急性颅脑损伤治疗结果分析

Therapeutic effect analysis of acute traumatic brain injury

目的 通过对颅脑损伤病例的资料分析 ,找出规律性结果 ,为今后临床治疗提供科学的依据。方法 对近 5a内 370 0例急性颅脑损伤资料进行计算机数据库管理 ,对所有病例进行分类 ,并根据出院时情况对病人进行生存或死亡的治疗结果判定。并进一步分析紧急手术和颅内压重症监护对重型颅脑损伤死亡率的影响。结果 重型颅脑损伤死亡率为4 6 % ,中型为 12 % ,轻型为 0 ,所有死亡病例死亡率分布及其临床特点有明显的阶段性 ,并提出了各阶段的治疗重点。高颅压脑疝病人的紧急手术可使死亡率降至 32 % ,实施颅内压重症监护可使死亡率降至 36 %。结论 充分认识颅脑损伤后各阶段的临床特点是非常重要的 ,及时、正确的治疗方案 (包括紧急手术和颅内压重症监护 )

Objective To find out the factors that determine the prognosis of traumatic brain injury (TBI) by analysing the previous clinical data.Methods 3 700 cases of acute TBI in recent 5 years were classified, the survival rate and mortality of these patients were analysed to evaluate the therapeutic effect and the effect of both acute surgery and intra-cranial pressure monitor (ICPM) on the mortality of severe TBI were further evaluated.Results The mortality of severe(GCS≤8), moderate(GCS 9～12) and slight(GCS 13～15) TBI were 46%, 12% and 0 respectively. Both the temporal distribution and clinical characters of death can be obviously divided into different phases:acute phase(<1 week),80%of all dead patients occurred, the death was mainly due to intractable intracranial hypertension; Subacute phase or transition period (1～3 weeks), nearly 20% cases occurred, the death was mainly due to the failure of organs(lung,kidney,heart,etc.); Chronic phase or recovery stage(>3 weeks), <2%of that occurred, the death was mainly due to chronic consumption of the body, which reminded us the different therapeutic focuses in different phases. Emergent surgery and ICPM had lowered the mortality to 32% and 36% respectively.Conclusions It is very important to recognize the different characters in each phase. The timely and accurate treatment (including emergent surgery and ICPM) is very important to lower the mortality.