移动CT和常规CT检查对颅脑损伤后脑继发性损害及治疗效果的影响

Effects of mobile CT and conventional CT scanning on secondary cerebral pathological injury and therapeutic effect following brain trauma

目的对比分析重型颅脑损伤采用移动CT（MCT）床旁扫描和放射科常规CT（CCT）扫描的频次以及对颅内血肿、脑水肿等脑继发性损害发生率和治疗结果的影响。方法选取自2010年8月至2015年12月收治于陆军总医院附属八一脑科医院的2510例重型颅脑损伤患者，其中行MCT床旁检查1917例、CCT检查593例，并依据伤情分别分为特重型（GCS3-5分）和重型（GCS6—8分）2个亚组，分析不同GCS评分亚组的CT扫描频次、脑继发性病理改变和伤后3个月GOS评分变化。结果（1）MCT组GCS3-5分和GCS6-8分患者的例均检查次数为5．12次和4．88次，而CCT组的例均次数为3．53次和4．08次，差异具有统计学意义（P〈0．05）。（2）CCT组GCS3-5分和GCS6-8分2个亚组内各类脑继发性损害的发生率高于MCT组，差异具有统计学意义（P〈0．05）。（3）MCT组GCS3-5分和GCS6-8分2个亚组的死亡率（GOS1分）分别为53．08％及17．88％，而CCT组分别为67．16％和26．80％；MCT组重残率（GOS2-3分）分别为21．12％及13．48％，而CCT组分别为26．87％及20．72％；MCT组恢复良好率（GOS4-5分）分别为25．12％及68．64％。而CCT组分别为5．97％和52．47％；CCT组和MCT组之间预后差异具有统计学意义（P〈0．05）。结论对于重型颅脑损伤患者，使用MCT床旁扫描操作简便，可减少脑继发性损害的发生，提高治疗效果。

Objective To compare the scanning frequencies of patients with severe craniocerebral pathological injury with bedside mobile CT （MCT） in neurosurgical intensive care unit （NICU） or with conventional CT （CCT） in Radiology, and investigate the effects of MCT and CCT scanning on secondary cerebral injury and therapeutic results in patients with severe craniocerebral injury. Methods A total of 1917 patients with severe craniocerebral injury, admitted to our hospital from August 2010 to December 2015, under went MCT bedside scanning. And other 593 patients with severe craniocerebral injury were scanned with CCT in radiology. According to Glasgow coma scale （GCS） scores, the patients with severe craniocerebral injury were divided into extra-heavy subgroup （GCS scores： 3-5） and heavy subgroup （GCS scores： 6-8）; the CT scanning frequencies, secondary cerebral pathological damages and Glasgow outcome scale scores 3 months after injury were analyzed and compared. Results The average scanning frequencies of MCT were 5.12 and 4.88 in patients from extra-heavy subgroup and heavy subgroup while the average scanning frequencies of CCT were 3.53 and 4.08 in patients from extra-heavy subgroup and heavy subgroup, with significant differences （P〈 0.05）; patients accepted MCT had significantly higher scanning frequencies than those accepted CCT （P〈0.05）. The average scanning frequencies of patients from MCT group were significantly higher than those from CCT group. The incidence of complications was 3.32% and 0% in extra-heavy subgroup and heavy subgroup from MCT group, respectively; but the incidence of complications was 26.87% and 18.82% in extra-heavy subgroup and heavy subgroup from CCT group; significant differences were noted （P〈0.05）. GOS showed that the mortality rates （GOS score： 1） for the extra-heavy subgroup and heavy subgroup from MCT group were 53.08% and 17.88%, while those for CCT group were 67.16% and 26.80%, with significant differences （P〈0.05）. The severe disability rates （GOS scores： 2-3） for the extra-heavy subgroup and heavy subgroup from MCT group were 21.12% and 13.48%, while those for CCT group were 26.87% and 20.72%, with significant differences （P〈0.05）. The good recovery rates （GOS scores： 4-5） for the extra-heavy subgroup and heavy subgroup from MCT group were 25.12% and 68.64%, respectively, while those for CCT group were 5.97% and 52.47%, with significant differences （P〈0.05）. Conclusion The operation of MCT bedside scanning is simple, safe and reliable in the NICU, enjoying good clinical effects as compared with CCT scanning.