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目的 (1)确定因闭合性脑损伤 (CHI)或缺氧缺血性脑病 (HIE)所致严重脑损伤的患儿占PICU中 3岁以下患儿的比例 ;(2 )确定损伤 6个月后患儿的预后 ;(3)探讨脑损伤后 2 4h内预后评估与预后的关系。对象和方法 加拿大爱德蒙顿Glenrose康复医院新生儿和婴儿随访中心的患儿 ,年龄小于 3岁 (占 1995～ 1998年该院PICU住院患儿的4 % ) ,因严重脑损伤、Glasgow昏迷评分 (GCS)≤ 8分的患儿共计 5 3例 ,其中 12例 (2 3% )死亡 ,3例 (6 % )随访丢失 ,38例(71% )存活 ,并接受了多学科预后评价。对其进行有关预后的前瞻性、描述性研究。结果 已知预后的 5 0例儿童中 ,2 3例 (46 % )GCS评分显示“恢复良好” ,仅 8例 (16 % )Bayley 18～ 36个月婴儿发育 II(BSID II)精神和运动指数评估达到“一般或更高”的分数。导致预后不良的急性损伤预测因素有 :窒息、使用肾上腺素复苏、瞳孔无反应 ,动脉血pH≤ 7.2和GCS评分 3分。 38例幸存儿童 ,预测因子的敏感性和特异性 :GCS分别为 73%和 83% ;神经评分分别为 86 %和 93% ;运动评分分别为 75 %和 89%。结论 急性脑损伤后GCS≤ 8分的 3岁以下儿童 ,80 %以上预后不良 ,包括死亡、残疾、神经或运动发育评分低于平均分数。对GCS 5分者可能会过高估计其预后 ,需要对这些儿童进
Objectives (1) To determine the proportion of children with severe brain injury due to closed brain injury (CHI) or hypoxic-ischemic encephalopathy (HIE) in children under 3 years of age in the PICU; (2) Prognosis in children with post-traumatic brain injury; (3) To investigate the relationship between prognosis and prognosis in 24 h after brain injury. Subjects and Methods Children at the Neonatal and Infant Follow-up Center at Glenrose Rehabilitation Hospital in Edmonton, Canada, aged less than 3 years (4% of PICU inpatients in the hospital from 1995 to 1998), had severe brain injury, a Glasgow coma score Fifty-three (12.3%) died of GCS ≤ 8 points, 3 were missed (6%), and 38 (71%) survived and received multidisciplinary outcomes. Prospective, descriptive studies were performed on the prognosis. Results Out of 50 children with known prognosis, 23 (46%) GCS scores showed “good recovery” and only 8 (16%) Bayley 18-36 months Infant Developmental II (BSID II) mental and motor index Evaluate scores that reach “average or higher”. Predictors of acute injury that lead to a poor prognosis include asphyxia, adrenaline recovery, no pupil response, arterial pH ≤ 7.2 and GCS score of 3. Thirty-eight surviving children predicted the sensitivity and specificity of the factors: GCS 73% and 83%, neurological scores 86% and 93%, and motor scores 75% and 89%, respectively. Conclusions More than 80% of children under 3 years old with GCS≤8 points after acute brain injury have poor prognosis, including less than average scores of death, disability, neurological or motor development scores. Those with a GCS score of 5 may overestimate their prognosis and need to enroll these children