重型颅脑损伤术中急性脑膨出应对措施

目的探讨重型颅脑损伤手术中急性脑膨出的机理与处理措施。方法回顾性分析58例在颅脑手术过程中发生脑膨出的重型颅脑损伤患者临床资料,影像学资料及应对措施,采用标准大骨瓣减压、过度通气、咬除颅底骨质、阶梯性减压、及时复查颅脑CT等综合措施。结果术后随访三月按GOS评定预后恢复良好19例、轻残11例、重残11例、植物生存5例、死亡12例。迟发性血肿(63.8%),弥漫性脑肿胀(27.6%)及脑梗死(8.6%)是重型颅脑损伤手术中急性脑膨出的主要原因。结论对重型颅脑损伤手术中急性脑膨出的患者要正确判断,区别原因采取相应的措施。

Measure to severe traumatic brain injury with acute brain swelling

Objective To analyze the treating method for severe traumatic brain injury with acute brain swelling .Methods The clinical ,image data and treatment measure of 58 patients with severe traumatic brain injury with acute brain swelling were analyzed retrospectively .Standard craniotomy,hyperventilation,removal of skull base bone,reapped decompression and repetting CT scanning were used in these patients .ResultsIn The follow up of 3 months according to the GOS score showed 19 patients got good recovery ,11 light degree disability and 11 severe disability,5 vegetative state and 12 died.Delayed traumatic intracranial hematoma , diffuse brain swelling , post-traumatic cerebral infarction were the main reasons of severe traumatic brain injury with acute encephalocele . Conclusion Judgment for severe traumatic brain injury with acute encephalocele , attention to reasons of surgical intervention as early as possible were all keys to decreasing the mortality and disable rate.