CT早期动态监测脑外伤手术治疗及其预后评估的价值

Value of early dynamic monitoring CT for surgical treatment and predicting prognosis in traumatic brain injury

目的探讨CT早期动态监测与脑外伤临床手术治疗及预后的相关性。方法选择572例脑外伤患者,其中男性404例,女性168例;年龄16~75岁,平均年龄44.2岁。分为手术组131例,非手术组441例。进行CT早期动态监测。分析CT早期动态监测与脑外伤患者手术时机选择、患者死亡率及3个月、6个月格拉斯哥预后量表(GOS)评分的相关性,以及Rotterdam CT评分与脑外伤患者预后的相关性进行统计学分析。结果脑外伤后24 h之内与伤后24 h之后手术治疗者数量间差异有显著统计学意义(P<0.001)。Rotterdam CT评分越高,死亡率越高;Rotterdam CT评分与脑外伤患者出院时死亡率及伤后3个月、6个月GOS评分差异有统计学意义(P<0.05)。手术组与非手术组间患者死亡率差异无统计学意义(P>0.05);但两组间3个月及6个月GOS评分差异有统计学意义(P=0.002、0.003)。Rotterdam CT评分越高,患者伤后3个月及6个月GOS评分越低,即预后越差(3个月:秩相关系数r_s=0.369,P<0.001;6个月:秩相关系数r_s=0.382,P<0.001)。结论 CT早期动态监测可及时了解脑外伤患者颅内情况的动态变化,指导临床治疗策略,降低脑外伤患者的死亡率,但其在改善患者预后方面作用有限。

Objective To explore the value of early dynamic monitoring CT in clinical surgery, and assess the applicability of predicting prognosis in traumatic brain injury0YB1）. Methods A total of 572 TBI patients were enrolled, which included 404 males and 168 females, aged 16 - 75 years old with mean age of 44.2 years old. All of them were divided into operation group（n = 131） and non-operation group（n = 441）. The early dynamic monitoring CT were performed. The relationship of surgery timing, mortality rate, 3-month and 6-month Glasgow outcome scale（GOS） score between early dynamic monitoring brain CT and TBI were analyzed, the relationship of Rotterdam CT score and prognosis of TBI were analyzed. Results The surgical rate of TBI patients within 24 -hour and after 24-hour was significantly difference（P 〈 0.001）; The higher mortality rate with the higher Rotterdam CT score, and the results of Rotterdam CT score and the mortality rate, 3-month and 6-month GOS score were significant difference（P 〈 0.05）; The mortality rate between 2 groups was no statistical significance（P 〉 0.05）. But GOS score between 3-month and 6-month was significant differenee（P = 0.002 and 0.003）i The lower GOS score of 3-month and 6- month with higher Rotterdam CT, so with the worse prognosis（3-month： rs = 0.369, P 〈 0.001; 6-month： rs = 0.382, P 〈 0.001）. Conclusion It is demonstrated that early dynamic monitoring brain CT could detect the deterioration of TBI in time, and guide the clinic for optimal treatment. It could reduce the mortality rate of TBI, but not improve the prognosis of TBI.