目的 探讨皮质视觉等级量表(cortical atrophy scale,CAS)和脑萎缩指数对老年慢性硬膜下血肿(CSDH)的预测价值.方法 选择老年头部创伤患者268例,根据3周后有无CSDH发生分为CSDH组40例,非CSDH组228例.采用磁共振扫描仪记录患者脑脊髓液容量、颅内容量、脑容量、脑室容量、蛛网膜下腔容量,计算脑萎缩指数、双额角径或颅内径(Evans)指数、前角指数、CAS.所有患者入院时详细记录其性别、年龄等一般临床资料.比较2组在临床资料、实验室指标方面差异,分析老年CSDH患者各因素间相关性,并应用单因素和多因素logistic回归分析影响头部创伤老年患者CSDH发生的危险性因素.结果 CSDH组脑萎缩指数、CAS中度和重度萎缩比例明显高于非CSDH组(P＜0.01).相关性分析显示,脑萎缩指数与脑容量呈负相关,与脑室容量、蛛网膜下腔容量呈正相关;脑室容量与蛛网膜下腔容量、Evans指数呈正相关;蛛网膜下腔容量与Evans指数呈正相关(r=0.35,P=0.02);Evans指数与前角指数呈正相关(r=0.23,P=0.03).单因素和多因素logistic回归分析显示,入院时脑萎缩指数≥7.15％、CAS为中度萎缩和重度萎缩会增加老年头部创伤患者CSDH发生风险(P＜0.05).结论 CAS和脑萎缩指数可预测老年头部创伤患者CSDH发生.%Objective To study the value of CAS and brain atrophy index (BAD in predicting CSDH in elderly patients.Methods Two hundred and sixty-eight elderly head trauma patients were divided into CSDH group (n=40) and CSDH-free group (n=228).Their CSF volume,intracranial volume,brain volume,ventricular volume,subarachnoid space volume were measured by MR scanning,their BAI,Evans index,FHI,CAS score and clinical data such as gender and age were recorded,their clinical data and laboratory parameters were compared.Relationship between different factors in elderly CSDH patients was analyzed.The risk factors for CSDH in head trauma patients were analyzed by univariate and multivariate logistic regression analysis.Results The BAI and CAS score of moderate and severe brain atropy were significantly higher in CSDH group than in CSDH-free group (P＜0.01).Correlation analysis showed that BAI was negatively related with brain volume and positively related with ventricular volume and subarachnoid space volume,ventriclular volume was positively related with subarachnoid space volume and Evans index,subarachnoid space volume was positively related with Evans index (r=0.35,P=0.02),Evans index was positively related with FHI (r=0.23,P =0.03).Univariate and multivariate logistic regression analysis showed that BAI≥7.15％ on admission and CAS score of moderate and severe brain atrophy increased the risk of CSDH in elderly head trauma patients (P＜0.05).Concluson CAS score and BAI can predict the occurrence of CSDH in elderly head trauma patients.
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