颅CT检查时间、挫裂伤部位比较无明显差异（P〉0.05）。影像学进展比例、神经外科专科干预比例、住院天数、出院时格拉斯哥评分（GCS）及伤后6个月格拉斯哥预后评分（GOS）两组间比较无明显差异（P〉0.05）。结论首次CT检查发现有单纯脑挫裂隙伤的轻型颅脑损伤患者，密切观察神经系统症状体征，可不必行计划性CT复查。

ObjectiveTo study on the necessity of scheduled repeat computed tomography（CT）scans in patients,who were identifi ed mild traumatic brain injury with pure contusions based on the fi rst CT scan.MethodsOne hundred fi fty four patients were divided into scheduled repeat cranial CT group（n=77）and non-scheduled repeat cranial CT group（n=77）according to the standard. The group with scheduled repeat CT, even if clinically stable,is still required repeat cranial CT scans within 6 hours,24 hours,3 days,5 days and 7 days respectively after the fi rst CT scan. The group with non-scheduled repeat CT who required repeat CT scan is based on neurologic deterioration or at the day before discharging if normal neurologic examination. Age,gender,score of Glasgow Coma Scale（GCS）at admission,the result of the initial CT scans,radiographic progression,proportion of neurologic interventions,length of hospital stay,score of GCS at discharge,score of GOS at six month after injury were compared between groups.ResultsThere were no signifi cant difference in age,gender,score of GCS at admission,the result of the initial CT scans,radiographic progression,proportion of neurologic interventions,length of hospital stay,score of GCS at discharge,score of GOS between the two groups（P〉0.05）.ConclusionOur Resultsshowed that scheduled repeat cranial CT scans is unnecessary in patients with mild traumatic brain injury,who were identifi ed pure cerebral contusions based on the fi rst CT scan after injury,if closely monitored neurologic examination.