创伤性颅脑损伤患者CT征象及预后分析
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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 5points,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 Among168 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 0to 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.
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 5points,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 Among168 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 0to 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.
引文
[1]朱永山,张玉龙,程海云,等.创伤性脑损伤后脑白质损伤与认知功能障碍的相关性研究[J].中华创伤杂志,2016,32(1):69-73.
[2]张志强,刘丽娟,张强,等.移动CT和常规CT检查对颅脑损伤后脑继发性损害及治疗效果的影响[J].中华神经医学杂志,2016,15(11):1159-1163.
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[4]GuptaS,KlaricK,SamN,etal.Impact of Helmet Use on Traumatic Brain Injury from Road Traffic Accidents in Cambodia[J].Traffic Injury Prevention,2017,19(1):66-70.
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[7]秦德广,黄文勇,杨灵,等.高渗盐水在重型颅脑损伤去骨瓣减压术后颅内高压治疗中的应用研究[J].中华神经医学杂志,2016,15(12):1267-1273.
[8]张焕芝,尹元桂.重型颅脑损伤各项临床指标与预后的相关性分析[J].中国综合临床,2015,31(2):163-165.
[9]岳中华,颜雷.64排CT在创伤性颅脑损伤诊断中的临床价值分析[J].中国CT和MRI杂志,2016,14(2):27-28,68.
[10]汪慧娟,郑红云,袁强,等.体位对颅脑损伤患者颅内压、脑灌注压的影响[J].中华急诊医学杂志,2016,25(9):1197-1199.
[11]黄青良,周翔,刘国华,等.颅内压无创检测仪在颅高压患者中的应用[J].实用医学杂志,2018,34(11):1918-1920.
[12]郑书刚.中重度颅脑损伤后CT影像特点、颅内压与预后的关系[J].中国医药导刊,2016,18(6):572-573.
[13]屈波,牛立堂,朱金华,等.不同术式对重症对冲性颅脑损伤术后对侧血肿厚度及中线位移程度的影响[J].中国实用神经疾病杂志,2016,19(20):85-86.
[14]万振海.颅脑损伤患者手术治疗前后CT环池影像学改变分析[J].中国CT和MRI杂志,2017,15(5):19-20.
[2]张志强,刘丽娟,张强,等.移动CT和常规CT检查对颅脑损伤后脑继发性损害及治疗效果的影响[J].中华神经医学杂志,2016,15(11):1159-1163.
[3]崔倩宇,韩如泉.创伤性颅脑损伤围术期管理研究进展[J].临床麻醉学杂志,2017,33(5):504-507.
[4]GuptaS,KlaricK,SamN,etal.Impact of Helmet Use on Traumatic Brain Injury from Road Traffic Accidents in Cambodia[J].Traffic Injury Prevention,2017,19(1):66-70.
[5]许鹏程,邵雪非,陶进.CT对创伤性颅脑损伤评价及预后评估的研究进展[J].国际神经病学神经外科学杂志,2015,42(3):257-260.
[6]Lenstra J J,AraP,Fock J M,et al.Influence of guidelines on management of paediatric mild traumatic brain injury:CT-assessment and admission policy.[J].European Journal of Paediatric Neurology,2017,21(6):816-822.
[7]秦德广,黄文勇,杨灵,等.高渗盐水在重型颅脑损伤去骨瓣减压术后颅内高压治疗中的应用研究[J].中华神经医学杂志,2016,15(12):1267-1273.
[8]张焕芝,尹元桂.重型颅脑损伤各项临床指标与预后的相关性分析[J].中国综合临床,2015,31(2):163-165.
[9]岳中华,颜雷.64排CT在创伤性颅脑损伤诊断中的临床价值分析[J].中国CT和MRI杂志,2016,14(2):27-28,68.
[10]汪慧娟,郑红云,袁强,等.体位对颅脑损伤患者颅内压、脑灌注压的影响[J].中华急诊医学杂志,2016,25(9):1197-1199.
[11]黄青良,周翔,刘国华,等.颅内压无创检测仪在颅高压患者中的应用[J].实用医学杂志,2018,34(11):1918-1920.
[12]郑书刚.中重度颅脑损伤后CT影像特点、颅内压与预后的关系[J].中国医药导刊,2016,18(6):572-573.
[13]屈波,牛立堂,朱金华,等.不同术式对重症对冲性颅脑损伤术后对侧血肿厚度及中线位移程度的影响[J].中国实用神经疾病杂志,2016,19(20):85-86.
[14]万振海.颅脑损伤患者手术治疗前后CT环池影像学改变分析[J].中国CT和MRI杂志,2017,15(5):19-20.
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