儿童重度脑外伤后缄默症的临床表现与预后

【目的】探讨儿童脑外伤后缄默症（PTM）的临床表现与预后。【方法】对14例PTM患儿临床表现、影像学资料进行分析，对伤后昏迷时间与缄默时间、缺血脑区与缄默时间的相关性进行比较。【结果】本组患儿伤后昏迷时间4～82（28．75±22．63）d；苏醒后缄默症持续时间：3～55（20．03±16．78）d；所有患儿的SPECT均显示多脑区持续存在的缺血性改变。昏迷时间与缄默时间显著相关（P〈0．001）；左右脑区缺血数与缄默发生的相关性不明显（P=0．265）。【结论】PTM多见于弥漫性脑损伤，与多脑区缺血有关，PTM持续时间与伤后昏迷持续时间明显相关；可能与儿童相关语言脑区的发育尚欠成熟有关。

Clinical Manifestation and Prognosis of Post-Traumatic Mutism in Children

Objective]To investigate the clinical manifestation and prognosis of post-traumatic mutism （PTM） in children. Methods] The clinical manifestation , the data of brain imaging and brain SPECT of 14 children who suffered from PTM were analyzed retrospectively. The correlation between PTM duration and coma duration, brain ischemia and PTM were studied. Results] The coma duration of 14 children was 4-82 days（average 28.75±22.63 days） and the PTM duration was 3-55 days（average 20.03±16.78 days）. Persistent ischemia in many brain regions occurred in all patients by SPECT. PTM duration and coma duration had significant correlation（ P〈0. 001）. And the relation between the incidence of PTM and the number of brain ischemia was not evident （ P=0. 265）. Conclusion] PTM in children occurs mostly in the diffuse brain injury and is related to the ischemia in many brain regions . The correlation between PTM duration and coma duration is significant. PTM may be linked to the insufficiency of language area of brain in children.