运动评分在重型颅颌面损伤患者中的应用评价

Assessing the consciousness change after severe craniomaxillofacial injury with GCS-M scale

目的:探讨用单纯运动GCS评分(GCS-M)评估患者的意识变化,以期指导临床。方法 :回顾性分析63例重型颅颌面损伤患者入院后的GCS-M评分的变化及当时头颅CT改变,采用SPSS14.0软件包对数据进行统计学处理。结果:63例患者中,入院时GCS-M评分4分的17例患者8例变严重,评分降为3分,头颅CT示颅内血肿增大,中线移位加重,经积极手术后,中线移位回复,GCS-M评分又回到4分;入院时GCS-M评分3分的患者18例,手术后GCS-M评分好转,头颅CT显示脑内情况变好。统计学分析发现,GCS-M可准确评价这类患者的颅内情况,与颅内情况变坏呈负相关。结论:在无法运用GCS评分时,GCS-M是一种简单易行的评价重型颅颌面损伤患者伤情的方法,其变化与颅内伤情呈负相关。

PURPOSE： To estimate the ability of GCS-M to judge the change of consciousness in severe craniomaxillofaeial injury patients. METHODS： Sixty-three patients with severe craniomaxillofacial injury were retrospectively reviewed based on their GCS-M scale and CT scan. Statistical analysis was undertaken with SPSS 14.0 software package. RESULTS： Among 63 cases, there were 17 cases with 4 of GCS-M at admission and 18 cases with 3 of GCS-M. Of 17 cases , eight cases became worse, their GCS-M scale decreased to 3, and CT scan showed that the intracranial hematoma became larger and then received surgery. After operation, the GCS scale of these 8 cases recovered to 4. All 18 cases with 3 of GCS-M underwent operation because large intracranial hematoma volume or dislocation of the midline; after operation, their GCS-M scale increased to 4. Statistical analysis demonstrated that the relation of GCS-M with intracranial hematoma volume was negative. CONCLUSIONS： GCS could correctly assess the consciousness of head injury, but sometime it is not possible to use GCS to estimate the consciousness of craniomaxillofaeial injury such as periorbital injury with which the patient could not open the eye. GCS-M scale could compensate GCS. When GCS-M scale decreases, consciousness of patients would become worse.