脑挫裂伤不同时段CT复查的影像对比分析与临床价值

At Different Times CT Image Review Brain Contusion Comparative Analysis Brain Contusion with CT Images in Different Times to Judge the Clinical Value

目的:动态观察脑挫裂伤患者行首次CT检查、伤后24h内、24h左右及2天以上复查CT的影像表现,并进行对比分析,探讨不同时间段CT复查的影像变化与临床价值。材料与方法:收集我院2014年8月至2015年8月外伤后首次行脑CT检查,以及伤后复查发现脑挫裂伤的70例患者,比较两次或多次CT检查挫裂伤病变不同时间段影像的动态变化。结果:70例患者中,伤后首次检查发现脑挫裂伤的患者52例(74.3%),合并蛛血、硬膜下血肿、硬膜外血肿或骨折者30例(42.9%),单纯性脑挫裂伤者22例(31.4%)。其余18例(25.7%)患者未发现明显脑挫裂伤征象,但有蛛网膜下腔出血、硬膜下血肿、硬膜外血肿或骨折。第1次CT检查后2-26h再次复查CT,18例挫裂伤阴性患者均出现挫裂伤征象,6例(33.3%)表现为重度挫裂伤,12例(66.7%)表现为轻-重度挫裂伤;其余52例挫裂伤患者复查,22例(42.3%)患者挫裂伤区域出现出血、水肿明显加重征象,22例(42.3%)表现为轻-中度加重,8例(15.4%)表现稳定。44例患者于第1次CT后48h-8d进行了第3次复查,与第2次比较其中30例(68.2%)病变稳定,6例(13.6%)出现病变加重或明显加重,其余8例(18.2%)出现病变区水肿加重征象。结论:脑挫裂伤患者24h以内及24h左右复查价值重大,多数患者在此时间段病变进展迅速,CT及时复查对采取正确的治疗方案意义重大。

Purpose： comparison analysis the CT images of cerebral contusion within 24 h and more than 2 days late after injure to study the change of images and the clinical value. Materials and Methods： 70 cases of cerebral contusion with CT examination at the first time and reexamination in period of 26 h after trauma had been collected to observe the dynamic changes of the images from August,2014 to August,2015. Results： 52 cases with cerebral contusion of CT examination had been revealed for the first time after injury（ 74. 3%）,only 22 cases（ 31. 4%） with simple brain contusion,30 cases（ 42. 9%） with composited with subarachnoid hemorrhage,subdural hematoma,epidural hematoma or fractures in the 70 cases. 18 cases（ 25. 7%） found no obvious signs of brain contusion,but with subarachnoid hemorrhage,subdural hematoma,epidural hematoma or fracture but 6 cases（ 33. 3%） with severe contusion,12 cases（ 66. 7%） with light to severe contusion while 22 cases（ 42. 3%） became more heavier,22 cases（ 42. 3%） with slight to moderate change,8 cases（ 15. 4%） with the stable in the hemorrhage and edema around the contusion under the images of reexamination had been found after 2 to 26 h.compared with second images,6 cases found the lesions becoming more serious,8 cases（ 18. 2%） with heavier edema sign around the contusion,30 cases（ 68. 2%） with the stable status at the 48 to 72 h with the reexamination. Conclusion： it is important to reexamination the patients with cerebral contusion in period of 24 h and 24 h due to the progress rapidly at the same time and it is worth to check with CT to be treat correctly and timely.