儿童重型脑外伤的特点及预后分析

目的分析儿童重型脑外伤的临床特点及对预后的影响。方法用寿命表分析,单变量和多变量分析等统计学方法分析各种危险因素对预后的影响。结果31例患儿,死亡8例(25.8%),预后与原发性损伤的严重程度有关,GCS评分是影响预后最主要因素,GCS评分5~8分者存活20例,存活率90.9%,而GCS评分<5分者存活3例,存活率33.3%,外伤后弥漫性脑肿胀(P<0.000 1)是影响预后的因素,年龄、颅骨骨折和颅内血肿对预后的影响无统计学意义。用Cox模型进一步分析发现治疗前的反射消失、外伤后急性弥漫性脑肿胀是影响预后的最主要因素(P<0.000 9),年龄、颅骨骨折和颅内血肿对预后无影响。结论发现原发生性反射消失、GCS评分是预测预后的最好指标,脑水肿、脑肿胀是影响预后的最主要因素。因此,为了改善患儿的预后,应将颅脑损伤患儿的治疗重点放在预防和减轻脑水肿、脑肿胀上。

Analysis of Characteristics and Prognoses of Severe Cerebral Trauma in Children

Objective To analysis the clinical characteristics of severe cerebral trauma in children and their prognoses.Methods The influences of various risk factors on the prognoses were analyzed by life table,single or multiple variable analysis.Results Among the 31 children with severe cerebral trauma,eight ones(25.8%) died.The degree of primary trauma was relative with their prognoses,whose main influencing factor was Glasgow coma score(GCS).The survival rate of those with a GCS between 5 and 8 was 90.9%,and of those with a GCS lower than 5 was 33.3%.Diffuse cerebral swelling after trauma acted as an factor with an influence on the pronoses,whereas age,cerebral fracture and intracranial hematoma had no statistical influences.According to Cox model,areflexia and acute difuse cerebral swelling before trauma acted as the main factors that exerted an influence on the prognoses.Conclusion Primary areflexia and GCS are the best indexes that predict the prognosis of severe cerebral trauma in children,which is influenced mainly by the factor of cerebral swelling or edema.Doctors should lay stress on the prevention and the alleviation of cerebral swelling so as to improve the prognosis.