摘要
目的探讨颅脑损伤术中出现急性脑膨出的原因,分析相关对策。方法回顾性分析70例颅脑损伤术中出现急性脑膨出患者的临床资料。结果在手术台上翻转头部后开着力侧清除硬膜外血肿7例(10%);术后即刻复查头颅CT,迟发性颅内血肿致急性脑膨出34例(48.6%),广泛性脑挫裂伤致急性弥漫性脑肿胀17例(24.3%),大脑半球外伤性大面积梗死急性脑肿胀8例(11.4%),创伤性休克及术中有明显低血压及低氧血症4例(5.7%)。术后随访6个月,按GOS预后评分,恢复良好(Ⅴ级)15例,轻残(Ⅳ级)10例,重残(Ⅲ级)15例,植物生存(Ⅱ级)2例,死亡(Ⅰ级)28例。结论迟发性颅内血肿和急性弥漫性脑肿胀是导致颅脑损伤术中出现急性脑膨出的主要原因,术前仔细研究受伤机制及影像资料,及时发现原因并正确处理是预防急性脑膨出的关键。
Objective To observe the reasons of acute encephalocele in craniocerebral injury operation and analyze the countermeasures.Methods The clinical data of 70 cases with acute encephalocele in craniocerebral injury operation was ana-lyzed retrospectively. Results There were 7 cases of cleaning epidural hematoma after turning the head on the operating table （10% ）.The head CT was reexamined immediately after operation. There were 34 cases with acute encephalocele caused by de-layed traumatic intracranial hematoma （48.6% ）. There were 17 cases with acute diffuse brain swelling caused by generalized contusion and laceration of brain （24.3% ）. There were 8 cases with traumatic acute brain swelling of cerebral hemisphere （11.4% ）. There were 4 cases with evident hypotension and hypoxemia of traumatic shock in operation （5.7% ）. The patients were followed up for 6 months. According to GOS prognosis score ,there were 15 cases with good recovery （Ⅴ level） ,10 cases with light disability （Ⅳ level） ,15 cases with server disability（Ⅲ level） ,2 cases with vegetative state（Ⅱlevel） and 28 dead ca-ses （Ⅰlevel）.Conclusion Delayed traumatic intracranial hematoma and acute diffuse brain swelling are important reasons cau-sing acute encephalocele in craniocerebral injury operation. Carefully studying injury mechanism and image data before opera-tion ,and timely finding the reasons and correct handling is the key to prevent acute encephalocele ,for example ,thoroughly re-moving hematoma and brain tissue contusion ,improving oxygen supply of brain ,reducing intracranial pressure ,rapidly remo-ving late-onset hematoma and shortening operation time.
出处
《中国实用神经疾病杂志》
2014年第9期39-40,共2页
Chinese Journal of Practical Nervous Diseases
基金
连云港市卫生局科研课题
课题编号:1151
关键词
急性脑膨出
开颅手术
颅脑损伤
颅内血肿
脑肿胀
Acute encephalocele
Craniotomy
Craniocerebral injury
Intracranial hematoma
Brain swelling
