中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (3): 197-203. doi: 10.3969/j.issn.1672-6731.2021.03.012

• 神经外科疾病大数据 • 上一篇    下一篇

2 贵州省颅脑创伤临床特点：附1931例病例分析

徐学友, 曾茜, 杨振宇, 宋佳泉, 刘健, 向欣, 出良钊, 陈益民, 董明昊, 隋建美, 李玉明, 杨华   

  1. 550004 贵阳, 贵州医科大学附属医院神经外科
  • 收稿日期:2021-03-12 出版日期:2021-03-25 发布日期:2021-04-02
  • 通讯作者: 杨华,Email:yhmed@163.com

Clinical analysis for 1931 cases of traumatic brain injury in Guizhou Province

XU Xue-you, ZENG Xi, YANG Zhen-yu, SONG Jia-quan, LIU Jian, XIANG Xin, CHU Liang-zhao, CHEN Yi-min, DONG Ming-hao, SUI Jian-mei, LI Yu-ming, YANG Hua   

  1. Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
  • Received:2021-03-12 Online:2021-03-25 Published:2021-04-02

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摘要：

目的 总结贵州省颅脑创伤患者社会人口学信息、致伤资料、治疗方法和预后，探讨该地区颅脑创伤的救治思路。方法 纳入2016年1月至2018年12月贵州医科大学附属医院神经外科诊断与治疗的1931例颅脑创伤患者，采用自行设计的数据调查表统一录入患者性别、年龄、职业、受伤地区、致伤原因、创伤类型、脑损伤部位、创伤严重程度、是否中线偏移、血肿部位、合并伤、是否院前急救、是否手术治疗、手术时间窗、术后并发症、住院期间感染等，采用Glasgow预后分级（GOS）评价预后。结果 1931例颅脑创伤患者根据GOS评分，恢复良好1488例（77.06%）、轻残134例（6.94%）、重残101例（5.23%）、植物状态生存134例（6.94%）、死亡74例（3.83%）。（1）社会人口学资料：不同年龄（F=6.411，P=0.000）和职业（F=5.446，P=0.000）之间预后（GOS评分）差异有统计学意义，其中，46~55岁患者预后差于5~15岁者（t=5.047，P=0.000），个体经营者预后差于学龄前儿童（t=-3.570，P=0.021）、学生（t=-5.050，P=0.000）和厨师（t=-3.763，P=0.013）；而不同性别之间预后差异无统计学意义（t=0.123，P=0.902）。（2）致伤资料：不同致伤原因（F=2.585，P=0.017）、脑损伤部位（F=5.314，P=0.000）和创伤严重程度（F=238.321，P=0.000）之间预后差异有统计学意义，其中，交通伤患者预后差于打击伤（t=-3.731，P=0.004），基底节区损伤患者预后差于小脑损伤（t=-3.340，P=0.002），重型（t=15.983，P=0.000）和中型（t=5.711，P=0.000）患者预后均差于轻型、重型患者预后亦差于中型（t=9.130，P=0.000）。非贵阳市患者预后差于贵阳市（t=-2.231，P=0.026），开放性损伤患者预后差于闭合性损伤（t=-3.069，P=0.002），硬膜下血肿患者预后差于硬膜外血肿（t=4.559，P=0.000），中线偏移患者预后差于中线未偏移（t=-17.781，P=0.000），存在合并伤患者预后差于不存在合并伤（t=-4.725，P=0.000）。（3）治疗及并发症：院前急救患者预后差于未院前急救（t=4.343，P=0.000），手术治疗预后差于保守治疗（t=-5.506，P=0.000），术后出现并发症患者预后差于无并发症（t=-15.845，P=0.000），住院期间并发感染患者预后差于无感染患者（t=-14.645，P=0.000）；但是伤后不同CT检查时间（t=-1.942，P=0.052）和手术时间窗（t=-1.483，P=0.140）之间预后差异无统计学意义。结论 贵州省颅脑创伤病残率仍较高，加强交通和生产安全知识宣教，可预防和减少颅脑创伤；加强县级医院神经外科医师专业培训，可使颅脑创伤患者得到及时、规范化、同质化治疗，改善预后。

关键词: 脑损伤, 创伤性, 预后, 贵州

Abstract:

Objective To summarize the sociodemographic information, injury data, treatment methods and prognosis of patients with traumatic brain injury (TBI) in Guizhou Province, and to explore the treatment ideas of TBI in this area. Methods A total of 1931 patients with TBI who were diagnosed and treated in Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University from January 2016 to December 2018 were recruited by self-designed data questionnaire. The clinical data included gender, age, occupation, area of injury, cause of injury, type of injury, location of injury, severity of injury, whether the midline deviated, location of hematoma, combined injury, whether pre-hospital first aid, whether surgical treatment, operation time window, postoperative complications and infection during hospitalization. Glasgow Outcome Scale (GOS) was used to evaluate the prognosis of patients. Results According to GOS score, there were 1488 cases (77.06%) with good recovery, 134 cases (6.94%) with mild disability, 101 cases (5.23%) with severe disability, 134 cases (6.94%) with vegetative survival and 74 cases (3.83%) with death. 1) Social demographic data:there were significant differences in GOS scores between different ages (F=6.411, P=0.000) and occupations (F=5.446, P=0.000). The prognosis of 46-55 years old patients was worse than that of 5-15 years old patients (t=5.047, P=0.000). The prognosis of self-employed workers was worse than that of preschool children (t=-3.570, P=0.021), students (t=-5.050, P=0.000) and cooks (t=-3.763, P=0.013). There was no significant difference in the prognosis between different genders (t=0.123, P=0.902). 2) Injury data:there were significant differences in the prognosis among different injury causes (F=2.585, P=0.017), injury sites (F=5.314, P=0.000) and injury severity (F=238.321, P=0.000). The prognosis of traffic injury was worse than that of strike injury (t=-3.731, P=0.004). The prognosis of basal ganglia injury was worse than that of cerebellar injury (t=-3.340, P=0.002). The prognosis of severe (t=15.983, P=0.000) and medium (t=5.711, P=0.000) patients was worse than that of mild, and severe patients was worse than that of the medium (t=9.130, P=0.000). The prognosis of no-Guiyang patients was worse than that of patients in Guiyang (t=-2.231, P=0.026). The prognosis of open injury patients was worse than that of closed injury patients (t=-3.069, P=0.002), subdural hematoma patients was worse than that of epidural hematoma patients (t=4.559, P=0.000), and the prognosis of patients with midline shift was worse than that of patients without midline shift (t=-17.781, P=0.000). The prognosis of patients with combined injury was worse than that of patients without combined injury (t=-4.725, P=0.000). 3) Treatment and complications:the prognosis of patients with pre-hospital first aid was worse than that without pre-hospital first aid (t=4.343, P=0.000). The prognosis of patients with surgical treatment was worse than that of patients with conservative treatment (t=-5.506, P=0.000). The prognosis of patients with postoperative complications was worse than that of patients without complications (t=-15.845, P=0.000), and the prognosis of patients with concurrent infection during hospitalization was worse than that of patients without infection (t=-14.645, P=0.000). While there was no significant difference in prognosis between CT examination time (t=-1.942, P=0.052) and operation time window (t=-1.483, P=0.140). Conclusions The disability rate of TBI in Guizhou Province is high. Strengthening the propaganda and education of traffic and production safety knowledge can prevent and reduce TBI. Strengthening the professional training of neurosurgeons in county-level hospitals can make TBI patients get timely, standardized and homogeneous treatment, and improve the prognosis.

Key words: Brain injury, traumatic, Prognosis, Guizhou

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