小儿重型颅脑损伤临床特点分析

Analysis of clinical characteristics in children with severe traumatic craniocerebral injury

目的 分析总结小儿重型颅脑损伤的临床特点。方法 回顾性研究小儿重型颅脑损伤患者的致伤原因、损伤类型、临床表现 ,以及救治方法和预后状况。结果 本组共 4 5 8例 ,男性 317例 ,女性 14 1例。年龄 1个月～ 15岁。车祸伤 185例 ,坠落伤 15 9例 ,二者合计占 75 .1%。闭合性颅脑损伤 35 7例 ,开放性颅脑损伤 10 1例。合并颅内血肿 16 2例 (35 .4 % ) ;并发颅骨骨折 2 2 1例 ,其中凹陷骨折 82例。全组均有不同程度的意识障碍 ,有生命体征变化 2 5 3例 (5 5 .2 % ) ;癫痫发作 10 7例(2 3.4 % )。 36 7例施行血肿清除、去骨瓣减压、凹陷骨折复位术等手术治疗 ,另外 91例保守治疗。恢复良好 337例 (73.6 % ) ;中残 2 7例 (5 .9% ) ;重残 12例 (2 .6 % ) ;植物生存 7例 (1.5 % ) ;死亡 75例(16 .4 % )。结论 小儿重型颅脑损伤的主要临床特点是原发性脑损伤表现重 ;生命体征紊乱明显 ;颅骨凹陷骨折和颅缝分离多见 ;囟门闭合前后临床特征不同 ;对冲性颅内血肿发生率低 ;癫痫发生率高 ;

Objective To analyze the clinical characteristics of children with severe traumatic craniocerebral injury.Methods Retrospective study had been done on the causes and types of trauma, treatment methods, and prognosis.Results The data of 458 cases (317 male ,141 female) aged from 1 month to 15 years was analyzed retrospectively. The main causes of severe traumatic craniocerebral injury were road traffic accident in 185 cases and fall in 159, accounting for 75.1% of the total. There were 357 cases with closed craniocerebral injury and 101 with open craniocerebral injury.One hundred and sixty two patients (35.4%) had intracranial hematoma and 221 with skull fracture (in which 82 were depressed skull fracture). All patients were of unconsciousness in various degree, and 253 (55.2%) had life sign changes and 107(23.4%)had epilepsy onset. Most cases (367) were operated on and 91 underwent non operative treatment. Three hundred and thirty seven patients (73.6%) showed a good outcome , while 27(5.9%) were moderately disabled, 12(2.6%) severely disabled , 7(1.5%)survived in a permanent vegetative state, 75 died. The mortality rate was 16.4%. Conclusion The main clinical characteristics of children with severe traumatic craniocerebral injury include severe primary cerebral injury, obvious changes of life sign, depressed skull fracture with high incidence, different symptoms before and after fontanel closing , low incidence of intracranial contrecoup injury, high incidence of epilepsy and better prognosis than in adults.