[1]郭　浩　蔺　慧　郭建平.中青年与老年急性颅脑损伤颅内血肿动态变化对比分析[J].中国临床神经外科杂志,2017,(01):20-22.[doi:10.13798/j.issn.1009-153X.2017.01.007]
　GUO Hao,LIN Hui,GUO Jian-ping..Dynamic changes in intracranial hematomas in young and middle-aged patients and the senile with acute craniocerebral trauma[J].,2017,(01):20-22.[doi:10.13798/j.issn.1009-153X.2017.01.007]
点击复制

中青年与老年急性颅脑损伤颅内血肿动态变化对比分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2017年01期
页码:
20-22
栏目:
论著
出版日期:
2017-01-18

文章信息/Info

Title:
Dynamic changes in intracranial hematomas in young and middle-aged patients and the senile with acute craniocerebral trauma
文章编号:
1009-153X（2017）01-0020-03
作者:
郭　浩　蔺　慧　郭建平
712000 陕西，咸阳市第一人民医院急诊科（郭　浩、郭建平），护理部（蔺　慧）
Author(s):
GUO Hao1;  LIN Hui2;  GUO Jian-ping1.
1. Emergency Department, The First People’s Hospital of Xianyang City, Xianyang 712000, China; 2. Nursing Department, The First People’s Hospital of Xianyang City, Xianyang 712000, China
关键词:
急性颅脑损伤; 颅内血肿; 动态变化; 中青年; 老年
Keywords:
Acute craniocerebral trauma;  Intracranial hematoma;  Young and middle-aged;  Senile;  Dynamic changes
分类号:
R 651.1+5
DOI:
10.13798/j.issn.1009-153X.2017.01.007
文献标志码:
A
摘要:
目的 探讨中青年与老年急性颅脑损伤颅内血肿动态变化特征。方法 2013年5月至2016年3月收治急性颅脑损伤400例，根据年龄划分为中青年组（220例）和老年组（180例）。以入院后即刻CT（距受伤<3 h）作为基准，入院后6、12、24、48、72 h复查CT。根据临床表现和CT检查判断：血肿未扩大，为血肿未进展；血肿扩大，临床表现无显著恶化，为Ⅰ型血肿进展；血肿扩大，临床表现进行性恶化，出现手术指征，为Ⅱ型血肿进展。结果 中青年组血肿未进展115例，Ⅰ型进展65例，Ⅱ型进展40例；老年组血肿未进展84例，Ⅰ型进展60例，Ⅱ型进展36例。中青年组Ⅰ型血肿进展稳定时间和Ⅱ型血肿进展峰值时间较老年组均显著缩短（P<0.05）。老年组血肿未进展、Ⅰ型血肿进展、Ⅱ型血肿进展预后良好（GOS评分4~5分）率具有显著差异[分别为92.9%、75.0%、30.6%；P<0.05]；中青年组血肿未进展、Ⅰ型血肿进展、Ⅱ型血肿进展预后良好率无显著差异[分别为91.3%、84.6%、85.0%；P>0.05]；中青年组Ⅱ型血肿进展预后良好率显著高于老年组（P<0.05）。结论 急性颅脑损伤的颅内血肿进展类型与年龄无明显相关性，但老年血肿进展至稳定时间、峰值时间均高于中青年，故老年颅脑损伤在急性期需行头部CT复查，适当延长持续观察时间，在临床表现出现恶化之前最大程度地进行积极应对，改善患者预后。
Abstract:
Objective To study the dynamic changes in intracranial hematomas in the young and middle-aged patients and the senile with acute craniocerebral trauma (ACT). Methods Of 400 patients with ACT treated in our hospital from May, 2013 to March, 2016 220 were young and middle-aged patients and 180 senile patients. All the patients received head CT scanning. The dynamic changes in intracranial hematomas were observed by head CT scan and the prognoses were compared between both the groups. Results There was insignificant difference in intracranial hematoma progression (ICHP) types including no ICHP, type-Ⅰ ICHP (ICHP without deterioration of the clinical manifestation) and type-Ⅱ ICHP (ICHP with deterioration of the clinical manifestation) between the two groups (P>0.05). The time from ACT to stable hematoma [(20.7±4.8) hours] of type-Ⅰ ICHP was significantly shorter in the young and middle-aged patients group than that [(40.6±9.0) hours] in the senile group (P<0.05). The time [(10.6±4.4) hours] from ACT to maximal hematoma of type-Ⅱ ICHP in young and middle-aged patients group was significantly shorter than that [(19.6±7.8) hours] than that in the senile group (P<0.05). The prognosis in the senile patients with no ICHP was significantly better than that in the senile patients with type-Ⅰ ICHP (P<0.05), in whom the prognosis was significantly better in the senile patients with type-Ⅱ ICHP (P<0.05). The prognosis in the young and middle-aged patients with type-Ⅱ ICHP was significantly better than that in the senile patients with type-ⅡICHP (P<0.05). Conclusions The ICHP type is insignificant related with patients’ age in the patients with ACT. The time from ACT to stable hematoma and time from ACT to maximal hematoma in the senile patients are significantly longer than that in the young and middle-aged patients. It is necessary to repeat head CT scanning in acute phase and appropriately prolong continuous observation time in order to take positive treatment before clinical condition deterioration in the senile patients with ACT compared to the young and middle-aged patients.

