THE OUTCOME OF SEVERE CLOSED HEAD-INJURY
THE OUTCOME OF SEVERE CLOSED HEAD-INJURY
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DOI：
10.3171/sup.1991.75.1s.0s28
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发表时间：
1991-11-01
影响因子：
4.1
通讯作者：
FOULKES, MA
中科院分区：
文献类型：
--
作者：
MARSHALL, LF;GAUTILLE, T;FOULKES, MA
对从 1984 年 1 月 1 日到 1987 年 9 月 30 日的 45 个月期间登记在创伤性昏迷数据库 (TCDB) 的患者中严重头部损伤的结果进行了前瞻性研究。数据收集了连续 1030 名因严重头部损伤入院的患者（定义为非手术复苏后格拉斯哥昏迷量表 (GCS) 评分为 8 或更低）。其中，284 人入院时脑死亡或大脑受枪伤。这两组患者被排除，留下 746 名患者可供分析。这 746 名患者的总死亡率为 36%，在受伤后 6 个月时确定。正如预期的那样。死亡率从复苏后 GCS 评分为 3 分的患者的 76% 逐渐下降到 GCS 评分为 6、7 或 8 分的患者的约 18%。在非手术损伤的患者中（总死亡率为 31%），根据计算机断层扫描结果采用新的颅脑损伤分类评估，颅内压升高的可能性增加的患者死亡率较高。在276名接受开颅手术的患者中，死亡率为39%。一半的急性硬膜下血肿患者死亡——比之前报告的结果有了显着改善。四个 TCDB 中心之间的结果差异很小，部分原因是患者年龄以及损伤类型和严重程度的差异。本研究描述了四个选定的头部损伤中心的头部损伤结果。这表明，在经验丰富的神经外科病房收治的此类患者中，预计死亡率约为 35%。
The outcome of severe head injury was prospectively studied in patients enrolled in the Traumatic Coma Data Bank (TCDB) during the 45-month period from January 1, 1984, through September 30, 1987. Data were collected on 1030 consecutive patients admitted with severe head injury (defined as a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation). Of these, 284 either were brain-dead on admission or had a gunshot wound to the brain. Patients in these two groups were excluded, leaving 746 patients available for this analysis.The overall mortality rate for the 746 patients was 36%, determined at 6 months postinjury. As expected. the mortality rate progressively decreased from 76% in patients with a postresuscitation GCS score of 3 to approximately 18% for patients with a GCS score of 6, 7, or 8. Among the patients with nonsurgical lesions (overall mortality rate, 31 %), the mortality rate was higher in those having an increased likelihood of elevated intracranial pressure as assessed by a new classification of head injury based on the computerized tomography findings. In the 276 patients undergoing craniotomy, the mortality rate was 39%. Half of the patients with acute subdural hematomas died - a substantial improvement over results in previous reports. Outcome differences between the four TCDB centers were small and were, in part, explicable by differences in patient age and the type and severity of injury.This study describes head injury outcome in four selected head-injury centers. It indicates that a mortality rate of approximately 35% is to be expected in such patients admitted to experienced neurosurgical units.