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目的 了解外伤后局部脑血肿、水肿发生发展的动态变化及其与临床表现的关系。方法 选择湘雅医院 1998～ 2 0 0 2年进行过多次头部CT扫描的脑外伤病人 12 0例 ,记录每次CT扫描多项影像学及相关临床指标 ,并对这些指标进行统计分析。结果 96 .7% (116 / 12 0 )的病人CT上存在局部水肿。血肿体积于伤后 1d(中位数 )达到高峰 ,水肿体积伤后 9d达到高峰。最大水肿体积与最大占位体积呈高度相关r =0 .95 9(P <0 .0 1) ,而最低GCS评分在血肿达最大体积时出现 (z =- 1.6 7P >0 .0 5 )。结论 外伤后局灶性脑水肿普遍存在 ,但与血肿相比 ,水肿对临床表现的影响相对较小 ;脑外伤病人当CT扫描示中线移位不明显 ,且病情稳定时应慎用脱水剂。
Objective To understand the dynamic changes of local cerebral hematoma and edema after trauma and its relationship with clinical manifestations. Methods A total of 120 traumatic brain injury patients were performed in Xiangya Hospital from 1998 to 2002, and multiple imaging and related clinical indexes of each CT scan were recorded. Statistical analysis was made on these indexes. Results 96.7% (116/1200) patients had localized edema on CT. The volume of hematoma peaked at 1d (median) after injury, and peaked at 9d after edema volume wounding. The maximum edema volume was highly correlated with the largest volume occupying volume (r = 0.959, P <0.01), while the lowest GCS score was found when the hematoma reached its maximum volume (z = -1.67P> 0.05). Conclusions Focal cerebral edema is common after trauma. Compared with hematoma, however, edema has less influence on clinical manifestations. When traumatic brain injury is not obvious in CT scan, the dehydration agent should be used with caution when the condition is stable.