Department of Neurosurgery, Pudong New Area People's Hospital, 490, South Chuanhuan Road, Shanghai, 201200, China.
Neuroradiology. 2011 May;53(5):305-9. doi: 10.1007/s00234-010-0659-8. Epub 2010 Feb 4.
Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation.
To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI.
A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01).
For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time.
自从神经外科学文献中引入进行性出血性损伤（PHI）以来，已经进行了多项研究，这些研究的结果影响了医生，但并未为 PHI 的最佳治疗制定指南。PHI 可通过连续计算机断层扫描（CT）扫描来确认，并且已经表明其与临床恶化风险增加五倍相关，并且也是发病率和死亡率的重要原因。因此，在临床情况下，早期发现 PHI 实际上非常重要。
为了分析急性创伤性脑损伤（TBI）后进行性出血性损伤的早期 CT 征象及其临床意义，通过比较首次和重复 CT 扫描来确认 PHI。分析和比较了包括从损伤到首次 CT 和早期 CT 扫描征象的时间在内的数据。使用逻辑回归分析显示与 PHI 相关的危险因素。
评估了 630 名 TBI 患者的队列，其中有 189 名（30％）患者患有 PHI。对于首次 CT 扫描在损伤后 2 小时内获得的患者，有 116 名（77.25％）患有 PHI。在初始 CT 扫描中，PHI 和非 PHI 之间的差异在显示骨折、蛛网膜下腔出血（SAH）、脑挫伤、硬膜外血肿（EDH）、硬膜下血肿（SDH）和多个血肿以及从损伤到首次 CT 扫描的时间（P <0.01）。逻辑回归分析表明，早期 CT 扫描（EDH、SDH、SAH、骨折和脑挫伤）是 PHI 的预测因素（P <0.01）。
对于首次 CT 扫描在损伤后 2 小时内获得的患者，应迅速进行随访 CT 扫描。如果初始 CT 扫描显示 SAH、脑挫伤和原发性血肿伴脑肿胀，则应进行更早和动态的 CT 扫描，以便尽早发现 PHI，并及时进行医疗干预。
