72例急性严重脑损伤的监护治疗

目的探讨严重脑外伤在SICU对全身多种生理功能及生化指标等进行重症监测和加强治疗的体会。方法回顾分析2005～2007年在SICU和治疗严重脑外伤72例。其中合并多发伤占45例,单纯有颅脑损伤27例,对以上病例做相应手术处理后住SICU,需呼吸机支持呼吸,给予循环、呼吸等多种监测仪的监测和加强治疗及高质量的护理。结果治愈46例,植物生存6例,死亡18例,死亡率25.0%。其中早期死亡6例,是严重颅脑损伤合并急性呼吸窘迫综合征(ARDS);中期死亡12例是肺部感染、全身炎症反应综合征(SIRS)及多器官功能障碍综合征(MODS)。结论(1)迅速查明受伤部位及器官,优先处理危及生命的部位伤。(2)充分发挥ICU各监测仪的优势,给予高质量的护理,在重要脏器功能出现异常的早期及早发现并予以纠正,可减少并发症及病死率。

Surveillance and treatment of 72 cases of severe brain injury

Objective To summarize the experience in intensive care of multiple physiological functional and biochemical indicators,and intensive therapy of severe brain injury.Methods Retrospective analysis was performed on the clinical data of 72 patients(45 cases were complicated with multiple wound,and 27 cases were with simple craniocerebral injury)suffered from severe brain injury from 2005 to 2007.All subjects underwent operation and then given mechanical ventilation,circulatory and respiratory monitoring,intensive care and therapy in ICU.Results 46 cases were fully cured;6 cases were with persistent vegetative state(PVS);18 cases ended in death,with 25.0% of mortality rate,in which 6 cases died of ARDS during the early phase,and 12 cases died of pulmonary infection,SIRS and MODS during the intermediate stage.Conclusion It suggests that injured place and organs should be ascertained as soon as possible,and life-threatening injury should be treated in advance.It is important for taking advantage of monitors in ICU and giving intensive care,discovering and retrieving timely vital organ function disorder to reduce the complications and case fatality ratio.