参考文献/References:

[1] 郝继山，刘玉和，李鹤松，等. 多发伤合并颅脑损伤患者颅 内血肿进展相关因素分析[J]. 创伤外科杂志，2016，18 （6）：324-327.
[2] 张国栋，姜晓玲，郑建辉，等. 颅脑损伤患者进展性颅内血 肿增多196例诊治体会[J]. 河北中医，2013，35（12）： 1915-1916，1920.
[3] 尚杰雄，史志勇. 老年重型颅脑损伤58例的诊断与治疗 分析[J]. 检验医学与临床，2014，11（1）：98-100.
[4] 雷　鹏，朱　迪，周　杰，等. 老龄创伤性颅脑损伤患者的 神经影像学特点及意义[J]. 创伤外科杂志，2016，18（3）： 138-142.
[5] 严海霞. CT对重型颅脑损伤的诊断与预后评估的临床价 值[J]. 实用临床医药杂志，2015，19（24）：161-162，172.
[6] 柳兴军，王鲁波，刘慧权，等. 外伤性颅内血肿的CT动态 观察[J]. 中国医药，2012，7（11）：1464.
[7] 汤秉洪，覃宗明，杨明彬，等. 颅脑损伤后进展性颅内血肿 临床分析[J]. 中华神经外科疾病研究杂志，2014，13（1）： 40-42.
[8] 李雪元，马　林，王新军，等. 急性颅脑损伤后进展性出血 性损伤高危因素分析[J]. 重庆医学，2014，43（25）：3533.
[9] Alali AS, Burton K, Fowler RA, et al. Economic evaluations in the diagnosis and management of traumatic brain injury: a systematic review and analysis of quality [J]. Value Health, 2015, 18(5): 721-734.
[10] 陈江生，马文斌，李志祥. 急性颅脑损伤迟发性颅内血肿 预后的影响因素分析[J]. 海南医学，2016，27（3）：379- 381.
[11] Todd S, Colin K, Smith Susan S, et al. Influences of deve- lopmental age on the resolution of diffuse traumatic intra- cranial hemorrhage and axonal injury [J]. J Neurotrauma, 2014, 31(2): 206-214.
[12] 施小龙，左春生，朱前生. 老年脑外伤的临床特点分析[J]. 吉林医学，2014，35（15）：3207-3208.

相似文献/References:

