Ono J, Yamaura A, Kubota M, Okimura Y, Isobe K
Department of Neurosurgery, Chiba University School of Medicine, Japan.
J Clin Neurosci. 2001 Mar;8(2):120-3. doi: 10.1054/jocn.2000.0732.
Retrospective analysis of 272 patients with severe head injury was performed. Patient age, Glasgow Coma Scale (GCS) score, pupillary abnormalities, impaired oculocephalic response, presence of subarachnoid haemorrhage, and multiplicity of parenchymal lesions on computerised tomography (CT) were examined. The CT findings were divided into 2 groups, diffuse brain injury (DBI) and mass lesion, according to the classification of the Traumatic Coma Data Bank. The DBI, basically, has no high or mixed density lesion more than 25 ml on CT, and was classified into 4 subgroups: DBI I includes injuries where there is no visible pathology; DBI II includes all injuries in which the cisterns are present with a midline shift of less than 5 mm; DBI III includes injuries with swelling where the cisterns are compressed or absent and the midline shift is less than 5 mm; DBI IV includes injuries with a midline shift of more than 5 mm. The mass lesions were categorised into 3 subgroups: epidural haematoma; acute subdural haematoma; and intracerebral haematoma. Outcomes were determined at 6 months following trauma using the Glasgow Outcome Scale. All DBI I patients recovered well. In the DBI II group, age, GCS score and detection of multiple parenchymal lesions on CT were significantly correlated with outcome. For the DBI III and IV groups, the only significant prognostic factor was the GCS score. In patients with a mass lesion, the GCS score was the only significant prognostic factor in the epidural haematoma group, but the GCS score and the presence of subarachnoid haemorrhage were predictive factors in the acute subdural haematoma group. Outcomes were unfavourable in the majority of patients with intracerebral haematoma. GCS score could predict outcome in all groups. The confidence of the outcome prediction ranged from 75.8 to 92.1%, depending on logistic regression analysis.
对272例重型颅脑损伤患者进行了回顾性分析。检查了患者的年龄、格拉斯哥昏迷量表（GCS）评分、瞳孔异常、眼前庭反射受损、蛛网膜下腔出血情况以及计算机断层扫描（CT）上实质病变的多发性。根据创伤昏迷数据库的分类，CT表现分为2组，即弥漫性脑损伤（DBI）和占位性病变。基本上，DBI在CT上没有超过25 ml的高密度或混合密度病变，并分为4个亚组：DBI I包括无可见病变的损伤；DBI II包括所有脑池存在且中线移位小于5 mm的损伤；DBI III包括脑池受压或消失且中线移位小于5 mm的肿胀性损伤；DBI IV包括中线移位大于5 mm的损伤。占位性病变分为3个亚组：硬膜外血肿；急性硬膜下血肿；以及脑内血肿。使用格拉斯哥预后量表在创伤后6个月确定预后。所有DBI I组患者恢复良好。在DBI II组中，年龄、GCS评分和CT上多实质病变的检测与预后显著相关。对于DBI III和IV组，唯一显著的预后因素是GCS评分。对于占位性病变患者，GCS评分是硬膜外血肿组唯一显著的预后因素，但GCS评分和蛛网膜下腔出血的存在是急性硬膜下血肿组的预测因素。大多数脑内血肿患者预后不佳。GCS评分可以预测所有组的预后。根据逻辑回归分析，预后预测的置信度在75.8%至92.1%之间。
