中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
2期
168-173
,共6页
创伤性脑损伤%创伤性脑出血%外伤性蛛网膜下腔出血%Rotterdam CT评分%去骨瓣减压术%预后%分类和回归树%Glasgow预后评分
創傷性腦損傷%創傷性腦齣血%外傷性蛛網膜下腔齣血%Rotterdam CT評分%去骨瓣減壓術%預後%分類和迴歸樹%Glasgow預後評分
창상성뇌손상%창상성뇌출혈%외상성주망막하강출혈%Rotterdam CT평분%거골판감압술%예후%분류화회귀수%Glasgow예후평분
Traumatic brain injury%Brain hemorrhage,Traumatic%Subarachnoid hemorrhage,traumatic%Rotterdam CT score%Decompressive craniectomy%Prognosis%Classification and regression tree%Glasgow outcome scale
目的 探讨重型颅脑损伤患者单侧去骨瓣减压术后挫伤性脑出血增大的相关因素及与预后的关系.方法 本研究为前瞻性研究:对2008年1月至2011年12月期间浙江省绍兴市人民医院神经外科收治的行去骨瓣减压术的重型颅脑损伤患者(共291例,其中56例因缺乏头颅CT数据等情况不纳入分析,最终研究对象为235例)进行随访观察,收集记录性别、年龄、致伤原因、术前情况(GCS评分,瞳孔状态,实验室检查和头颅CT数据)、术后血肿增加量、预后(GOS评分)指标,比较血肿增大组与血肿未增大组各参数差异(视数据特性进行t检验,x2检验和秩和检验),同时采用分类和回归树预测血肿是否增大,并进行Rotterdam CT评分与GOS相关性分析.结果 235例患者中血肿增大组120例,血肿未增大组115例,组间比较显示,年龄(t=2.034,p=0.043)、首次Rotterdam CT评分(Z=4.838,P＜0.01)、GCS评分(Z =4.440,P＜0.01)、瞳孔状态(Z=3.235,P=0.001)、外伤到开颅时间(Z=3.874,P＜0.01)、血糖值(Z=3.880,P＜0.01)和疝出幅度(Z=2.529,P=0.012)差异具有统计学意义；分类和回归树分析结果表明:最初头颅CT的Rotterdam评分、血糖值和外伤到开颅间隔时间是强有力的预测因子,年龄和骨瓣大小也对挫伤性脑出血是否增大产生有意义的影响,分类和回归树预测准确率为83.3％；相关性分析结果说明Rotterdam CT评分与GOS呈负相关(r=-0.333,P＜0.01).结论 重型颅脑损伤患者头颅CT的严重程度、血糖值和外伤到开颅间隔时间可以预测去骨瓣减压术后脑挫伤出血增大的风险；Rotterdam CT评分与预后密切相关.
目的 探討重型顱腦損傷患者單側去骨瓣減壓術後挫傷性腦齣血增大的相關因素及與預後的關繫.方法 本研究為前瞻性研究:對2008年1月至2011年12月期間浙江省紹興市人民醫院神經外科收治的行去骨瓣減壓術的重型顱腦損傷患者(共291例,其中56例因缺乏頭顱CT數據等情況不納入分析,最終研究對象為235例)進行隨訪觀察,收集記錄性彆、年齡、緻傷原因、術前情況(GCS評分,瞳孔狀態,實驗室檢查和頭顱CT數據)、術後血腫增加量、預後(GOS評分)指標,比較血腫增大組與血腫未增大組各參數差異(視數據特性進行t檢驗,x2檢驗和秩和檢驗),同時採用分類和迴歸樹預測血腫是否增大,併進行Rotterdam CT評分與GOS相關性分析.結果 235例患者中血腫增大組120例,血腫未增大組115例,組間比較顯示,年齡(t=2.034,p=0.043)、首次Rotterdam CT評分(Z=4.838,P＜0.01)、GCS評分(Z =4.440,P＜0.01)、瞳孔狀態(Z=3.235,P=0.001)、外傷到開顱時間(Z=3.874,P＜0.01)、血糖值(Z=3.880,P＜0.01)和疝齣幅度(Z=2.529,P=0.012)差異具有統計學意義；分類和迴歸樹分析結果錶明:最初頭顱CT的Rotterdam評分、血糖值和外傷到開顱間隔時間是彊有力的預測因子,年齡和骨瓣大小也對挫傷性腦齣血是否增大產生有意義的影響,分類和迴歸樹預測準確率為83.3％；相關性分析結果說明Rotterdam CT評分與GOS呈負相關(r=-0.333,P＜0.01).結論 重型顱腦損傷患者頭顱CT的嚴重程度、血糖值和外傷到開顱間隔時間可以預測去骨瓣減壓術後腦挫傷齣血增大的風險；Rotterdam CT評分與預後密切相關.
