Onyia Ephraim Eziechina, Chikani Mark C, Mezue Wilfred C, Uche Enoch O, Iloabachie Izuchukwu, Mesi Matthew, Ejembi Sunday, Agunwa Chuka
Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria.
Department of Surgery, Memfys Hospital for Neurosurgery, Enugu State, Nigeria.
Niger J Surg. 2017 Jan-Jun;23(1):47-52. doi: 10.4103/1117-6806.205751.
Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded.
Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004-2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed.
Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality.
Admitting GCS and bullet trajectory were predictive of outcome.
在尼日利亚，平民穿透性颅脑枪伤已不再罕见。然而，此类损伤的报告却很少。它们与不良预后相关，在近距离时，尤其是被高速武器击中时，往往是致命的。及时转诊至神经外科服务并进行紧急干预，可能会改善那些未受致命伤患者的预后。
回顾性分析了在尼日利亚大学教学医院和埃努古Memfys神经外科医院10年期间（2004 - 2014年）收治的52例平民穿透性枪伤患者，并对其数据进行分析，以评估影响预后的因素。本研究仅纳入有颅脑枪伤临床和影像学证据且入院时存活的患者。分析了总体死亡率和格拉斯哥预后评分。
共确定52例孤立的平民穿透性枪伤患者（男:女 = 7.7:1）；平均（标准差）年龄为32.8（11.9）岁。患者性别与预后之间存在高度相关性（0.983）。总体死亡率为30.8%，复苏后格拉斯哥昏迷量表（GCS）评分≤8的患者死亡率为57%，而复苏后GCS评分>8的患者死亡率为12.9%；这意味着复苏后GCS评分>8的患者中有87.1%存活。31例患者（59.6%）有瞳孔异常。大多数单半球损伤患者存活，而所有涉及间脑、经脑室和后颅窝的患者死亡率为100%。
入院时的GCS评分和子弹轨迹可预测预后。
