颅脑损伤后进展性颅内血肿临床分析简

目的探讨颅脑损伤后进展性颅内血肿的临床特征和急救措施。方法对我院2006年1月至2011年12月所诊治处理68例颅脑外伤后进展性颅内血肿患者的临床资料进行回顾性分析。结果本组68例患者中,手术治疗65例,保守治疗2例,放弃治疗1例,按GOS评分,出院时恢复良好53例,中残7例,重残3例,植物生存1例,死亡3例。结论颅脑损伤后进展性颅内血肿为临床急危重症,变化快,其预后与及时发现及处理密切相关,动态观察病情变化及时复查CT并急诊手术是成功抢救患者的关键所在。     

颅脑损伤后进展性颅内血肿临床分析

目的探讨颅脑损伤后进展性颅内血肿的临床特征和急救措施。方法对我院2006年1月至2011年12月所诊治处理68例颅脑外伤后进展性颅内血肿患者的临床资料进行回顾性分析。结果本组68例患者中,手术治疗65例,保守治疗2例,放弃治疗1例,按GOS评分,出院时恢复良好53例,中残7例,重残3例,植物生存1例,死亡3例。结论颅脑损伤后进展性颅内血肿为临床急危重症,变化快,其预后与及时发现及处理密切相关,动态观察病情变化及时复查CT并急诊手术是成功抢救患者的关键所在。     

外伤性进展性颅内血肿的临床分析

目的探讨颅脑损伤后进展性颅内血肿的临床特点、发病机制及早期诊治措施。方法对63例外伤后进展性颅内血肿患者的临床资料进行回顾性分析。结果手术54例，保守治疗9例，死亡10例。结论对外伤性颅内血肿严密观察，动态CT监测，早期CT复查有助于早期确诊进展性颅内血肿，改善患者预后。     

脑电图在脑损伤后综合征中的诊断意义

脑损伤后综合征是临床上较为常见,病人感觉症状十分明显,又无神经系统检查阳性体征而治疗效果较差的一组综合征。脑电图检查及动态跟踪对患者的伤情及预后提供重要依据。现将2年来该类患者脑电图进行分析,报告如下。1资料与方法1.1一般资料本组病人30例,为轻型闭合性颅脑损伤,诊断标准为GCS,昏迷程度评分为13~15分,伤后意识障碍在20min以内。男18例,女12例,年龄16~57岁。伤后3~6个月CT扫描,除外脑萎缩、脑积水或局灶性病变,排除精神病及中枢神经系统疾病及既往脑外伤史。神经症诊断符合中国精神疾病分类方案与诊断标准第2版修订本(CCMD-…     

外伤性多发性颅内血肿139例分析

目的总结外伤性多发性颅内血肿的诊治经验。方法回顾性分析139例急性外伤性多发性颅内血肿患者的临床资料。结果保守治疗18例,死亡6例,恢复良好12例;手术治疗121例,死亡20例,均为术前GCS≤8分或未能及时手术的患者。生存者术后4~6周按GOS评分评估预后：恢复良好72例,中残18例,重残7例,植物状态生存4例。结论外伤性多发性颅内血肿易导致脑疝,动态颅脑CT检查有助于早期诊断及动态评估手术指征;及时手术清除血肿并采取个体化的手术方案可减少手术创伤并取得良好疗效。     

外伤性基底节区血肿42例临床分析

目的 研究外伤性基底节区血肿（TBGH)的发病机理、临床特点及预后因素。方法 回顾分析了42例TBGH病人的临床资料。结果 TBGH常见于车祸所致的减速性损伤,血肿多位于受力对侧;伤后早期出现偏瘫而意识障碍相对较轻为临床特征;年龄大于60岁、原发性脑损伤重、血肿量大于30ml、瞳孔异常、GCS评分小于8分死亡率高。结论 “中间脑挫伤”概念可解释TBGH形成;其临床表现具有特征性,正确认识该病,动态CT可明确诊断;原发性脑损伤程度、年龄、瞳孔变化、血肿量、意识状态是影响预后的主要因素。     

急性颅脑创伤后进展性颅内出血的CT表现

目的：探讨急性颅脑创伤后进展性颅内出血（PIH）发生的CT表现与临床价值。方法回顾性分析我院2009-02-2013-09收治的626例急性颅脑创伤患者的临床资料,分析PIH患者与非 PIH患者的CT 表现差异以及PIH发生的危险因素。结果单因素回归分析发现,PIH组与非 PIH组首次CT 表现中颅骨骨折、蛛网膜下腔出血、脑挫裂伤、硬膜外血肿、硬膜下血肿差异有统计学意义（P＜0·05）。多因素回归分析发现,颅骨骨折、蛛网膜下腔出血、脑挫裂伤、硬膜外血肿是影响急性颅脑创伤后进展性颅内出血的独立危险因素（P＜0·05）,蛛网膜下腔出血是最强因素。结论急性颅脑创伤后应尽快进行头颅CT检查,以便尽快确诊PIH及时进行治疗。     

