儿童脑挫裂伤的临床分析及救治策略探讨

摘要

目的 分析儿童脑挫裂伤的临床特点并探讨相应的救治策略.方法 收集2013年2月—2017年12月武警后勤学院附属医院脑科中心收治的32例1~14岁脑挫裂伤患儿的临床资料,其中男22例,女10例.年龄1~13.5岁,平均(6.03±3.96)岁.按照年龄分为低年龄(1~4岁)组14例和高年龄(5~14岁)组18例.总结并分析脑损伤位置分布、格拉斯哥昏迷评分(GCS)/儿童昏迷评分(CCS)、颅内压(ICP)、脑水肿、气道情况、外伤性癫痫发作及脑电图情况.结果 本组住院时间17~57 d,平均(34.2±11.5)d.所有患儿均接受高压氧治疗,为14~51 d,平均(36.1±5.1)d.2组脑损伤深度分类及损伤脑叶位置差异无统计学意义(P>0.05).2组昏迷评分比较显示,入院和出院2个时间点,低龄组昏迷评分均低于高龄组(P<0.05);ICP监护结果显示,2组ICP监护时长为6~15 d,平均(7.5±2.0)d.入院时低龄组ICP、脑水肿扰动系数(RI)高于高龄组,而RI异常时间少于高龄组(P<0.05).癫痫发作及脑电图显示,2组患儿不同时间段癫痫发作及脑电图情况差异无统计学意义(P>0.05).气道观察显示,2组各有10例接受经口气管插管,低龄组平均带管时间长于高龄组(P<0.05).结论 不同年龄段患儿脑挫裂伤在临床表现、影像特征、ICP、脑水肿程度、癫痫发作及气道管理方面具有一定的差异,应尽早、积极、全面性地开展救治,特别要重视低龄段患儿的临床管理.%Objective To study the clinical characteristics of brain contusion in children and discuss the corresponding treatment strategies.Methods From February 2013 to December 2017,the clinical data of 32 patients(aged 1-14 years)with cerebral contusion and treated in the department of brain of the affiliated hospital of armed police logistics college were collected,including 22 males and 10 females.The age of patients ranged from 1 to 13.5 years,with the average of(6.03 ± 3.96)years.Patients were divided into low age group(1-4 years old,n=14)and high age group(5-14 years old,n=18)according to their age.Data of the brain damage location and distribution,Glasgow Coma Scale(GCS)/Children's Coma Scale (CCS), intracranial pressure (ICP), cerebral edema, airway condition, traumatic epilepsy and electroencephalogram (EEG) were summarized and analyzed. Results The duration of hospitalization was 17-57 d, with the average of (34.2 ± 11.5)d.All the children were treated with hyperbaric oxygen for 14-51 d,with an average of(36.1±5.1)d.There were no significant differences in the depth of brain damage and the location of brain injury between the two age groups(P>0.05). The coma scores at the admission and the discharge were significantly lower in low age group than those of the high age group (P<0.05). The duration of ICP monitoring was 6-15 d, with the average of (7.5±2.0) d. The ICP level and the resonance index(RI)value of cerebral edema monitoring at the admission was higher in the low age group than those in the high age group(P<0.05).The abnormal time of RI was less in the low age group than that in the high age group(P<0.05).There were no significant differences in seizures and EEG classification between two groups (P>0.05). There were 10 cases in each group received the transnasal intubation,and the average days with intubation were longer in the low age group than those of the high age group(P<0.05).Conclusion The clinical manifestations,imaging features,ICP,the degree of brain edema, seizures and airway management in children of different ages are different. The treatment should be carried out as soon as possible,actively and comprehensively,especially in the clinical management for the children of low age.