목적 탐토중형로뇌손상환자단측거골판감압술후좌상성뇌출혈증대적상관인소급여예후적관계.방법 본연구위전첨성연구:대2008년1월지2011년12월기간절강성소흥시인민의원신경외과수치적행거골판감압술적중형로뇌손상환자(공291례,기중56례인결핍두로CT수거등정황불납입분석,최종연구대상위235례)진행수방관찰,수집기록성별、년령、치상원인、술전정황(GCS평분,동공상태,실험실검사화두로CT수거)、술후혈종증가량、예후(GOS평분)지표,비교혈종증대조여혈종미증대조각삼수차이(시수거특성진행t검험,x2검험화질화검험),동시채용분류화회귀수예측혈종시부증대,병진행Rotterdam CT평분여GOS상관성분석.결과 235례환자중혈종증대조120례,혈종미증대조115례,조간비교현시,년령(t=2.034,p=0.043)、수차Rotterdam CT평분(Z=4.838,P＜0.01)、GCS평분(Z =4.440,P＜0.01)、동공상태(Z=3.235,P=0.001)、외상도개로시간(Z=3.874,P＜0.01)、혈당치(Z=3.880,P＜0.01)화산출폭도(Z=2.529,P=0.012)차이구유통계학의의；분류화회귀수분석결과표명:최초두로CT적Rotterdam평분、혈당치화외상도개로간격시간시강유력적예측인자,년령화골판대소야대좌상성뇌출혈시부증대산생유의의적영향,분류화회귀수예측준학솔위83.3％；상관성분석결과설명Rotterdam CT평분여GOS정부상관(r=-0.333,P＜0.01).결론 중형로뇌손상환자두로CT적엄중정도、혈당치화외상도개로간격시간가이예측거골판감압술후뇌좌상출혈증대적풍험；Rotterdam CT평분여예후밀절상관.
Objective To identify the factors enhancing the contusive brain hemorrhage following unilateral decompression craniectomy in patients with severe traumatic brain injury (TBI),and to explore the relationship between the initial Rotterdam CT score and clinical outcomes.Methods A prospective study of 291 consecutive patients with TBI admitted from Jan 2008 through Dec 2012 was carried out.Patients treated with unilateral decompression craniectomy were enrolled for study.Patients without preoperative or postoperative cranial CT imaging were excluded.Of them,235 patients were followed up.Gender,age,the causes of injury,preoperative general condition including Glasgow Coma Scale (GCS) score,pupillary response,laboratory data and the initial CT scans before operation,contusion hematoma size in CT scans following operation and Glasgow Outcome Scale (GOS) score were recorded.With t test,x2 test and nonparametric rank sum test,differences in the above listed variables were compared between patients with enlarged hematoma size group and those without change in hematoma size.A Classification And Regression Tree (CART) was used to predict the size of hematoma.Correlation analysis was used to find the relationship between the Rotterdam CT scores and GOS scores.Results The differences in age (t =2.034,P =0.043),first Rotterdam CT score (Z =4.838,P ＜ 0.01),GCS score (Z =4.440,P ＜ 0.01),pupillary response (Z =3.235,P =0.001),the length of time elapsed between the trauma occurred and the decompressive craniectomy (Z =3.874,P ＜ 0.01),glucose level (Z =3.880,P ＜ 0.01) and cerebrum hernia magnitude (Z =2.529,P =0.012) were significant between the patients with hematoma expanded (n =120) and those without change in hematoma size (n =115).The results of the CART indicated that Rotterdam score got from the initial head CT,glucose level and the length of time elapsed between trauma occurred and decompressive craniectomy were strong predictors of the risk for expanded hemorrhagic contusions following decompressive craniectomy.Both age and size of the removed bone-flap also could predict the risk of postoperative expansion of hemorrhagic contusions.The overall predictive accuracy of the CART model was 83.3％.Correlation analysis results indicated that Rotterdam CT score was negatively correlated with GOS (r =-0.333,P ＜ 0.01).Conclusions Initial Rotterdam CT scores,glucose level and the length of time between trauma and decompressive craniectomy may predict the risk of contusions expansion following decompressive craniectomy.Rotterdam CT score was negatively correlated with GOS.
