重型颅脑损伤4462例诊治分析

目的 总结大宗重型创伤性脑损伤(severe traumatic brain injury,sTBI)患者的诊疗经过,以提高治愈率,减低残死率.方法 对1951年6月-2008年5月间我院收治的4 462例sTBI患者(GCS≤8分)的诊疗过程进行回顾性分析.其中男3 298例(73.9%),女1 164例(26.1%);致伤原因最常见为交通伤(1 583例,35.5%);闭合性损伤3 654例(81.9%),开放性损伤808例(18.1%);临床表现主要为意识障碍、瞳孔变化与生命体征改变等;1 158例(26.0%)有合并伤,1 356例(30.4%)有并发症.治疗方式包括急救、手术与非手术处理,尤其强调二次脑损伤的防治. 结果 手术治疗3 023例(67.7%),其中开颅血肿清除术856例,开颅血肿清除与去骨瓣减压2 167例,死亡540例(17.9%).非手术治疗1 439例(32.3%),死亡341例(23.7%).全部患者出院时COS评定结果 :良好2 462例(55.2%).中残508例(11.4%),重残339例(7.6%),植物生存272例(6.1%),死亡881例(19.7%). 结论 积极的诊断治疗、严格的诊疗制度与防治二次脑损伤是提高sTBI救治成功率,降低残、死率的关键.

Diagnoses and treatment of severe traumatic brain injury in 4 462 cases: a retrospective study

Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI.