关键词：老年人；颅脑损伤；脑缺血；脑微循环；多器官功能衰竭
摘要 78例老年人重型颅脑损伤(HSI)，其GCS评分均在3～8分，存活55例(70.51%)，死亡23例，病死率为29.49%。认为采用颅内压(ICP)监护，GCS评分和观察瞳孔改变相结合的方法对判断预后具有重要意义。其病死率的高低及预后与原发或继发性脑损害的程度有关，而ICP的高低是判断原发或继发性脑损害程度的可靠指标。脑缺血、受压、微循环障碍是引起脑继发性损害、造成死亡的主要原因。治疗脑损害适情尽早手术，积极防治脑缺血，有效地改善脑微循环，早期应用脑保护剂，注意酸碱及水电解质平衡，保护和调节各脏器的正常机能等，是提高老年人HSI的生存率、降低病死率的重要措施。
Retrospective analysis ofsevere head injuries in elderly men
Zhou Mingqi
Qiaotou Hospital, Dongguan, Guangdong, P.R.China 511738
Thesevere head injury in 78 elderly men were treated in our hospital. Their GCS was between 3to 8. 55 of them survived, the survival rate was 70.51%. 23 died, the fatality rate was29.49%. It indicated that the combined methods of ICP monitor, GCS evaluation, andobservation on changes of pupils were valuable for prediction of the prognosis. Thefatality rate and prognosis were correlated with the degree of primary or secondary severehead injury. ICP levels were reliable index for the judgement of degrees of primary orsecondary severe head injury. Cerebral ischema, encephalothlipsis and microcirculationdysfunction were the major factors of the death induced by secondary brain injuries. Themajor steps to improve the survival rate of elderly severe head injury and decrease thefatality rate were earlier surgery, prevention of cerebral ischema, improvement of brainmicrocirculation, giving brain protective agent in early stage, paying attention toacid-base, water-electrolyte balance and protection of the normal function of each organs.
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