分析儿童重型脑外伤临床特点及对预后影响.docVIP

分析儿童重型脑外伤临床特点及对预后影响 　【摘要】 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（Plt;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（Plt;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。 【关键词】 重型颅脑损伤；预后；脑肿胀 　　Abstract： 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. 　　Key words： severe cerebral trauma; prognosis; cerebral swelling 儿童重型颅脑损伤较为常见，对儿童重型颅脑损伤的救治是当今神经外科领域的重点及难点，尽管与成人相比，存活率较高，但致残率也高。2000年2月—2005年10月我科收治儿童重型颅脑损伤31例，现总结、分析如下。 　　1 资料与方法 　　1．1 一般资料 　　本组31例，男21例，女10例，年龄最小4个月，最大12岁，平均6.5岁。交通事故伤19例，坠落伤8例，打击伤4例；开放伤5例，闭合伤26例；GCS 8~5分22例，GCSlt;5分9例；单纯脑外伤16例，复合外伤15例。癫痫大发作12例，反射消失20例，有颅骨骨折13例，颅内血肿19例，