重型颅脑损伤术中急性脑膨出原因及治疗措施

目的总结近年来在救治重型颅脑损伤开颅术中发生急性脑膨出的原因及治疗疗效。方法对重庆市急救医疗中心神经外科收治的GCS3~8分重型颅脑损伤开颅术中发生急性脑膨出的原因及治疗疗效进行回顾性总结。结果几年来共收治410例GCS3~8分手术的重型颅脑损伤病人,开颅术中发生急性脑膨出的有32例(7.8%),因急性脑肿胀引起的有10例(31%),因迟发性血肿引起的有21例(66%),其他原因1例(3%)。其中急性脑肿胀者死亡10例(31%),迟发性血肿者死亡7例(22%),总死亡17例(53%),植物生存3例(9.45%),重残4例(12.5%),轻残5例(15.6%),恢复正常生活者3例(9.45%)。结论急性脑肿胀与迟发性血肿引起的脑膨出预后不同,前者死亡率几乎达100%,而远隔部位迟发性血肿只要处理及时,预后良好。因此,尤其应注意远隔部位迟发血肿的可能,以提高治疗效果。

Causes and treatment of acute brain fungus in the craniotomy on patients with severe head injury

Objective To discuss the causes and treatment of acute brain fungus in craniotomy on patients with severe head injury in recent years.Methods Four hundrad and ten patients with severe head injury(GCS 3-8) were studied retrospectively.The causes and treatment of acute brain fungus in craniotomy on patients were concluded.Results In 410 cases with severe head-injuried patients(GCS 3-8),acute brain fungus developed in 32(7.8%),Ten(31%) manifested in acute brain swelling,21(66%) in delayed intracranial hematoma and 1 was induced by other cause.Ten(31%) cases died from acute brain swelling and 7(22%) from delayed intracranial hematoma.The total mortality was 53%(17 cases).Three(9.45%) cases were in vegetative,4(12.5%) in severe disability,5(15.6%) in mild disability and Three(9.45%) in normality.Conclusion The prognosis in these patients with brain fungus caused by acute brain swelling and delayed intracranial hematoma was diferent.The mortality in patients with acute brain swelling was almost 100%.If available treatment was performed,these patients with distal-site delayed intracranial hematoma would be gotten better prognosis.The distal-site delayed intracranial hematoma should be focused in order to elevate the effect of treatment.