头颅CT指南在中国轻型颅脑外伤患者中的适用性探究

发布时间：2018-03-13 15:30

本文选题：轻型颅脑外伤　切入点：CT检查　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:头颅CT检查是诊断颅脑外伤的主要依据,但是在轻型颅脑外伤中CT阳性率非常低(10%左右)。在中国并不存在相关决策指南来帮助医生选择性地使用头颅CT检查。本项研究通过验证加拿大头颅CT检查(CCHR)指南和新奥尔良标准(NOC)在中国轻型颅脑外伤患者的适用性,来减少非必需头颅CT检查的使用。方法:本项研究对2015年1月1日-2015年12月31日在浙江大学医学院附属第一医院急诊就诊的颅脑外伤患者进行回顾性分析。纳入患者为伤后24小时内入院并且行头颅CT检查,GCS=13-15分的轻型颅脑外伤患者,分析患者的基本资料以及受伤相关信息。两位神经外科医生独立评估CT结果。利用统计学方法分析加拿大头颅CT指南和新奥尔良标准与头颅CT阳性结果之间的联系,同时计算两个决策指南的敏感性和特异性。结果:研究总共纳入625名患者,其中13.12%(82/625)轻型颅脑外伤患者CT检查结果为阳性表现,6.88%(43/625)患者收治入院进行下一步治疗。最终有11名患者(1.76%,11/625)行神经外科急诊手术治疗。研究计算所得,加拿大头颅CT检查指南和新奥尔良标准均具有100%的敏感性发现存在颅脑损伤的患者,但是加拿大头颅CT检查指南的特异性较新奥尔良标准更高(43.36%VS 33.12%)。结论:加拿大头颅CT指南和新奥尔良标准都具有高度的敏感性发现轻型颅脑外伤CT检查结果阳性的患者,两项标准均适用于中国患者。
[Abstract]:Objective: cranial CT examination is the main basis for the diagnosis of craniocerebral trauma. However, the positive rate of CT in mild craniocerebral trauma is very low, about 10%. There is no relevant decision guide to help doctors selectively use CT scan in China. This study verifies the CCHRs in Canada. And New Orleans Standard (NOC) in patients with mild craniocerebral trauma in China, Methods: from January 1st 2015 to December 31st 2015, this study analyzed retrospectively the patients with craniocerebral trauma who were treated in emergency department at the first affiliated hospital of Zhejiang university medical school from January 1st 2015 to December 31st 2015. The patients were mild craniocerebral trauma patients who were admitted to hospital within 24 hours after injury and who underwent head CT examination with GCSS 13-15 points. The two neurosurgeons independently evaluated the CT findings. A statistical analysis was used to analyze the relationship between the Canadian skull CT guidelines and the New Orleans standard and the positive results of the cranial CT. The sensitivity and specificity of the two decision guidelines were calculated simultaneously. Results: the study included a total of 625 patients. Among them, 13.12 / 82 / 625) the CT findings of mild craniocerebral trauma patients were 6.88% positive and 6.88% 63% 625). Finally, 11 patients were admitted to hospital for the next step of treatment. Finally, 11 patients were treated with emergency neurosurgery surgery, 11% 625%). The results of the study were calculated. The Canadian skull CT guidelines and New Orleans criteria are 100% sensitive in detecting craniocerebral injury. But the specificity of the Canadian skull CT guidelines is higher than that of the New Orleans standard. Conclusion: both the Canadian skull CT guidelines and the New Orleans criteria are highly sensitive in patients with mild craniocerebral trauma who have positive CT findings. Both criteria apply to Chinese patients.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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