颅脑损伤术中急性脑膨出原因及防治分析

目的探讨重度颅脑损伤术中急性脑膨出的形成原因、治疗方法及体会。方法对手术中出现急性脑膨出的20例重度颅脑损伤病人进行回顾性分析并复习文献,总结其形成机理及诱发因素,易发疾病以及其防治方法和疗效。结果急性脑肿胀、术中迟发性颅内血肿形成、严重脑挫裂伤、长时间脑组织缺血缺氧是重型颅脑损伤开颅术中并发急性脑膨出的主要原因,早期施行气管内插管等保持呼吸道通畅,尽早手木及应用脱水剂、缓慢降低颅内压,术中适当控制血压,过度通气,清除颅内迟发性血肿及积极治疗其井发症,纠正全身缺血缺氧状态等是防治术中急性脑膨出的有效措施。结论针对不同病因,早期积极采取相应防治措施,可有效地防治重型颅脑损伤术中脑膨出的发生,减少重残率和死亡率。

The Causes and Prophylactic Therapeutic Method of Acute Intraoperative Encephalocele in Severe Head-injured Patients

Objective To summarize the causes and prophylactic therapeutic methods of acute intraoperative encephalocele in severe head-injured patient.Methods Twenty severe head injured patients with acute intraopera-tive encephalocele were analyzed retrospectively and the preventive and treating mehods were implemented.Re-sults Delayed intracranial hematomas,acute diffuse brain swelling,cerebral anoxia,long-term brain herniaion and massive brain contussion and larceration were the main causes of intraoperative encephalocele.The methods of treatment should be keeping the respiratory tract unobstructed through tracheal intubation,removing hematomas completely,decreasing intracranial pressure gradually,intraoperative hyperventilation,large dose of mannitol and maintaining systolic blood pressure respectively.Conclusion According to different causes,the acute intraopera-tive encephalocele in head injured patients could be prevented and treated effectively to decrease the disability rate and mortality rate.