创伤性颅脑损伤的CT征象与患者伤情及预后的相关性分析

摘要

Objective To investigate the association between computerized tomography(CT)scanning signs and patients'traumatic condition and prognosis,so as to provide an objective assessment of the structural damage to the brain following traumatic brain injury(TBI).Methods Data of patients with traumatic intraeerebral haematomas from Jan.2008 to Nov.2010 were collected,including age,gender,post-resuscitation GCS,bilateral in-tracerebral haematomas,loeation of the intracerebral haematomas,GCS motor score,presence of subarachnoid hemor-rhage,status of basal cistern,midline shift and GOS after 6 months.The data were statistically analyzed so as to e-valuate the relationship between craniocerebral injury CT signs and patients'traumatic condition and prognosis.Results There were 95 patients with mean age of 50.2±18.7 years.The median Glasgow Coma Scale(GCS)onadmission was 10.From the in-hospital mortality,the mortality of elders was higher than youths(20%VS.2%).There was an association between age and inpatient mortality(P=0.006).The GCS motor score of in-hospital non-survived patients was 1.4±0.7,while 3.9±1.4 for survived patients,indicating statistical significance(P=0.001).Additionally,there was a higher rate of subdural haematoma,bilateral intracerebral haematomas,temporal intracerebral haematoma,subarachnoid hemorrhage in in-hospital non-survived patients than the survived patients on discharge.Logistic regression analysis showed that there was an association between temporal intracerebral haemato-ma and inpatient mortality(P=0.034).But the association between subdural hematoma and inpatient mortality was not obvious (P=0.054).The CT indirect sign indicated an association in the status of basal cistern and middle shift between the two groups(P<0.001).The GOS after 6 months showed a higher rate of bilateral intracerebral haematomas,subarachnoid hemorrhage,subdural haematoma,temporal intracerebral haematoma in the patients with bad prognosis,while there was statistical significance in temporal intracerebral haematoma and subarachnoid hemor-rhage between the two groups(P=0.043,P=0.027).Conclusion CT is a firstly-chosen method in judging the presence and severity of intra-cranial injmy.Bilateral intracerebral haematomas,subarachnoid hemorrhage,sub-dural haematoma,temporal intracerebral haematoma are meaningful in predicating patients'mortality and prognosis,which can provide reference for clinical treatment and recovery.%目的 探讨创伤性颅脑损伤各种CT征象与患者伤情及预后的相关性,并为其预后评价提供有价值的早期影像学信息.方法 回顾性分析2008年1月~2010年11月我院收治的创伤性颅脑损伤患者的伤情及预后情况,收集患者的年龄、性别、入院时格拉斯哥昏迷评分(GCS)、GCS运动评分、血肿的位置及侧别、有无蛛网膜下腔出血、中线结构的偏移及程度、基底池的受压情况、6个月后的格拉斯哥预后评分(GOS)等数据,并进行统计学分析,采用统计描述、Logistic回归等统计方法对数据进行分析,评价各征象与伤情和临床预后的相关性.结果 本组95例患者,平均年龄为(50.2±18.7)岁.GCS的中位数是10,43.2%的严重脑外伤患者在复苏后GCS评分≤9.根据入院患者死亡率,老年人明显高于年轻人,为20%:2%,年龄在住院后死亡和存活患者的组间比较的差异有统计学意义(P=0.006);入院后死亡患者的GCS运动评分为1.4±0.7,入院后存活的患者GCS运动评分为3.9±1.4,两组之间的差异有统计学意义,P=0.001.在CT直接征象上,入院后死亡患者较存活患者有较高比例的硬膜下血肿、双侧血肿、颞叶血肿和蛛网膜下腔出血,通过Logistic回归得出,颞叶血肿在入院死亡和入院存活患者的组间差异有统计学意义,P=0.034.在CT间接征象上,基底池受压和中线结构移位情况在两组之间的差异有统计学意义(P＜0.001).对颅脑损伤患者6个月后的预后情况进行统计学分析,得出在预后较差组有较高比例的双侧血肿、蛛网膜下腔出血、硬膜下血肿和颞叶血肿,颞叶血肿和蛛网膜下腔出血在两组组间比较的差异有统计学意义,分别为P值=0.043,P值=0.027.结论 CT是急性脑外伤后判断颅内有无损伤及损伤程度的首选检查方法,双侧血肿、蛛网膜下腔出血、硬膜下血肿、颞叶血肿对患者入院死亡率和预后情况有重要的提示意义,可为临床治疗和患者后期恢复提供有效的参考依据.