不同年龄段小儿急性颅脑损伤临床特点分析

Clinical features of acute craniocerebral injuries in infants and children in different age groups

目的分析不同年龄段小儿急性颅脑创伤临床特点。方法选取自2016年1月至2018年1月焦作市人民医院神经外科收治的130例10岁以下小儿急性颅脑损伤病例资料进行回顾性分析,其中男性72例,女性58例;年龄0～10岁,平均(4.12±0.63)岁。按年龄分为0～5岁组和6～10岁组,其中0～5岁组91例(69.5%),6～10岁组39例(30.5%)。分析两组患儿一般资料及受伤机制、损伤类型、伤情及治疗方法、预后等特点。结果共纳入130例,跌倒是0～5岁组主要致伤原因,6～10岁组患儿中交通事故及高处坠落伤等所占比例明显上升,两组在致伤机制方面差异有统计学意义(P<0.05)。6～10岁组开放性颅脑损伤发生率(28.2%,11/39)高于0～5岁组(14.3%,13/91),两组差异有统计学意义(P<0.05)。6～10岁组患儿急性硬膜外血肿发生率(46.2%,18/39)及脑脊液漏发生率(30.8%,12/39)高于0～5岁组(分别为20.9%,19/91及4.4%,4/91)(P<0.05)。按GCS评分分级,两组均以轻型颅脑损伤为主,两组主要治疗手段均为非手术治疗。23例(17.7%)患者采用开颅手术治疗,23例实施了开颅手术之外的有创治疗措施,两组手术方式差异有统计学意义(P<0.05)。按受伤3个月时随访的格拉斯哥预后评分(GOS),130例患者中恢复良好117例(90%),中残11例,重残3例,死亡3例。两组总体预后均较好,差异无统计学意义(P>0.05)。结论不同年龄段小儿颅脑创伤在受伤机制、治疗方式等方面存在明显差异。依据颅脑创伤的特点,早期采取积极有效的治疗措施,可改善预后,降低病死率及致残率。

Objective To investigate the clinical features and therapeutic effects of acute craniocerebral trauma in infants and children under 10 years old.Methods A retrospective analysis of 130 cases of infants and children with cranial injury in infants under 10 years old from January 2016 to January 2018 was conducted.Among them,72 cases were males and 58 were females,with average age of(4.12±0.63) years.The injury mechanisms,types,treatment methods and prognosis were analyzed.130 cases were divided into two groups:0~5 years old group and 6~10 years old group.The characteristics of the two groups were analyzed,and the differences in injury mechanism,type and prognosis of children of different age groups were compared.Results A total of 130 cases were enrolled in this study,including 72 males and 58 females,91 cases(69.5%) in the 0-5-year-old group and 39 cases(30.5%)in the 6-10-year-old group.Falling was the main cause of injury in 0-5 years old group.The proportion of traffic accidents and falling injuries in 6-10 years old group increased significantly.There was significant difference in the mechanism of injury between the two groups(P<0.05).The incidence of open craniocerebral injury in 6-10 years old group(28.2%,11/39)was higher than that in 0-5 years old group(14.3%,13/91).There was significant difference between the two groups(P<0.05).The incidence of acute epidural hematoma(46.2%,18/39)and cerebrospinal fluid leakage(30.8%,12/39)in children aged 6-10 years were significantly higher than those in children aged 0-5 years(20.9%,19/91 and 4.4%,4/91,respectively)(P<0.05).According to the grading of Glasgow Coma Scale(GCS),mild craniocerebral injury was the main type in both groups,and conservative therapy was the main treatment in both groups.Twenty-three patients(17.7%) underwent craniotomy,and 23 patients underwent invasive treatment besides craniotomy.There was a significant difference between the two groups(P<0.05).According to Glasgow Outcome Scale(GOS) the patients were followed up for 3 months after injury;117(90%)of 130 patients recovered well,11 were moderately disabled,3 were severely disabled and 3 died.The overall prognosis of the two groups was good,and there was no significant difference(P>0.05).Conclusions The traumatic brain injury of infants and children has its special characteristics.The incidence of different age groups differs in gender and treatment methods.According to the characteristics of pediatric craniocerebral trauma,active and effective treatment measures can be taken early to improve prognosis and reduce the mortality and morbidity.