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1、小儿重型颅脑损伤78例治疗预后分析魏璐城黎莉蒋金泉李卫贤(遵义医学院第五附属医院神经外科广东珠海519100)【摘要】目的总结小儿重型颅脑损伤的治疗体会；旨在提高治疗小儿重型颅脑损伤的疗效，降低致残率和病死率。方法对78例小儿重型颅脑损伤患者临床资料进行回顾性总结。结果根据格拉斯哥积分(Glasgowoulcomescale,GOS评分法)于伤后1年随访：痊愈50例，占79.4%;中残6例，占9.5%;重残3例，占5%;死亡4例，占6%。RLA(RanchoLosAmigos)认知功能水平量表及汉
2、密尔顿抑郁量表3年随访治愈37例，占47.4%,死亡(含自杀)5例，占6.4%。其余认知缺陷、精祌障碍36例，占46.2%。结论小儿重型颅脑损伤短期预后较成年患者佳，长期预后不佳。【关键词】重型颅脑损伤治疗预后小儿认知缺陷精神障碍【中图分类号】R651.1+5【文献标识码】A【文章编号】2095-1752(2012)19-0395-02Childrenwithseveretraumaticbraininjurytreatmentandprognosisof78casesWEI-lucheng.LI
3、-weixian,JIANG-jinquan.etal.Departnent.OfNeurosurgerg,ZunyiMedicalCollegeAffiliatedNo.5Hospital(Zhuhai,Guangdong,519100china).【Abstract】Objectivesummarizethetreatmentofchildrenwithseveretraumaticbraininjuryexperience;toimprovethetreatmentefficacyofchi
4、ldrenwithseverebraininjuryandreducethemorbidityandmortality.Methods78casesofpediatricpatientswithseveretraumaticbraininjuryclinicaldataretrospectively.ResultsAccordingtotheGlasgowpoints(Glasgowoulcomescale,GOSscore)afterinjuryand1yearfollow-up:cured50
5、cases,79.4%;theresiduein6cases,9.5%;severedisabilityin3cases,5%;deathin4cases6%.RLA(RanchoLosAmigos)thelevelofcognitivefunctionscaleandtheHamiltonDepressionRatingScale3-yearfollow-up37patientswerecured,47.4%,death(includingsuicide)in5cases,6.4%.Otherc
6、ognitivedeficits,36patientswithmentaldisorders,accountingfor46.2%.ConclusionShort-termprognosisofchildrenwithseveretraumaticbraininjurybetterthanadults,long-termprognosisispoor【Keywords】braininjurytreatmentprognosischildrencognitivedeficitsmental_diso
7、rders随着我国国民经济和交通工具的发展，我国颅脑伤发生率和因颅脑伤致死、致残的伤员也逐年增加。小儿重型颅脑损伤是指头部受伤患者年龄小于14岁、GCS3〜8分，伤后昏迷在6h以上。由于小儿有不同于成人的颅脑解剖和病理生理特点，故其重型颅脑损伤亦有其独特性，我科自1993年迄今收治小儿重型颅脑损伤78例，总结分析报道如下。1资料与方法1.1一•般资料78例中男45例，女33例；年龄小于3岁10例，占12.8%；4〜8岁24例，占30.8%;9〜14岁54例，占69.3%。致伤原因：坠落伤38例，占
8、59%;车祸伤31例，占39.7%;打击伤6例，占7.7%;其它伤3例，占3.8%。1.2损伤类型①闭合性颅脑损伤65例，dj*83.3%,其中脑挫裂伤并硬膜下血肿例32例；脑挫裂伤继发脑干损伤6例；硬膜外血肿例28;脑内血肿8例；多发性血肿4例。②开放性颅脑损伤13例，占16.7%。主要合并伤：合并颅骨骨折者59例，占75.6%，其中粉碎性或凹陷性骨折41例、伴颅底骨折34例；伴四肢骨折21例；伴闭合性胸腹伤3例，无合并伤10例。1.3临床表现意识障碍GCS3〜5分30例，占38
