NGHIÊN CỨU ĐẶC ĐIỂM LÂM SÀNG, HÌNH ẢNH CẮT LỚP VI TÍNH TRONG ĐIỀU TRỊ BỆNH NHÂN CHẤN THƯƠNG SỌ NÃO NẶNG

Abstract

Study of clinical characteristics, computed tomography scan images in the treatment of Severe traumatic brain injury. Objectives: Evaluate the results of treatment of severe traumatic brain injury without intracranial hematoma by decompressive craniectomy. Methods: An uncontrolled intervention study based on 45 patients with severe traumatic brain injury, no intracranial hematoma, high intracranial pressure above 20 mmHg, unresponsive to medical therapy, and operated decompressive craniectomy at Viet Duc Hospital from 5/2017 to 12/2022. Research variables: age, gender, cause of accident, preoperative GCS, pulse and blood pressure before surgery, computed tomography images before and 3 months after surgery. Comparison of treatment outcomes between groups. Results: We studied 45 patients, including 42 males and 3 females, the oldest age was 78 and the lowest was 6 years old, traffic accidents accounted for the majority of 86.7%, daily-life accidents 8.9. %. GCS before surgery: 3 - 5 points: 55.6%, GCS 6 - 8 points: 44.4%; 8.9% GCS is 8 points. Before surgery, the lowest systolic blood pressure was 110 mmHg, the highest was 170 mmHg, the mean was 133.33± 13.01, most of the patients had normal systolic blood pressure from over 90 mmHg to 140 mmHg. accounted for 86.7%. The pupils on both sides are equal, do not dilate and have reflect light accounted for 38.6%, the pupil dilate and lose reflect light on one side accounted for 38.6%, the pupils dilate and lose light reflex on both sides accounted for 22.8%. On the CT scan of the brain, images of hematoma are diverse with many different lesions on the same patient with severe traumatic brain injury, mainly brain contusion accounted for 84.4%, intracerebral hematoma 77.8%, acute subdural hematoma 60.0%. There were 29 cases of midline shift ≤ 5 mm, accounting for 64.4%; midline shift from 5-10 mm accounted for 35.6%. There were no cases of midline shift >10 mm. The mean ICP was: 43.84 ± 15.19 mmHg, the SBP was 97.18 ± 9.00 mmHg and the mean cerebral perfusion pressure was 53.34 ± 16.03 mmHg. Cerebral perfusion pressure was positively correlated with mean arterial pressure (r = 0.372; p < 0.05) and negatively correlated with ICP (r = 0.835; p < 0.001). Conclusion: Clinical characteristics and computed tomography images in patients with severe traumatic brain injury are diverse.