重型颅脑损伤术中急性脑膨出原因及处理

目的总结重型颅脑损伤开颅术中发生急性脑膨出的原因及处理。方法对近年我科收治的重型颅脑损伤开颅术中发生急性脑膨出的原因及疗效进行回顾性分析。结果几年来共收治310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29例（9．4％），因急性脑肿胀引起10例（34．5％），因迟发性血肿引起18例（62．1％），其他原因1例（3．4％）；其中急性脑肿胀者死亡10例（34．5％），迟发性血肿者死亡6例（20．7％），总死亡16例（55．2％），植物生存2例（6．9％），重残3例（10．3％），轻残5例（17．2％），恢复正常生活者3例（10．3％）。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。

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 Three hundred and ten patients with severe head injury(GCS3-8) were studied retrospectively.The causes and treatment of acute brain fungus in craniotomy on patients were concluded.Results In 310 cases with severe head injuried patients(GCS3-8),acute brain fungus developed in 29(9.4%).Ten(34.5%) manifested in acute brains welling,18(62.1%) in delayed intracranial hematoma and 1 was induced by other cause.Ten(34.5%) cases died from acute brain swelling and 6(20.7%) from delayed intracranial hematoma.The total mortality was 55.2%(16cases).Two(6.9%) cases were in vegetative,3(10.3%) in severe disability,5(17.2%) in mild disability and three(10.3%) in normality.Conclusion The prognosis in these patients with brain fungus caused by acute brain swelling and delayed intracranial hematoma was different.The mortality in patients with acute brain swelling was almost 100%.If available treatment was performed,these patients with distal site delayedintracranial hematoma would ce got better prognosis.