Li Lai-Fung, Lui Wai-Man, Wong Heidi Hay-Tai, Yuen Wai-Kei, Leung Gilberto Ka-Kit
Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Asian J Neurosurg. 2017 Jan-Mar;12(1):37-43. doi: 10.4103/1793-5482.148787.
The management of traumatic brain injuries in the elderly (age ≥ 65 years) is a constant dilemma. The aim of this study is to investigate for factors that may predict outcome of operative treatment in this group of patients.
A retrospective analysis was conducted on 68 elderly patients who had been operated in a designated center from 2006 to 2010. Patients' age, Glasgow Coma score (GCS), pupillary responses, imaging findings, medical conditions, and the use of anticoagulant/antiplatelet agents on patient outcomes were studied.
The overall mortality rate was 55.9%. Older age, abnormal pupillary response, low GCS, the presence of midline shift and cistern obliteration on computerized tomography were associated with poor survival. Patient aged 75-84 with normal bilateral pupillary response still had an overall survival rate of 52.6% and good outcomes (Glasgow outcome score: 4 or 5) in 36.8% of patients. Abnormal pupillary response in at least one eye and preoperative GCS ≤ 12 were associated with very poor prognosis.
More advanced age was found to be associated with progressively worse outcome. A subgroup patients aged below 85 would survive and could achieve good clinical outcome. The prognosis of those aged over 85 with moderate or severe head injuries was extremely poor.
老年（年龄≥65岁）创伤性脑损伤的管理一直是个难题。本研究旨在调查可能预测该组患者手术治疗结果的因素。
对2006年至2010年在指定中心接受手术的68例老年患者进行回顾性分析。研究了患者的年龄、格拉斯哥昏迷评分（GCS）、瞳孔反应、影像学检查结果、医疗状况以及抗凝/抗血小板药物的使用对患者预后的影响。
总死亡率为55.9%。年龄较大、瞳孔反应异常、GCS评分低、计算机断层扫描显示有中线移位和脑池闭塞与生存率低相关。75 - 84岁双侧瞳孔反应正常的患者总体生存率仍为52.6%，36.8%的患者预后良好（格拉斯哥预后评分：4或5）。至少一只眼睛瞳孔反应异常且术前GCS≤12与预后极差相关。
发现年龄越大，预后越差。85岁以下的亚组患者能够存活并可获得良好的临床结果。85岁以上中度或重度颅脑损伤患者的预后极差。
