Semple P L, Domingo Z
Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town.
S Afr Med J. 2001 Feb;91(2):141-5.
To determine the outcome of craniocerebral gunshot injuries, analyse factors that affect prognosis and suggest a management protocol.
A retrospective analysis of civilian craniocerebral gunshot injuries treated over a 7-year period.
Groote Schuur Hospital's neurosurgery and trauma unit service.
One hundred and eighty-one patients with craniocerebral gunshot injuries were admitted to the Department of Neurosurgery, Groote Schuur Hospital, University of Cape Town, over a 7-year period and a retrospective analysis of these patient records with regard to outcome and prognostic factors was carried out.
Seventy-six patients sustained non-penetrating injuries, 8 (11%) of whom had underlying cerebral injury on computed tomography (CT) scan. The prognosis was good in the case of non-penetrating injuries. One hundred and five patients sustained penetrating injuries and 57% (62) had a poor outcome. A Glasgow Coma Score (GCS) of 5 or less following resuscitation was associated with a 98% mortality rate. CT scan evidence of transventricular injury was associated with 100% mortality, bihemispheric injury with 90% mortality, and diffuse cerebral swelling with 81% mortality.
Patients with non-penetrating craniocerebral gunshot injuries should all undergo a CT scan as 10% will have cerebral injury. The prognosis is normally good. In penetrating craniocerebral gunshot injuries a GCS of 5 or less, or a GCS of 8 or less with CT scan findings of transventricular or bihemispheric injury have such a poor outcome that conservative treatment is indicated.
确定颅脑枪伤的治疗结果，分析影响预后的因素并提出治疗方案。
对7年间治疗的 civilian 颅脑枪伤进行回顾性分析。
格罗特舒尔医院神经外科和创伤科。
在7年期间，181例颅脑枪伤患者被收治入开普敦大学格罗特舒尔医院神经外科，对这些患者的病历进行了关于治疗结果和预后因素的回顾性分析。
76例患者为非穿透性损伤，其中8例（11%）在计算机断层扫描（CT）上有潜在脑损伤。非穿透性损伤的预后良好。105例患者为穿透性损伤，57%（62例）预后不良。复苏后格拉斯哥昏迷评分（GCS）≤5与98%的死亡率相关。CT扫描显示经脑室损伤的死亡率为100%，双侧半球损伤为90%，弥漫性脑肿胀为81%。
非穿透性颅脑枪伤患者均应进行CT扫描，因为10%的患者会有脑损伤。预后通常良好。在穿透性颅脑枪伤中，GCS≤5或GCS≤8且CT扫描显示经脑室或双侧半球损伤的患者预后极差，应采取保守治疗。
