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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2015, Vol. 01 ›› Issue (01) : 24 -27. doi: 10.3877/cma.j.issn.2095-9141.2015.01.007

临床研究

应用CT影像数据化评估重型颅脑损伤去骨瓣减压术预后影响因素
李培建1, 樊娟1, 张洪钿1, 汤浩1, 徐如祥1,†()   
  1. 1.100700，北京军区总医院附属八一脑科医院
  • 收稿日期:2014-12-22 出版日期:2015-02-15
  • 通信作者: 徐如祥
  • 基金资助:
    国家自然基金青年项目(81200959)

CT image datamation as the outcome related factors of patients with traumatic brain injury after decompressive craniectomy

Peijian Li1, Juan Fan1, Hongtian Zhang1, Hao Tang1, Ruxiang Xu1,†()   

  1. 1.Bayi Brain Hospital affiliated to the Military General Hospital of Beijing PLA,100700,China
  • Received:2014-12-22 Published:2015-02-15
  • Corresponding author: Ruxiang Xu
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李培建, 樊娟, 张洪钿, 汤浩, 徐如祥. 应用CT影像数据化评估重型颅脑损伤去骨瓣减压术预后影响因素[J]. 中华神经创伤外科电子杂志, 2015, 01(01): 24-27.

Peijian Li, Juan Fan, Hongtian Zhang, Hao Tang, Ruxiang Xu. CT image datamation as the outcome related factors of patients with traumatic brain injury after decompressive craniectomy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2015, 01(01): 24-27.

目的

将CT影像表现进行数据化，分析重型颅脑损伤(sTBI)去骨瓣减压术患者的影响因素，评价其与预后的关系。

方法

回顾性分析2011年1月至2013年6月北京军区总医院附属八一脑科医院收治的121例重型颅脑损伤去骨瓣减压患者的临床资料，研究CT影像表现数据值变化，并分析年龄、受伤-手术时间间隔、入院格拉斯哥昏迷评分(GCS)、瞳孔直径等因素对患者预后的影响，预后以6个月时的格拉斯格预后(GOS)评分判断。

结果

预后良好组(GOS 3～5分)共75例，预后不良组(GOS 1～2分)共46例。两组间在CT数据值(3.55±0.92和4.51±0.96，t=19.221，P=0.000)以及年龄(39.12±6.42 和53.93±8.64，t=27.257，P=0.000)、受伤至手术时间间隔(35.75±7.86 和9.43±2.15，t=11.712，P=0.000)、入院GCS评分(6.40±1.52和4.54±1.11，t=25.147，P=0.000)、瞳孔直径(2.81±0.49和3.57±1.02，t=39.579，P=0.000)等方面差异均具有统计学意义。

结论

术前头颅CT影像数据化后可与年龄、受伤-手术时间间隔、入院GCS评分、瞳孔变化等一起作为评价脑外伤预后的重要临床参考指标。

关键词: 创伤性颅脑损伤, 去骨瓣减压术, CT数据化, 格拉斯哥预后评分

Objective

To explore CT image datamation as the outcome related factors of the patients with severe traumatic brain injury (sTBI) following decompressive craniectomy, and evaluate the relation between outcomes and the factors.

Methods

During January 2011 to June 2013, 121 TBI patients underwent decompressive craniectomy were selected for analysis. CT image datamation,age,interval of the injury to operation,admit Glasgow coma score(GCS),pupil diameter as well as the outcome influenced by them were evaluated. The prognosis was evaluated according to Glasgow outcome scale(GOS).

Results

Through statistical analysis, CT image datamation, age, interval of injury to operation, GCS, and pupil diameter are all close correlated with outcome(P＜0.05).

Conclusions

CT image datamation, ages, interval of the injury to operation, admit GCS and pupil diameter could be generally applied as indicators to assess the outcome of TBI patient.

