중증 두부손상환자의 예후인자에 대한 고찰
Prognostic Factors in Patients with Severe Head Injury
소속 상세정보
이승욱/Seung Wook Lee
김오룡/우병길/김성호/배장호/최병연/조수호/Oh Lyong Kim/Byung Gil Woo/Seong Bo Kim/Jang Ho Bae/Byung Yon Choi/Soo Ho Cho
KMID : 0359819990280091288
Abstract
결론
1987년 1월부터 1996년 12월까지 10년간본원에서 치료받았던 두부손상환자 2223명중
GCS 8 점이하의 중증 두부 손상환자 292명을 대상으로 회복과 예후에 관계하는 인자를 밝
히고, 이 인자를 통하여 중증 두부손상에 대한 적절한 치료계획을 수립하는데 이용하기 위
해서 본 연구를 시행하여 다음과 같은 결과를 얻었다.
1) 중증두부손상환자는 전체 두부손상의 13.1%를 차지하였고 이중 미만성 뇌손상은 63%
였으며 환자의 분포는 활동량이 많은 젊은 남자에 많았다.
2) 초진시 CT소견은 종괴병변이 있는 경우보다 미만성 손상에서 내원시 GCS이 높고 예
후가 좋은 경향을 보였으며, 특히 미만성 손상 Ⅰ과 Ⅱ형에서 현저히 좋은 예후를 보였다.
3) 중증 두부손상환자에서 어린 연령층, 내원시 높은 GCS, 좋은 운동반응, 양안의 정상적
인 대광반사, 미만성 뇌손상 Ⅱ과 Ⅲ형에서 좋은 예후를 보였으며, 이러한 결과는 환자의 예
후를 평가하는데 유용하게 이용될 것으로 사료된다.
#초록#
Objective : To elucidate the problems that must be dealt with in the prognosis of
patients with severe head injury and to find out the prognosis factors related to severe
head injury.
Methods : A clinical analysis was carried out retrospectively with 292cases of severe
head-injured patients(Glasgow coma scale score 3-8) admitted to the our department for
10 years from January 1987 to December 1996.
Result : Patients who were classified as having severe brain injury belonged to 13 l%
of all craniocerebral trauma cases among which sixty-three cases had diffuse brain
injury. The causes of head injuries were motor vehicle accident. falls from heights,
bicycle anti other causes in order of frequency. Pediatric patients showed better
outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients
with high initial GCS score(6-8, 47.9%) had significantly better outcome than the
patients with low initial GCS score(3-5, 16.9%)(p<0.0001). Fifty point tares percents of
patients with good motor response had good outcome, whereas only 15.8 percent in
patients with poor motor response. The cases with diffuse head injury without basal
cistern compression had significantly higher percentage of good outcome(74.0%) than
those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary
reaction had significantly higher percentage of good outcome(50.3%) than those with
bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had
good outcome(48.1%), compare to 20 3% of patients without skull fracture(p<0.0017).
Conclusion : The good prognostic factors in this study were young ass, initial high
Glasgow coma scale. good motor response, diffuse brain injury type Ⅰ, Ⅱ, bilaterally
intact light reflex. with skull fracture Individual prognostic factor is significant to
indicate the patient's outcome and may be utilized for assessing the relative efficacy of
the alternative treatment and prognosis.
키워드
Severe head injury; Prognostic factor; Glasgow coma scale; Computerized tomography; Motor;
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