上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (6): 793-.doi: 10.3969/j.issn.1674-8115.2011.06.024

• 论著（临床研究） • 上一篇    下一篇

创伤性脑损伤后常规CT复查的临床研究

丁 军, 郭 衍, 陈世文, 王 敢, 高文伟, 陈 浩, 袁 方, 田恒力   

  1. 上海交通大学附属第六人民医院神经外科, 上海 200233
  • 出版日期:2011-06-28 发布日期:2011-06-27
  • 通讯作者: 田恒力, 电子信箱: tianhengli1964@yahoo.com.cn。
  • 作者简介:丁 军（1984—）, 男, 硕士生；电子信箱: dingjun198408@126.com。
  • 基金资助:

    上海市科委基金（10JC1412500）

Clinical study of routine repeat CT after traumatic brain injury

DING Jun, GUO Yan, CHEN Shi-wen, WANG Gan, GAO Wen-wei, CHEN Hao, YUAN Fang, TIAN Heng-li   

  1. Department of Neurosurgery, the Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
  • Online:2011-06-28 Published:2011-06-27
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 10JC1412500

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摘要：

目的 探讨创伤性脑损伤后常规复查CT的必要性。方法 选择入院时未行急诊手术治疗的创伤性脑损伤患者103例，随机分为常规复查组（n=53）和非常规复查组（n=50）。比较两组患者的性别、年龄、入院格拉斯哥昏迷评分(GCS)、受伤机制、受伤至首次CT检查的时间（HCT1）、损伤类型和部位、血肿量、入院时凝血功能指标、重症监护病房（ICU）住院时间、总住院时间、出院GCS和治疗总费用。对进展性出血的相关因素进行Logistic回归分析。将常规复查组患者根据入院GCS分为3组（3～8分组、9～12分组、13～15分组），评价各组有无必要进行常规CT复查。结果 两组患者间出院GCS、ICU住院时间和总住院时间比较，差异均有统计学意义（P＜0.01）。两组治疗总费用比较，差异无统计学意义（P＞0.05）。Logistic回归分析显示，年龄、FDP、INR和DD为进展性出血的危险因素（OR>1,P<0.05）；入院GCS、HCT1、PLT越小越容易发生进展性出血（OR<1,P<0.05）。在常规复查组中，53例患者复查了161次CT；其中25例轻度创伤性脑损伤（GCS 13～15分组）患者中，仅1例（4%）发生进展性损伤且改变了治疗方式；28例中、重度创伤性脑损伤（GCS 9～12分和GCS 3～8分组）患者中，18例（64.3%）患者改变了治疗方式。结论 常规CT复查在中、重度创伤性脑损伤患者中具有一定应用价值。

关键词: 创伤性脑损伤, CT, 进展性出血

Abstract:

Objective To investigate the necessity of routine repeat CT after traumatic brain injury. Methods One hundred and three patients with traumatic brain injury without emergency operations at admission were selected and randomly divided into routine repeat CT group (n=53) and non-routine repeat CT group (n=50). Age, gender, score of Glasgow coma scale (GCS) at admission, mechanism of injury, time between first CT scan and injury （HCT1）, type and location of injury, volume of hematoma, blood coagulation function at admission, length of stay at intensive care unit (ICU), length of hospital stay, score of GCS at discharge and hospital charge were compared between groups. Related factors of progressive hemorrhage were investigated by Logistic regression analysis. Patients in routine-repeat CT group were subdivided into three groups according to GCS scores (3 to 8 points group, 9 to 12 points group and 13 to 15 points group), and the necessity for routine repeat CT was evaluated. Results There were significant differences in score of GCS at discharge, length of stay at ICU and length of hospital stay between these two groups (P＜0.01). There was no significant difference in hospital charge between these two groups （P＞0.05）. Logistic regression analysis indicated that age, fibrin degradation products (FDP), international normalized ratio (INR) and D-dimer concentration (DD) were risk factors for progressive hemorrhage (OR＞1, P＜0.05). Lower GCS score at admission, HCT1 and platelet count (PLT) were associated with a greater likelihood of developing progressive hemorrhage (OR<1, P<0.05). In routine repeat CT group, 53 patients underwent 161 times of repeat CT, 1 (4%) of the 25 patients with mild traumatic brain injury (13 to 15 points group) developed progressive injury and changed the therapy, and 18 （64.3%）of the 28 patients with moderate and severe traumatic brain injury (3 to 8 points group and 9 to 12 points group) changed the therapy. Conclusion Routine repeat CT has definite value in patients with moderate and severe traumatic brain injury.

Key words: traumatic brain injury, CT, progressive hemorrhage