创伤性脑出血患者的早期治疗及预后

Early treatment and prognosis in patients with traumatic cerebral hemorrhage

目的本课题为了研究早期手术与初始保守治疗对创伤性脑实质内出血患者预后的影响。方法收集到我院就诊的创伤性脑损伤48 h内的患者,分为早期手术治疗组(分组后12 h内手术清除血肿)和初始保守治疗组(治疗后期如认为有必要方行血肿清除术)。如患者少于两处大于10 m L的血肿以及无硬膜外血肿及硬膜下血肿则满足条件。主要预后的评估是对患者6个月的情况进行格拉斯哥预后评分(GOS)量表问卷调查。对患者6个月进行欧洲五维健康量表(EQ-5D)问卷调查患者生活质量。结果早期手术治疗组58例中34例(75.6%)格拉斯哥预后评分结果为预后好,较初始保守治疗组的29例(50.0%)高,相对危险度(OR):0.43;95%置信区间(CI):0.21~0.88;P=0.02。初始保守治疗组与早期手术治疗组相比死亡率更高[21(36.2%):7(15.6%),P=0.0231]。结果显示两组患者6个月的生活质量水平差异不明显。结论对创伤性脑实质出血患者早期手术治疗较初始保守治疗能使患者有更好的结局。

Objective The effect of early surgery and initial conservative treatment was compared for the prognosis of patients with traumatic intraparenchymal hemorrhage. Methods The cases of traumatic brain injury within 48 h in the hospital were collected and randomly assigned into early surgery group （hematoma evacuation within 12 h of randomization） and initial conservative treatment （subsequent evacuation allowed if deemed necessary）. Patients were eligible when no more than two intraparenchymal hemorrhages over 10 mL and no extradural or subdural hematoma occurred. The primary outcome was evaluated by Glasgow outcome scale （COS） obtained by questionnaires within 6 months. The quality of life of patients was performed by European Quality of Life- 5 Dirnensions（EQ-5D） questionnaires at 6 months. Results In fifty-eight patients randomized to early surgery with complete follow-up, 34 （75.6%） had a favorable outcome, which was better than that of initial conservative treatment group （29, 50.0% ） （OR： 0.43; 95% CI： 0.21 -0.88; P =0.02）. There were significantly more death eases in the first 6 months in the initial conservative treatment group [ 21 （36. 2% ） ： 7 （ 15.6% ）, P =0. 0231 ]. The level of quality of life at 6 months in two groups were not significantly different. Conclusion Early surgical treatment for the patients with traumatic oarenchymal hemorrhage may lead to a better prognosis.