脑内血肿病人神经功能恶化的预测

脑内血肿病人病情既可稳定,也可以突然恶化,且恶化后生存率明显降低,预后差。本文通过临床和CT扫描特征来预测其临床症状加重的可能性。 作者收集72例自发性脑出血患者,并除外脑外伤、出血性梗塞、多发性顶区内出血、血管病变、肿瘤及入院时Glasgow昏迷评分(GCS)<8分或意识不清的病人。其中男女各一半,平均年龄74岁,83％有高血压病史,25％接受抗凝治疗。入院后33例(46％)病后1hr～     

颅内血肿合并脑梗塞43例临床分析

我院自1993年~1998年共收治脑外伤后颅内血肿合并脑梗塞患者43例,均经头颅CT证实,现报告如下。1临床资料1.1一般资料本组43例中男性38例,女性5例,年龄32岁~68岁,平均53．6岁,车祸30例,坠落伤6例,打伤7例。急性硬膜外血肿14例,脑挫裂伤合并硬膜下血肿22例,急性硬膜下血肿7例。意识障碍时间120分钟以内对例,持续意识障碍22例,梗塞灶在病灶侧32例,对侧11例,其中基底节区19例,额叶7例,颞叶9例,预顶叶8例。1．2治疗及预后14例急性硬膜外血肿手术清除血肿11例,双例脑挫裂伤合并硬膜下血肿手术清除病灶6例,7例急性硬膜下血肿手…     

出血性脑梗死44例临床分析

目的总结出血性脑梗死(HI)的临床特点及治疗效果。方法回顾性分析2007-06~2010-03经CT、MRI确诊的44例HI患者的临床资料。结果 44例中非血肿型28例,血肿型16例;经治疗基本痊愈9例(20.45%),显著进步23例(52.27%),进步11例(25.00%),1例死于多器官功能衰竭(2.27%)。结论对脑梗死患者应采取个体化治疗方案,及时复查CT、MRI为HI早期诊断的关键;对大面积脑梗死、溶栓治疗、合并高血压等疾病者应密切观察,及时复查,以免漏、误诊。     

弥散性血管内凝血（DIC）评分预测颅脑损伤进展性出血和预后的作用：352例分析

Coagulation abnormalities,such as disseminated intravascular coagulation(DIC),are associated with progressive hemorrhagic injury(PHI)following head trauma.However,the exact relationship between coagulopathy and PHI remains unclear.The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI.This study was a multicenter prospective design involving four hospitals,a 6-month observation,and follow-up.Of 352 traumatic brain injury(TBI)patients,serial CT scan indicated approximately one third of patients developed progressive hemorrhage,which was most frequently observed in the frontal,temporal,and orbitofrontal lobes of patients with brain contusion.PHI-positive patients exhibited poor prognosis,as indicated by prolonged length of hospital/intensive care unit stay and high mortality.More importantly,a DIC score after TBI,as well as patient age and sex,could serve as predictors for PHI.In addition,DIC scores were closely associated with injury severity.Therefore,the DIC scoring system facilitated early PHI diagnosis in TBI patients,and DIC scores might serve as a valuable predictor for TBI patients with PHI.     

新型国产16层移动CT在颅脑创伤中的临床应用

目的探讨新型国产16层移动CT在颅脑创伤中的应用价值。 方法收集吉林大学第一医院神经创伤外科自2018年10月16日至11月16日选取的100例志愿者的新型16层移动CT的头部影像资料,包括普通头部体检者50例,神经创伤外科普通病房患者25例和重症监护室患者25例。所有患者在神经创伤外科重症监护病房的铅防护CT室内进行16层移动CT头部扫描,同时在放射线科行普通CT头部检查。对比分析新型16层移动CT头部成像质量和性能,并对重症监护室患者行16层移动CT头部检查耗时与转运去放射线科普通CT头部检查耗时进行比较。 结果50例体检者头部16层移动CT扫描显示脑组织形态、结构和密度清楚,成像质量清晰;50例颅脑创伤患者头部16层移动CT扫描显示脑挫裂伤、颅内血肿、脑梗死、颅骨骨折等病灶显示清晰,满足颅脑创伤疾病的诊断要求。重症监护室患者16层移动CT检查耗时[（7.2±0.4）min]显著少于转运去放射线科普通CT检查耗时[（22.3±1.9）min]。 结论新型国产16排移动CT成像清晰,适合于颅脑创伤患者的临床应用,并且耗时短,尤其适合神经重症监护室的颅脑创伤患者。     

