颅脑外伤合并胸部外伤的诊治体会

目的总结颅脑外伤合并胸部外伤的救治经验和疗效。方法回顾125例颅脑外伤合并胸部外伤的治疗。行急诊开颅手术75例,其中合并肋骨骨折、肺挫伤的50例采用药物、胸带固定等保守治疗胸部外伤,合并血气胸的25例行胸腔闭式引流术;行急诊开胸术4例;采用药物保守治疗46例。结果根据GOS评分,本组恢复良好45例,轻残11例,重残27例,植物状态10例;死亡32例,死亡率25.6%,分别死于:脑疝18例(56.2%),原发性脑干损伤5例(15.6%),胸腔大血管破裂致休克3例(9.4%)及多器官功能衰竭6例(18.8%)。结论重视受伤机制,检查突出重点,治疗迅速分清主次,警惕迟发出血和通畅的绿色急救通道及多科合作有利于提高颅脑外伤合并胸部外伤的抢救成功率,降低死亡率。

Experience on Diagnosis and Treatment of Craniocerebral Trauma Combined with Thoracic Injury

Objective To summary the methods and experience on treatment of craniocerebral trauma combined with thoracic injury.Methods The clinical data of 125 cases with craniocerebral trauma combined with thoracic injury were analyzed retrospectively.In the 75 patients received emergency craniotomy,50 cases with rib fractures or pulmonary contusion were treated by conservative treatment such as medication,chest bandage fixation and so on,and the other 25 hemopneumothorax cases were performed closed drainage of thoracic cavity.Four cases were carried out emergency thoracotomy,and 46 cases were treated by conservative treatment in neurosurgery or ICU.Results According to Glasgow outcome scale（GOS）,45 patients were cured,11 were mild disability,27 were severe disability and 10 were vegetative state.32 cases died and the mortality was 25.6%.Among the death cases,18 died of encephalocele,5 of primary brain-stem injury,3 of hemorrhagic shock associated with thoracic cavity angiorrhexis,and 6 of multiple organ failure.Conclusion The strategies such as attaching importance to the injury mechanism,strengthening inspection,distinguishing the primary and secondary aspects of treatments,observing late-occurred bleeding,establishing emergency green path and carrying out co-operation may be helpful to increase the successful rescue the rate and reduce the mortality.