目的总结重型颅脑损伤患者的死亡率,探讨死亡的相关因素。方法建立颅脑损伤数据库,总结我科2000年1月至2005年12月之间收治的重型颅脑损伤患者的临床诊疗情况,并对影响患者死亡的相关临床特点进行比较分析。结果213例重型颅脑损伤患者中,车祸致伤152例(71.4%),手术103例(48.4%),其中血肿清除加标准大骨瓣减压术75例。GCS 3～5分患者死亡率61.2%,GCS 6～8分患者死亡率19.1%,总死亡率39.4%。外院转入99例(46.5%)。直接来院及入院时间在4h以内的患者死亡率明显下降。血糖明显升高(>13mmol/L)、上消化道出血和严重的低氧血症可以增加患者死亡率,尤其是晚期死亡者。结论在强化现场急救、规范住院治疗的基础上,完善转诊机制、减少转院、缩短入院时间,对降低重型颅脑损伤死亡率、尤其是早期(24h之内)的死亡,有重要意义。加强继发性损伤的治疗、预防并及时准确处理并发症,可以降低患者的中晚期死亡率。 Objective To summarize the mortality of patients with severe craniocerebral injury and explore the related factors of death. Methods The database of craniocerebral injury was established. The clinical diagnosis and treatment of patients with severe craniocerebral injury admitted from January 2000 to December 2005 in our department were summarized. The clinical characteristics of patients with death were compared and analyzed. Results Among the 213 patients with severe craniocerebral injury, 152 (71.4%) were injured by car accident and 103 (48.4%) were operated by car accident. Among them, 75 cases were treated with standard decompressive hematoma and standard decompressive craniectomy. The mortality rate of patients with GCS 3 ~ 5 was 61.2%, that of patients with GCS 6 ~ 8 was 19.1%, and the total mortality was 39.4%. The hospital transferred to 99 cases (46.5%). The mortality rate of patients who came directly to hospital or admitted to hospital within 4 hours decreased significantly. High blood glucose (> 13mmol / L), upper gastrointestinal bleeding and severe hypoxemia can increase patient mortality, especially in late deaths. Conclusions On the basis of intensifying on-site first aid and standardizing hospitalization, it is of great significance to improve the referral mechanism, reduce the number of referrals and shorten the time of admission, and reduce the mortality of severe craniocerebral injury, especially in the early (within 24 hours). To strengthen the treatment of secondary injuries, prevention and timely and accurate treatment of complications, can reduce the patient’s late mortality.