外伤性进展性颅内血肿的诊断和治疗

目的探讨外伤性进展性颅内血肿的临床特点,总结其发病机制及诊断、治疗方法。 方法选取自2011年1月至2015年12月中国人民解放军第二五一医院神经外科收治的97例外伤性进展性颅内血肿的临床资料进行分析。 结果本组97例占同期外伤性颅内血肿的15.3%,手术63例,死亡7例;保守治疗34例,死亡1例,总死亡率8.2%。 结论外伤性进展性颅内血肿临床意义重大,绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,而应进行动态观察和CT监测,根据患者血肿量的变化及时调整治疗方案。     

急性颅脑损伤后进展性出血性损伤极高危因素分析及定时复查CT时间探讨

目的 探讨急性创伤性颅脑损伤后进展性出血性损伤(PHI)极高危患者的影响因素及伤后首次定时复查CT的时间窗.方法 对苏州大学附属第二医院神经外科自2009年6月至2010年5月收治的329例闭合性创伤性颅脑损伤住院患者的临床资料进行回顾性分析,将患者按是否于常规首次定时复查CT前出现临床症状恶化分为PHI极高危组、非PHI极高危组并进行对照研究.结果 PHI极高危组41例患者出现临床症状恶化而提前复查头颅CT,时间为(3.67±0.96)h(Md=3.8 h),与非PHI极高危组288例患者常规首次定时复查CT时间[(8.38±3.03)h(Md=7.6h)]比较差异有统计学意义(P<0.05).PHI极高危组与非PHI极高危组在首次CT颅内血肿>10 mL、颅内血肿类型≥2、合并蛛网膜下腔出血、入院时意识障碍、瞳孔扩大、GCS评分≤12分、平均动脉压增高、Plt减少、PT延长、APTT延长、FIB降低、首次CT为双侧伤、合并脑挫裂伤、骨折处硬膜外血肿上的差异有统计学意义(P<0.05).Logistic多元回归分析示PHI极高危患者与首次CT颅内血肿>10 mL、入院时意识障碍、瞳孔扩大密切相关(P<0.05).结论 急性创伤性颅脑损伤患者伤后早期特别是2 h内首次CT颅内血肿>10 mL或入院时存在意识障碍或瞳孔扩大,最好于颅脑损伤后3～4 h甚至更早进行首次定时复查CT扫描.

Abstract：

Objective To investigate the high-risk factors of progressive hemorrhagic injury (PHI)after acute traumatic brain injury(TBI)and discuss its time for first scheduled brain CT.Methods Retrospective analysis of clinical data of 329 adult patients with blunt TBI,admitted to second affiliated hospital of Suzhou University from August 2009 to July 2010,was performed.Patients were divided into PHI high-risk group and non-PHI high-risk group based on whether clinical symptoms worsened before the first routine scheduled brain CT;and control study was established. Results Forty-one patients from the PHI high-risk group were performed first routine scheduled brain CT ahead of time([3.67±0.96]h)for appearing worsened clinical symptoms,while 288 patients with non-PHI high-risk group were performed first routine brain CT as schedule(8.38±3.03 h);significant difference on the time for the first brain CT was noted between the 2 groups(P<0.05).Statistical differences in aspects of intracranial hematoma volume>10 mL,intracranial hematoma type≥2,associated subarachnoid hemorrhage on initial brain CT,disturbance of consciousness,pupil dilation and scores of Glasgow Coma Scale≤12 on admission were noted between the 2 groups(P<0.05),and statistical differences in aspects of reduced platelet(Plt),prolonged prothrombin time(PT),prolonged activated partial thromboplastin time(APTT),decreased Fibrinogen(FIB)on admission,bilateral brain injury,associated brain contusion,and skull fracture with epidural hematoma on initial brain CT were found between the 2 groups(P<0.05).Logistic regression analysis showed that intracranial hematoma volume>10 mL on initial brain CT, disturbance of consciousness and pupil dilation on admission were predictors for PHI high-risk patients (P<0.05). Conclusion For patients with intracranial hematoma volume>10 mL on initial brain CT, disturbance of consciousness and pupil dilation on admission within 2 h of TBI, first routine scheduled brain CT should be performed within 3-4 h of TBI or even earlier.     

The Usefulness of Brain Magnetic Resonance Imaging with Mild Head Injury and the Negative Findings of Brain Computed Tomography

Objective

To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury.

Methods

During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly.

Results

Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105).

Conclusion

Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.     

