论著-头颈部
创伤性颅脑损伤患 者CT征象及预后分 析
作者:林 炜1 陈 建1 王化强1 张建松2 葛凯杰1 张海锋3
所属单位:1.河南省许昌市中心医院重症医学 科 (河南 许昌 461000) 2.河南省许昌市中心医院普外科 (河南 许昌 461000) 3.河南省郑州市中心医院放射科 (河南 郑州 450007)
PDF摘要
目的 研究创伤性颅脑损伤患者 CT征象及对其预后评估价值。方法 回顾 性分析我院2015年3月至2018年3月收治创 伤性颅脑损伤患者168例,并根据患者创 伤后3月格拉斯哥预后量表(GOS)评分将其 分为预后良好组(评分为4-5分)126例和 预后不良组(评分为1-3分)42例。所有患 者均使用64排螺旋CT检查,对所有患者CT 征象(三脑室形态、侧脑室受压、中线位 移及环池变化)进行统计,并分析CT征象 与预后之间关系。结果 共168例创伤性颅 脑损伤患者中三脑室宽径6-10mm患者最 多为74例(44.05%),侧脑室受压比例> 0.2患者最多为89例(52.98%),中线位移 6-10mm患者最多为72例(42.86%),环池宽 度2-3mm患者最多为81例(48.21%)。影响 创伤性颅脑损伤患者GOS预后评分单因素 有:三脑室宽径、侧脑室受压比例、中 线位移、环池宽度(P<0.05);影响创伤 性颅脑损伤患者GOS预后评分不良的多因 素有:三脑室宽径在6-10mm、中线位移 >10mm、环池宽度0-1mm(P<0.05)。结论 CT征象对创伤性颅脑损伤程度有一定提示 作用,且三脑室宽径、侧脑室受压比例、 环池宽度可在一定程度预测患者预后,可 为患者临床治疗及后期恢复提供参考依 据。
Objective To study the CT imaging findings of patients with traumatic brain injury and to evaluate and analyze the prognostic value. Methods A total of 168 cases of patients with traumatic brain injury from March 2015 to March 2018 in our hospital were analyzed retrospectively and were divided into good prognostic group (score from 4 to 5 points, 126 cases) and poor prognostic group (score from 1 to 3 points, 42 cases) according to the Glasgow Outcome Scale (GOS) score at 3 months after trauma. All patients were given 64-slice spiral CT examination, analyze the CT findings of third ventricle morphology, lateral ventricle compression, midline displacement and cisterna changes, and to analyze the relationship between these CT findings and the prognosis. Results Among 168 patients with traumatic brain injury, there were 74 cases (44.05%) of patients with a widened third ventricle of 6-10 mm, and there were 89 cases (52.98%) of lateral ventricle compression more than 0.2, and there were 72 cases (42.86%) patients with midline displacement from 6-10 mm, and there were 81 cases (48.21%) of patients with cisterna width of 2 to 3 mm. The single factors affecting the GOS prognosis score in patients with traumatic brain injury were the width of third ventricle, proportion of lateral ventricle compression, midline displacement and cisterna width (P<0.05). The multiple factors affecting GOS prognosis scores in patients with traumatic brain injury were the width of third ventricle from 6 to 10mm, midline displacement> 10mm and cisterna width from 0 to 1mm (P<0.05). Conclusion CT signs have a certain role in suggesting the condition of patients with traumatic brain injury, and the width of the third ventricle, the compression ratio of lateral ventricle and the width of cistern can predict the prognosis of patients to a certain extent, which can provide a reference basis for clinical treatment and later recovery of patients.
【关键词】创伤性颅脑损伤;CT征象;预后
【中图分类号】R44;R57
【文献标识码】A
【DOI】10.3969/j.issn.1672- 5131.2019.01.009
前言
创伤性颅脑损伤是神经外科常见疾病之一,是青壮年人群残疾及 死亡的主要原因之一,其致残及死亡率均居各类创伤首位,其发病率 呈持续上升趋势。目前,创伤性颅脑损伤病情判断标准为格拉斯哥昏 迷及预后评估,通过长期临床随访发现其存在一定缺陷,该标准易受 患者主观因素、麻醉及镇静药物等影响,且随着发病时间的延长,预 测准确率持续下降[1]。CT扫描作为创伤性颅脑损伤辅助诊断方式,方 便、快捷且应用广泛,但在临床上仍缺乏统一诊断标准,且不同临床 医生对CT影像解读也存在一定差异,延误最佳治疗时机,出现不良预 后等现象[2]。因此,本文对创伤性颅脑损伤患者CT征象进行研究,分 析CT征象与预后评估的关系,现将研究结果报道如下。
中国CT和MRI杂志
第17卷, 第 1 期
2019年01月
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