Kotwica Z, Jakubowski J K
Department of Neurosurgery, Medical University of Lódź High School of Medicine, Poland.
Acta Neurochir (Wien). 1995;133(1-2):56-9. doi: 10.1007/BF01404948.
The authors analysed a series of 111 adult patients admitted to the Department of Neurosurgery, Medical University of Lódź directly after trauma with initial GCS of 3 points. 74% of them had intracranial haematoma, mainly subdural, and were treated surgically within the first 3 hours after trauma. 8 patients had no abnormalities on CT scans. 99 (89%) patients died 2 to 30 days after injury, 8 (7%) survived in a vegetative state, and only in 4 (4%) was a satisfactory result noted, but 2 of them had a stable neurological deficit. 3 of these 4 patients had epidural haematomas and 1 had not abnormalities on repeated CT examinations. We conclude, that among patients with GCS of 3 on admission, only those without major CT abnormalities or with epidural haematoma have a chance of survival. Cases with cerebral lesions on the initial CT examination have an invariably bad prognosis. They could be taken into account as a potential organ donor from the very moment of admission, but only after cerebral circulatory arrest occurred and brain death has been proved according to internationally accepted standards.
作者分析了111例成年患者，这些患者在创伤后直接被收入罗兹医科大学神经外科，初始格拉斯哥昏迷量表（GCS）评分为3分。其中74%有颅内血肿，主要是硬膜下血肿，并在创伤后3小时内接受了手术治疗。8例患者CT扫描无异常。99例（89%）患者在受伤后2至30天死亡，8例（7%）存活但处于植物人状态，只有4例（4%）结果令人满意，但其中2例有稳定的神经功能缺损。这4例患者中有3例有硬膜外血肿，1例重复CT检查无异常。我们得出结论，入院时GCS评分为3分的患者中，只有那些没有严重CT异常或有硬膜外血肿的患者有存活机会。初始CT检查有脑损伤的病例预后总是很差。从入院那一刻起，他们就可以被视为潜在的器官捐献者，但前提是发生脑循环停止并根据国际公认标准证明脑死亡。