重型颅脑损伤术中急性脑膨出应对措施

目的探讨重型颅脑损伤手术中急性脑膨出的机理与处理措施。方法回顾性分析58例在颅脑手术过程中发生脑膨出的重型颅脑损伤患者临床资料,影像学资料及应对措施,采用标准大骨瓣减压、过度通气、咬除颅底骨质、阶梯性减压、及时复查颅脑CT等综合措施。结果术后随访三月按GOS评定预后恢复良好19例、轻残11例、重残11例、植物生存5例、死亡12例。迟发性血肿(63.8%),弥漫性脑肿胀(27.6%)及脑梗死(8.6%)是重型颅脑损伤手术中急性脑膨出的主要原因。结论对重型颅脑损伤手术中急性脑膨出的患者要正确判断,区别原因采取相应的措施。     

磁敏感加权成像在轻型颅脑损伤患者中的诊断价值

目的探讨磁共振磁敏感加权成像(SWI)对轻型颅脑损伤(MTBI)患者的诊断价值。方法回顾分析32例MTBI患者(格拉斯哥昏迷量表评分13~15分)的临床资料。患者伤后1周内给予头部CT、MRI及SWI检查,结合CT及相位图排除气体、血管和颅底伪影后,SWI图上的低信号为脑内挫伤出血灶。分别记录MRI常规序列和SWI探查到的病灶数目、发生部位,并结合临床症状进行分析。结果 SWI对脑外伤微小挫伤出血灶检查阳性率明显高于CT及MRI普通序列扫描,特别是在伤后出现晕厥昏迷史或持续性出现临床症状的患者中更为明显。结论 SWI比常规CT及MRI对MTBI患者脑内微小挫伤及出血灶的检出有更高的准确性和客观的诊断价值,并对指导临床治疗及判断预后有重大意义。     

进行性出血性脑损伤病灶体积变化对手术治疗的影响

目的分析颅脑外伤后进行性出血性脑损伤(Progressive Hemorrhagic Injury,PHI)患者病灶体积变化对于手术治疗的影响。方法 PHI患者共4 8例,分为手术组(n=3 2)与非手术组(n=1 6)例,比较两组入院时格拉斯哥评分(GCS),年龄,六个月GOS,首次CT损伤灶体积以及伤后2 4小时内损伤灶体积变化。采用独立样本t检验比较两组数据的差异;采用Logistic回归分析手术治疗的影响因素。结果首次CT损伤灶体积与伤后2 4小时内损伤灶体积变化,六个月GOS的差异有统计学意义(P<0.0 5),入院时格拉斯哥评分(GCS),年龄的差异没有统计学意义(P>0.0 5),伤后2 4小时内损伤灶体积变化(增大)是手术治疗的高危因素(OR 5.9 6 0,P<0.0 5)。结论对于颅脑外伤后进行性出血性脑损伤(PHI)患者,伤后2 4小时内损伤灶体积增长速度越快,需要手术治疗的风险就越大,手术治疗患者六个月GOS较非手术患者差。     

重型颅脑损伤开颅术中急性脑膨出的防治

目的 探讨重型颅脑损伤患者开颅术中急性脑膨出的原因及防治措施.方法 回顾性分析43例术中出现急性脑膨出的重型颅脑损伤患者的临床资料.结果 本组病人术中急性脑膨出的原因包括迟发性颅内血肿21例,弥漫性脑肿胀13例,长时间脑疝(2 h以上)4例,外伤性大面积脑梗死3例,术中低血压或低氧血症2例.出院后半年按GOS评定预后:恢复良好14例,重、中残6例,植物生存3例,死亡20例.结论 术前详细了解受伤机制,认真研究影像学资料对术中脑膨出的预判具有重要意义;针对不同病因的综合治疗有助于改善患者预后及降低患者死亡率.     

Management of minor head injury: the value of early computed tomography and serum protein S-100 measurements

Computed tomography (CT) scan was performed within 6 h in 91 patients with minor head injury (MHI). Eight patients (9%) demonstrated intracranial lesions on CT scan (6 brain contusions, 1 brain edema and 1 extradural hematoma). No patient required craniotomy. In patients with normal CT scan, no complications to the head injury were observed. Patients with intracranial lesions were hospitalized significantly longer (mean 9.4 days) than patients without (mean 1.6 days). In a subgroup of 50 patients with normal CT scan, serum S-100 protein was measured on admission. Elevated S-100 levels were seen in 10 of 50 patients (0.5-2.4 mug/L, mean 1.1). These patients were hospitalized significantly longer (mean 3.4 days) compared to patients with normal CT scan and normal S-100 levels (mean 1.1 days). MHI patients with GCS 14-15 without neurological deficits can safely be discharged when CT scan is normal. Serum protein S-100 measurements appear to provide information about diffuse brain injury after MHI.