间脑期双额叶脑挫裂伤患者手术预后研究

Surgical prognosis of patients with bilateral frontal lobe contusion and laceration during diencephalons period

目的探讨间脑期双额叶脑挫裂伤患者术后预后情况,分析其临床特点。方法选取自2012年1月至2015年12月收治的行手术治疗的双额叶脑挫裂伤患者60例,根据术前病情分为非间脑期组(n=24)与间脑期组(n=36)。术后7 d,采用格拉斯哥昏迷评分(GCS)对60例患者术后情况进行评价。患者随访6个月至2年,采用格拉斯哥预后评分(GOS)评估患者预后情况。结果术后7 d,待脑水肿消退后对60例患者GCS评分进行复评,13~15分患者24例(40.0%),9~12分患者14例(23.3%),6~8分患者16例(26.7%),3~5分患者6例(10.0%)。对患者预后情况进行随访,间脑期组患者恢复良好18例(50.0%),轻度残疾16例(44.4%),重度残疾2例(5.6%);非间脑期组患者轻度残疾2例(8.3%),重度残疾16例(66.7%),植物生存2例(8.3%),死亡4例(16.7%)。非间脑期组患者预后差于间脑期组,差异有统计学意义(Z=-6.233,P<0.01)。结论双额叶脑挫裂伤发生脑中心疝时,早期识别间脑期改变,综合临床症状及影像学信息,准确评估病情,积极手术治疗是提高预后的关键。

Objective To investigate the prognosis of patients with bilateral frontal lobe contusion and laceration during diencephalons period,and analyze its clinical characteristics.Methods A retrospective study was performed on 60 cases of patients with bifrontal lobe contusion and laceration during diencephalons period who were admitted from January 2012 to December 2015.According to the preoperative condition,the patients were divided into the non-diencephalic group(n=24)and the diencephalic group(n=36).Glasgow coma scale(GCS)was used to evaluate the postoperative status of 60 patients 7 days after surgery.Patients were followed up for 6 months to 2 years,and the prognosis of the patients was evaluated by the Glasgow outcome score(GOS).Results On the 7 th day after the surgery,GCS scores of 60 patients were re-evaluated after the brain edema subsided,including 24 patients(40.0%)with a score of 13-15,14 patients(23.3%)with a score of 9-12,16 patients(26.7%)with a score of 6-8,and 6 patients(10.0%)with a score of 3-5.Following up the prognosis of the patients,18(50.0%)of the patients in the diencephalic group recovered well,16(44.4%)of the patients with mild disability and 2(5.6%)of the patients with severe disability.In the non-diencephalic group,2 patients had mild disability(8.3%),16 patients(66.7%)had severe disability,2 patients(8.3%)had plant survival and 4 patients(16.7%)had death.The prognosis of patients in the non-diencephalic group was worse than that in the diencephalic group,and the difference was statistically significant(Z=-6.233,P<0.01).Conclusion Early recognition of diencephalic phase changes,comprehensive clinical symptoms and imaging information,accurate assessment of the condition,and active surgical treatment are the key to improve the prognosis of bilateral frontal lobe brain contusion and laceration.