中青年与老年急性颅脑损伤颅内血肿动态变化对比分析

Dynamic changes in intracranial hematomas in young and middle-aged patients and the senile with acute craniocerebral trauma

目的探讨中青年与老年急性颅脑损伤颅内血肿动态变化特征。方法 2013年5月至2016年3月收治急性颅脑损伤400例,根据年龄划分为中青年组(220例)和老年组(180例)。以入院后即刻CT(距受伤<3 h)作为基准,入院后6、12、24、48、72h复查CT。根据临床表现和CT检查判断:血肿未扩大,为血肿未进展;血肿扩大,临床表现无显著恶化,为Ⅰ型血肿进展;血肿扩大,临床表现进行性恶化,出现手术指征,为Ⅱ型血肿进展。结果中青年组血肿未进展115例,Ⅰ型进展65例,Ⅱ型进展40例;老年组血肿未进展84例,Ⅰ型进展60例,Ⅱ型进展36例。中青年组Ⅰ型血肿进展稳定时间和Ⅱ型血肿进展峰值时间较老年组均显著缩短(P<0.05)。老年组血肿未进展、Ⅰ型血肿进展、Ⅱ型血肿进展预后良好(GOS评分4~5分)率具有显著差异[分别为92.9%、75.0%、30.6%;P<0.05];中青年组血肿未进展、Ⅰ型血肿进展、Ⅱ型血肿进展预后良好率无显著差异[分别为91.3%、84.6%、85.0%;P>0.05];中青年组Ⅱ型血肿进展预后良好率显著高于老年组(P<0.05)。结论急性颅脑损伤的颅内血肿进展类型与年龄无明显相关性,但老年血肿进展至稳定时间、峰值时间均高于中青年,故老年颅脑损伤在急性期需行头部CT复查,适当延长持续观察时间,在临床表现出现恶化之前最大程度地进行积极应对,改善患者预后。

Objective To study the dynamic changes in intracranial hematomas in the young and middle-aged patients and the senile with acute cranioeerebral trauma （ACT）. Methods Of 400 patients with ACT treated in our hospital from May, 2013 to March, 2016 220 were young and middle-aged patients and 180 senile patients. All the patients received head CT scanning. The dynamic changes in intracranial hematomas were observed by head CT scan and the prognoses were compared between both the groups. Results There was insignificant difference in intracranial hematoma progression （ICHP） types including no ICHP, type- I ICHP （ICHP without deterioration of the clinical manifestation） and type- Ⅱ ICHP （ICHP with deterioration of the clinical manifestation） between the two groups （P〉0.05）. The time from ACT to stable hematoma [（20.7±4.8） hours] of type- I ICHP was significantly shorter in the young and middle-aged patients group than that [（40.6±9.0） hours] in the senile group （P〈0.05）. The time [（10.6±4.4） hours] from ACT to maximal hematoma of type- II ICHP in young and middle-aged patients group was significantly shorter than that [（19.6±7.8） hours] than that in the senile group （P〈0.05）. The prognosis in the senile patients with no ICHP was significantly better than that in the senile patients with type- ] ICHP （P〈0.05）, in whom the prognosis was significantly better in the senile patients with type- Ⅱ ICHP （P〈0.05）. The prognosis in the young and middle-aged patients with type- II ICHP was significantly better than that in the senile patients with type- II ICHP （P〈 0.05）. Conclusions The ICHP type is insignificant related with patients＂ age in the patients with ACT. The time from ACT to stable hematoma and time from ACT to maximal hematoma in the senile patients are significantly longer than that in the young and middle-aged patients. It is necessary to repeat head CT scanning in acute phase and appropriately prolong continuous observation time in order to take positive treatment before clinical condition deterioration in the senile patients with ACT compared to the young and middle-aged patients.