重型颅脑损伤合并严重多发伤78例临床分析

目的探讨重型颅脑损伤并发多发伤的救治经验。方法对近4年收治的78例重型颅脑损伤并发多发伤的临床资料进行回顾性分析。结果 78例中按颅脑损伤GCS计分≤5分者26例,5～8分者52例,所有伤者入院时经简单包扎固定后行头胸腹及骨盆CT检查,52例行急诊开颅手术,胸腔闭式引流24例,8例脾破裂行脾切除术,伤口清创术17例。出院时按GOS分级评分:良好36例(46.2%),轻残14例(17.9%),重残7例(9%),植物状态3例(3.8%),死亡18例(23.1%)。结论颅脑损伤合并多发伤时应及早诊断,避免漏诊,密切监护,多科协作,重视并处理好颅内高压和休克是提高重型颅脑损伤并发多发伤救治成功的关键。

Clinical analysis of 78 cases severe craniocerebral injury patients with severe multiple trauma

Objective To explore the comprehensive treatment method for severe craniocerebral injury patients with multiple trauma.Methods Clinical data of 78 cases for 4 years in this hospital who had severe craniocerebral injury with severe multiple trauma were analyzed retrospectively.Results Among 78 patients,there were 26 cases with GCS≤5,52 cases with GCS 5~8,all of whom took CT examination after fixation and a simple bandaging.Fifty-two patients received emergency craniotomy,24 patients closed drainage of thoracic cavity,8 cases of spleen rupture did resection of the spleen,and 17 cases undertook debridement.Based on the effect evaluated by Glasgow outcome scale(GOS) after treatment,36 patients were under good condition(46.2%),14 light disability(17.9%),7 serious disability(9%),3 vegetable surviving(3.8%),and 18 death(23.1%).Conclusion The key successful treatment lies in early diagnosis,closely monitoring,avoiding misdiagnosis,and controlling acute intracranial hypertension and shock.