重症颅脑损伤术中急性脑膨出21例临床分析

目的 探讨重症颅脑损伤术中急性脑膨出临床特点及有效防治措施.方法 回顾分析21例术中发生急性脑膨出的重症颅脑损伤患者临床资料;其中男12例,女9例,年龄18～69岁.结果 21例中死亡6例,死亡率28.5%,1例死于术后严重脑肿胀及刀口脑脊液漏并发颅内感染,4例死于严重颅脑损伤、脑肿胀、脑干功能衰竭,1例术后病情危重家属放弃治疗自动出院后死亡;存活15例患者随访3～6个月,按GOS评分,恢复良好9例,中度残疾5例,重度残疾1例.结论 结合临床和颅脑CT扫描能判断术中脑膨出发生的可能性,术前术中采取正确的预防及治疗措施,能提高急性脑膨出救治成功率.

Abstract：

Objective To analyze the clinical features of acute intra-operative encephalocele and the proper prophylactico-therapeutic measures for severe craniocerebral injury. Methods The clinical data were collected and analyzed for 21 patients with severe head injuries who suffered acute intra-operative encephalocele from June 2008 to May 2010. There were 12 males and 9 females with an age range of 18 -69years old. Results Among these patients, 6 died with a mortality rate of 28.5%. It was lower than that reported in literatures. One patient died post-operatively of severe brain swelling and intracranial infection secondary to leakage of cerebrospinal fluid. Four patients died of severe craniocerebral injury, brain swelling and brain stem failure. And 1 patient died after his guardian abandoned the treatment. The follow-up period for the remaining 15 surviving patients was 3-6 months. According to the Glasgow outcome score (GOS),there were a favorable prognosis ( n = 9 ), moderate disabilities ( n = 5 ) and severe disability ( n = 1 ).Conclusion The probability of acute intra-operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The therapeutic success rate of acute encephalocele will be boosted by taking protective and therapeutic measures pre- and intra-operatively.

Clinical analysis of acute encephalocele during operation in 21 patients with severe craniocerebral injury

Objective To analyze the clinical features of acute intra-operative encephalocele and the proper prophylactico-therapeutic measures for severe craniocerebral injury. Methods The clinical data were collected and analyzed for 21 patients with severe head injuries who suffered acute intra-operative encephalocele from June 2008 to May 2010. There were 12 males and 9 females with an age range of 18 -69years old. Results Among these patients, 6 died with a mortality rate of 28.5%. It was lower than that reported in literatures. One patient died post-operatively of severe brain swelling and intracranial infection secondary to leakage of cerebrospinal fluid. Four patients died of severe craniocerebral injury, brain swelling and brain stem failure. And 1 patient died after his guardian abandoned the treatment. The follow-up period for the remaining 15 surviving patients was 3-6 months. According to the Glasgow outcome score (GOS),there were a favorable prognosis ( n = 9 ), moderate disabilities ( n = 5 ) and severe disability ( n = 1 ).Conclusion The probability of acute intra-operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The therapeutic success rate of acute encephalocele will be boosted by taking protective and therapeutic measures pre- and intra-operatively.