双额叶脑挫裂伤并发脑中心疝治疗策略

目的探讨双额叶脑挫裂伤并发脑中心疝的临床特点及治疗策略。方法回顾分析76例患者的临床资料。结果76例患者，存活53例，死亡23例。根据Karnofsky评分评估生活和生存质量：手术患者46例，其中恢复良好35例，不能自理或长期昏迷8例，死亡3例；保守治疗10例，其中恢复良好6例，不能自理或长期昏迷4例。两组差异有统计学意义（P〈0．05）。20例入院时或入院后短时间即已双侧脑疝，死于中枢性脑干功能衰竭。结论双额叶脑挫裂伤患者极易并发脑中心疝，病情易骤然恶化，密切观察病情变化至关重要，手术应在“间脑期”前进行，手术后患者大部分预后较好。有弥漫性脑肿胀者预后差，应尽早行手术减压。

Treatment strategy of bilateral frontal lobe contusion and laceration with central herniation

Objective To study the clinical features of the bilateral frontal brain contusion with cerebral hernia center and its treatment strategies. Methods The clinical data of 76 patients with cerebral central hernia were restropectively analyzed. Results In 76 patients,there were 53 cases survive,23 cases died.The life and survival quality of these patients were evaluated according to the Karnofsky scale systerm :46 patients underwent surgery,including 35 cases with good recovery,8 cases with long-term coma or unable to look after themselves,3 cases with death;10 cases underwent a expectant treatment,of which,6 cases with good recovery,4 cases with long-term coma or unable to look after themselves.The other 20 cases died of central brain stem failure,with a central hernia when admissioned. Conclusion Patients with bilateral frontal brain contusion were extremely complicated with central hernia,and had a suddenly deteriored condition.Close observation of changes were critical importance.The surgery should be carried out before "diencephalon period",for most recovery well after surgery.Patients with diffuse brain swelling should go under the depressioning surgery as earlier as possible.