重型闭合性颅脑损伤预后因素临床分析

目的 探讨影响重型闭合性颅脑损伤预后的相关因素.方法 总结2003-01～2007~(-1)2入院治疗的127例重型闭合性颅脑损伤患者,对其损伤后病情演化情况,从GCS评分、年龄、颅脑损伤类型、手术时机、高血糖、呼吸功能不全和继发大面积脑梗死等方面综合分析多种因素与预后的关系.结果 GCS评分越低,死亡率越高;随着年龄的增长,生存概率也随之下降;合并弥漫性脑肿胀、广泛性脑挫裂伤、脑内多发性血肿、脑干损伤患者较以单发性颅内血肿为主要表现者死亡率高;伴有明显血糖升高、呼吸功能不全、并发大面积脑梗死者与颅脑损伤的程度有关,并对疾病预后产生不利影响.结论 颅脑损伤的程度、类型及年龄因素直接影响预后,且手术时机、损伤后高血糖、呼吸功能不全、并发大面积脑梗死等因素对重型闭合性颅脑损伤的预后也产生重要的影响.

Influencing factors of the prognosis of severe closed craniocerebral trauma

Objective To discuss the influencing factors of the prognosis of severe closed craniocerebral trauma. Methods A retrospective study was conducted in 127 patients, who had suffered from severe closed craniocerebral injury and had been hospitalized in our department from Jan. 2003 to Dec. 2007. The influencing factors including etiological factor, Glasgow Coma Scale, age, the type of injury, the timing of operation, blood glucose level, respiratory function and secondary cerebral infarction were analyzed. Results The lower Glasgow Coma Scale and the older age both led to the higher mortality. Compared with the single intracranial hematoma, the survival rate decreased significantly in the patients with diffused cerebral edema, extensive contusion and laceration, multiple hematomas or brainstem injury. High blood glucose level, respiratory insufficiency or large cerebral infarction associated with the severity and prognosis of the disease. Conclusion The type of trauma and the age of the patient affected the prognosis directly. The timing of operation, high blood glucose, large cerebral infarction and respiratory insufficiency also have influences on the outcome.