[1]钟未鸣　许友松　董　斌　张　建　傅　鑫　魏　祎　庞春晓.破裂大脑中动脉动脉瘤伴颅内血肿的超早期手术治疗[J].中国临床神经外科杂志,2016,(08):500.[doi:10.13798/j.issn.1009-153X.2016.08.022]
[2]孙其凯　李珍珠　曹智洁　高　强　王清波　陈　正　耿　鑫　李泽福.3D打印模型引导下经颞部穿刺引流术治疗颅内血肿[J].中国临床神经外科杂志,2016,(10):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
　SUN Qi-kai,LI Zhen-zhu,CAO Zhi-jie,et al.Treatment of hypertensive cerebral hemorrhage by the minimally invasive puncture via temporal region under the guidance of 3D printing model[J].,2016,(01):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
[3]段继新,钟治军,刘　渊,等.外伤性颅内血肿合并严重颅底骨折治疗体会[J].中国临床神经外科杂志,2016,(11):713.[doi:10.13798/j.issn.1009-153X.2016.11.023]
[4]许乐宜,陈　丽,费智敏,等.脑干听觉诱发电位在颅脑损伤诊治中的应用[J].中国临床神经外科杂志,2016,(12):744.[doi:10.13798/j.issn.1009-153X.2016.12.004]
　XU Le-yi,CHEN Li,FEI Zhi-min,et al.Application of brainstem auditory evoked potential to diagnosis and treatment of acute craniocerebral trauma[J].,2016,(01):744.[doi:10.13798/j.issn.1009-153X.2016.12.004]
[5]肖高华　陈　钢　陈　峥　刘　科　刘　笑　熊绍棠.急性颅脑损伤外周血垂体前叶激素及脑脊液硫化氢水平变化[J].中国临床神经外科杂志,2017,(05):310.[doi:10.13798/j.issn.1009-153X.2017.05.009]
　XIAO Gao-hua,CHEN Zheng,CHEN Gang,et al.Changes of plasma anterior pituitary hormone and CSF H2S in patients with acute craniocerebral trauma[J].,2017,(01):310.[doi:10.13798/j.issn.1009-153X.2017.05.009]
[6]曹成龙 李艳玲 宋　健 姚　顺 房　莉 闫　研 徐国政.急性中、重型颅脑损伤早期病死率的预测：Marshall CT分级和Rotterdam CT评分的比较[J].中国临床神经外科杂志,2017,(10):676.[doi:10.13792017.09/j.issn.1009-153X.2017.10.002]
　CAO Cheng-long,LI Yan-ling,SONG Jian,et al.Prediction of early death in patients with traumatic brain injury: a comparison between Marshall and Rotterdam CT scoring systems[J].,2017,(01):676.[doi:10.13792017.09/j.issn.1009-153X.2017.10.002]
[7]梁　伟　张学军　王东挺　祝　韬.颅脑损伤开颅术后并发颅内血肿危险因素分析[J].中国临床神经外科杂志,2017,(12):819.[doi:10.13798/j.issn.1009-153X.2017.12.006]
　LIANG Wei,ZHANG Xue-jun,WANG Dong-ting,et al.Analysis of risk factors related to intracranial hematoma after craniotomy in patients with traumatic brain injury[J].,2017,(01):819.[doi:10.13798/j.issn.1009-153X.2017.12.006]
[8]文　明　李昊旻　杨先清.75岁以上高龄颅内血肿微创手术治疗体会[J].中国临床神经外科杂志,2019,(09):556.[doi:10.13798/j.issn.1009-153X.2019.09.015]
[9]陈华辉　王文雄　张刚利　张梦杰　张　豪.促红细胞生成素治疗急性颅脑损伤疗效的meta分析[J].中国临床神经外科杂志,2019,(11):662.[doi:10.13798/j.issn.1009-153X.2019.11.008]
　CHEN Hua-hui,WANG Wen-xiong,ZHANG Gang-li,et al.Effect of erythropoietin on acute traumatic brain injury and its safety: a meta-analysis[J].,2019,(01):662.[doi:10.13798/j.issn.1009-153X.2019.11.008]
[10]王　康　彭逸龙　李小辉　黄　戈　伍　益.软通道技术在中等量颅内血肿治疗中的应用[J].中国临床神经外科杂志,2020,(02):101.[doi:10.13798/j.issn.1009-153X.2020.02.013]
[11]韦可,杜威,陈大瑜,等.锥颅软通道引流术治疗儿童急性创伤性颅内血肿[J].中国临床神经外科杂志,2023,28(10):646.[doi:10.13798/j.issn.1009-153X.2023.10.011]
　WEI Ke,DU Wei,CHEN Da-yu,et al.Cranial puncture and drainage under CT guidance for acute traumatic intracranial hematomas in children[J].,2023,28(01):646.[doi:10.13798/j.issn.1009-153X.2023.10.011]

更新日期/Last Update: 2016-10-28