Cooke R S, McNicholl B P, Byrnes D P
Department of Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Injury. 1995 Jul;26(6):395-7. doi: 10.1016/0020-1383(95)00003-r.
As part of a study into the management of major trauma, the early management of severe head injury in Northern Ireland was evaluated over a 12-month period. The injury severity score was used to define those patients considered to have severe head injury. There were 131 patients with severe head injury; 27 per cent were hypoxic and 18 per cent were hypotensive on admission to the primary hospital. Almost half had severe multiple injuries. Early endotracheal intubation was performed in 92 per cent of comatose patients, and adequate resuscitation (including laparotomy in some) was performed in 87 per cent of shocked patients transferred to the neurosurgical unit (NSU). Eighty patients were transferred to the NSU; 60 per cent were comatose, 68 per cent were intubated and ventilated, and 74 per cent were transferred by an anaesthetist. Two patients were in hypovolaemic shock after transfer and required laparotomy. Thirty-eight had evacuation of an acute intracranial haematoma; 26 of these would not have been classified as severe head injury by the Glasgow coma scale. The overall mortality rate was 38 per cent, and 24 per cent for those transferred to the NSU. We conclude that the early management of head injury in Northern Ireland is good, but there are problems, including pre-hospital oxygenation and delays in transfer.
作为一项重大创伤管理研究的一部分，对北爱尔兰严重颅脑损伤的早期管理进行了为期12个月的评估。损伤严重程度评分用于定义那些被认为患有严重颅脑损伤的患者。有131例严重颅脑损伤患者；27%的患者入院时缺氧，18%的患者入院时低血压。几乎一半患者有严重多发伤。92%的昏迷患者进行了早期气管插管，87%转入神经外科病房（NSU）的休克患者进行了充分的复苏（包括部分患者进行剖腹手术）。80例患者转入NSU；60%昏迷，68%插管并通气，74%由麻醉医生转运。两名患者转运后出现低血容量性休克，需要进行剖腹手术。38例进行了急性颅内血肿清除术；其中26例按格拉斯哥昏迷量表不会被归类为严重颅脑损伤。总体死亡率为38%，转入NSU的患者死亡率为24%。我们得出结论，北爱尔兰颅脑损伤的早期管理良好，但存在问题，包括院前氧合和转运延迟。
