“三3”评分法在颞额叶脑挫裂伤治疗决策中的应用研究

目的探讨颞额叶脑挫裂伤伴小血肿及基底池变化的治疗决策,论证“三3”评分法的可行性。方法按意识、脑挫裂伤面积或血肿量、基底池变化三项评分,分为Ⅰ、Ⅱ、Ⅲ型（“三3”评分法）。根椐274例回顾分析Ⅰ病死率,立即手术组〈延迟手术组,手术治疗组〈保守治疗组的结果;应用于临床92例,进行对比分析。结果观察组Ⅰ型33例立即手术治疗,死亡3例;Ⅱ型44例非手术治疗观察中改（延迟）手术治疗17例,死亡1例;Ⅲ型15例非手术治疗。按GCS重型颅脑损伤分型及GOS预后分级,观察组49例,良好／中残30（61．2％）、重残12（24．4％）、植物生存3（6．1％）、死亡4（8．1％）。二组病死率比较：Ⅰ型观察组9．1％〈对照组28．4％（P〈0．05）,Ⅱ型观察组2．2％〈对照组7．9％。结论“三3”评分法分型是科学的,可在临床症状恶化之前作为治疗决策的量化指标。

A retrospective research on the desicions of 274 treatments of Contusion and laceration of the brain at Temporal lobe and Frontal lobe

Objective To explore the treatment desicions of Contusion and laceration of the brain at temporal lobe and frontal lobe with small hematoma and base pond changes. Methods According to three grades of consciousnee,areas of brain contusion or quantity of hematoma,and changes of base pond,it divided 274 patients into different types,then analyzed treatments and retrospect to them. Results 33 cases of Type Ⅰ:33 cases had operated immediatelly and 3 cases had died;44 cases of Type Ⅱ:17 cases had delayed operations and 1 case had died;27 cases without operations.Type Ⅲ: 15 cases without operations. Conclusion These three-3 method of grade could be regarded as the quantification index of treatment desicions before deterioration.