老年急性创伤性颅内血肿的临床诊治(附328例报道)

Clinical management of elderly patients with acute traumatic intracranial hematoma:a report of 328 cases

目的探讨老年人急性创伤性颅内血肿病人的基本特征和治疗效果,分析与预后相关的影响因素。方法2019年1月~2021年12月收治的老年急性创伤性颅内血肿病人328例。采用格拉斯哥结局量表评估其临床预后,根据评分将其分为预后较好组和预后不良组。Logistic回归分析不良预后的影响因素。结果328例急性创外伤性颅内血肿病人中,预后较好211例,预后不良117例,其中死亡75例。手术治疗110例,预后较好62例,预后不良48例。多因素Logistic回归分析显示,男性、瞳孔异常、重型颅脑损伤、CT基底池受压或闭合和ICU住院时间≥3天是不良预后的影响因素,而手术治疗是不良预后的负面预测因子。结论老年重型颅脑损伤预后差。男性、瞳孔对光反射异常、GCS≤8、基底池受压或闭合和ICU入住时间≥3天是预后不良的危险因素,手术治疗可改善老年颅脑损伤病人临床结局。

Objective To evaluate the basic characteristics and treatment effects of elderly patients with acute traumatic intracranial hematoma,and analyze the factors related to the prognosis.Methods This study retrospectively analyzed the clinical data of 328 elderly patients with acute traumatic intracranial hematoma from January 2019 to December 2021.The Glasgow Outcome Scale is used to evaluate the clinical prognosis,and they are divided into a good prognosis group and a poor prognosis group according to the scores.Logistic regression is used to analyze independent predictors of poor prognosis.Results 328 patients with acute traumatic intracranial hematoma were enrolled in the study.Two hundred and eleven patients had a good prognosis,117 patients had a poor prognosis,and 75 of them died.One hundred and ten cases were treated surgically,62 caseshad a good prognosis,and 48 cases had a poor prognosis.Multivariate Logistic analysis showed that male,pupil abnormality,GCS≤8,compressed or closed cisternand ICU stay≥3 days were independent predictors of poor prognosis.Surgical treatment was an important factor that negatively predicts poor prognosis.Conclusion The prognosis of elderly patients with severe head injury is very poor.Male,pupils with abnormal light reflex,GCS≤8,and compressed or closed cisterns and longer ICU stay(≥3 days)are the risks of poor prognosis.Administrating operation for the elderly patients with intracranial hematoma who need surgery might improve the outcome.