Elias-Jones A C, Punt J A, Turnbull A E, Jaspan T
Department of Child Health, Queen's Medical Centre, University Hospital, Nottingham.
Arch Dis Child. 1992 Dec;67(12):1430-5. doi: 10.1136/adc.67.12.1430.
In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury.
在五年期间，对39名年龄在2个月至13岁（平均7.8岁）的儿童（29名男孩，10名女孩）进行了研究，这些儿童均遭受了严重的头部损伤（29例道路交通意外、6例跌倒和4例非意外性损伤）。损伤通过临床评估以及头颅计算机断层扫描或头颅超声检查（仅一名2个月大的婴儿采用超声检查）。所有受试者的初始格拉斯哥昏迷评分为3 - 11分（平均5.5分），存活且无残疾者为5 - 11分（平均7.4分），轻度残疾者为4 - 11分（平均6.1分），重度残疾者为3 - 6分（平均4.3分），死亡者为3 - 6分（平均4.1分）。所有患儿均接受了镇静、麻痹、过度通气（动脉二氧化碳分压为3.0 - 3.5 kPa）、颅内压监测以及将体表温度适度降低至32摄氏度的治疗。9名儿童死亡，30名存活（9名无残疾，13名轻度残疾，8名重度残疾）。除一名幸存者外，其他所有幸存者的最低脑灌注压均超过40 mmHg，9名死亡者中有7名的脑灌注压低于40 mmHg。最初24小时内以及总体上的严重低碳酸血症均与不良预后（死亡或重度残疾）相关，双侧挫伤或弥漫性轴索损伤也与不良预后相关。
