本文選題：輕型顱腦外傷　切入點(diǎn)：CT檢查　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:頭顱CT檢查是診斷顱腦外傷的主要依據(jù),但是在輕型顱腦外傷中CT陽(yáng)性率非常低(10%左右)。在中國(guó)并不存在相關(guān)決策指南來(lái)幫助醫(yī)生選擇性地使用頭顱CT檢查。本項(xiàng)研究通過(guò)驗(yàn)證加拿大頭顱CT檢查(CCHR)指南和新奧爾良標(biāo)準(zhǔn)(NOC)在中國(guó)輕型顱腦外傷患者的適用性,來(lái)減少非必需頭顱CT檢查的使用。方法:本項(xiàng)研究對(duì)2015年1月1日-2015年12月31日在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院急診就診的顱腦外傷患者進(jìn)行回顧性分析。納入患者為傷后24小時(shí)內(nèi)入院并且行頭顱CT檢查,GCS=13-15分的輕型顱腦外傷患者,分析患者的基本資料以及受傷相關(guān)信息。兩位神經(jīng)外科醫(yī)生獨(dú)立評(píng)估CT結(jié)果。利用統(tǒng)計(jì)學(xué)方法分析加拿大頭顱CT指南和新奧爾良標(biāo)準(zhǔn)與頭顱CT陽(yáng)性結(jié)果之間的聯(lián)系,同時(shí)計(jì)算兩個(gè)決策指南的敏感性和特異性。結(jié)果:研究總共納入625名患者,其中13.12%(82/625)輕型顱腦外傷患者CT檢查結(jié)果為陽(yáng)性表現(xiàn),6.88%(43/625)患者收治入院進(jìn)行下一步治療。最終有11名患者(1.76%,11/625)行神經(jīng)外科急診手術(shù)治療。研究計(jì)算所得,加拿大頭顱CT檢查指南和新奧爾良標(biāo)準(zhǔn)均具有100%的敏感性發(fā)現(xiàn)存在顱腦損傷的患者,但是加拿大頭顱CT檢查指南的特異性較新奧爾良標(biāo)準(zhǔn)更高(43.36%VS 33.12%)。結(jié)論:加拿大頭顱CT指南和新奧爾良標(biāo)準(zhǔn)都具有高度的敏感性發(fā)現(xiàn)輕型顱腦外傷CT檢查結(jié)果陽(yáng)性的患者,兩項(xiàng)標(biāo)準(zhǔn)均適用于中國(guó)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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.15

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