Key words: Traumatic brain injury, Decompressive craniectomy, CT datamation, Glasgow outcome scale
表1 121例重型颅脑损伤去骨瓣减压手术患者的临床特征
Tab.1 Clinical characteristics of 121 patients underwent decompressive craniectomy
临床特征 例数
性别
男 104
女 17
年龄
15～20岁 4
21～30岁 12
31～40岁 16
41～50岁 40
51～60岁 16
61～70岁 20
71～80岁 12
80岁以上
受伤-手术时间间隔
≤24h 1
24～48h 102
＞48h 10
GCS评分
≤3 76
3～5 45
对光反射
双侧灵敏 18
单侧灵敏 37
双侧迟钝/消失 64
眼疾无法观察 2
CT值评分
1 1
2 3
3 20
4 51
5 34
6 12
表2 121例去骨瓣减压患者预后良好组与预后不良组的相关因素比较(±s)
Tab.2 Comparison of factors between favorable prognosis and unfavorable prognosis group of 121 decompressivecraniectomy(Mean±SD)
分组 年龄(岁) 受伤至手术间隔(h) 入院瞳孔(患侧)(mm) 入院瞳孔(对侧)(mm) 入院GCS(分) CT值
预后良好组(n=75) 39.12±6.42 35.75±7.86 2.81±0.49 3.02±0.73 6.40±1.52 3.55±0.92
预后不良组(n=46) 53.93±8.64 9.43±2.15 3.57±1.02 3.54±1.02 4.54±1.11 4.51±0.96
t值 27.257 11.712 39.579 8.661 25.147 19.221
P值 0.000 0.000 0.000 0.035 0.000 0.000
表3 预后相关因素的多因素Logistic回归分析
Tab.3 Multivariate Logistic regression analysis of factors related to outcome
影响因素 OR值 95%CI Ward P值
年龄 0.166 0.029～0.821 5.107 0.031
受伤至手术时间间隔 0.124 0.024～0.661 4.494 0.015
瞳孔直径 0.024 0.015～0.374 4.537 0.034
入院GCS评分 0.131 0.045～0.433 5.731 0.011
CT值 0.059 0.014～0.323 4.142 0.012
表4 121例去骨瓣减压患者预后良好组与预后不良组并发症的比较(例)
Tab.4 Comparison of the complication of favorable prognosis and unfavorable prognosis group of 121 patients underwent decompressive craniectomy(case)
分组 上消化道出血 脑积水 癫痫 肺部感染 颅内感染
预后良好组(n=75) 16 34 14 18 10
预后不良组(n=46) 46 40 36 46 18
χ 2值 32.582 11.214 29.142 13.761 40.221
P值 0.001 0.035 0.001 0.029 0.001
[1]
Shi HY, Hwang SL, Lee IC, et al. Trends and outcome predictors after traumatic brain injury surgery: a nationwide population- based study in Taiwan[J]. J Neurosurg, 2014,121(6):1323-1330.
[2]
Wijayatilake DS, Talati C, Panchatsharam S. The Monitoring and management of severe traumatic brain injury in the United Kingdom: is there a consensus?: a national survey[J]. J Neurosurg Anesthesiol,2014,9(12):1516-1521.
[3]
Yuan Q, Wu X, Sun Y, et al. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury:a systematic review and meta-analysis[J]. J Neurosurg, 2014,121(5):1164-1160.
[4]
Maas AI, Menon DK, Steyerberg EW, et al. Collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER- TBI): a prospective longitudinal observational study[J].Neurosurgery,2015,76(1):67-80.
[5]
Tomasello F. Risk- benefit balance of decompressive craniectomy in traumatic brain injury: what's new?[J]. World Neurosurg,2011,75(3-4):456-457.
[6]
Patel K, Kolias AG, Hutchinson PJ.What's new in the surgical management of- traumatic brain injury?[J]. J Neurol, 2014,261(12):2315-2321.
[7]
Huang YH, Deng YH, Lee TC, et al. Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy[J]. Neurosurgery,2012,71(1):80-85.
[8]
Raj R, Siironen J, Skrifvars MB, et al. Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (helsinki computerized tomography score[J].Neurosurgery,2014,75(6):632-647.
[9]
Rosenthal G. Long-term outcomes following decompressive craniectomy for severe traumatic brain injury--how long should we wait to evaluate results?[J]. Crit Care Med, 2011, 39(11):2575-2576.
[10]
Scholten AC, Haagsma JA, Andriessen TM, et al. Healthrelated quality of life after mild, moderate and severe traumatic brain injury: Patterns and predictors of suboptimal functioning during the first year after injury[J]. Injury, 2014, 45(4):1743-1751.
[11]
Wintermark M, Sanelli PC, Anzai Y, et al. Imaging Evidence and Recommendations for Traumatic Brain Injury:Conventional Neuroimaging Techniques[J]. J Am Coll Radiol,2014,25(11):1440-1452.
[12]
Giustini M,Longo E,Azicnuda E.Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI[J].Funct Neurol,2014,29(3):167-176.
[13]
Jagnoor J, Cameron ID. Traumatic brain injury support for injured people and their carers[J]. Aust Fam Physician, 2014,43(11):758-763.
[14]
Opara JA, Małecka E, Szczygiel J. Clinimetric measurement in traumatic brain injuries[J].J Med Life,2014,7(2):124-127.
[15]
Chen JW, Vakil- Gilani K, Williamson KL, et al. Infrared pupillometry, the Neurological Pupil index and unilateral pupillary dilation after traumatic brain injury: implications for treatment paradigms[J].Springerplus,2014,23(3):548-553.
[16]
Sobuwa S, Hartzenberg HB, Geduld H, et al. Predicting outcome in severe traumatic brain injury using a simple prognostic model[J].S Afr Med J,2014,104(7):492-494.
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