326例急性闭合性重型颅脑创伤早期死亡分析

目的 通过对颅脑创伤早期死亡资料的分析和讨论,为以后有针对性的治疗提供依据.方法 对326例死亡(1周内)病例的资料进行回顾性分析,探讨导致急性期死亡的主要原因.结果 在所有1周内死亡的病例中,顽固性高颅压脑疝居首位,占82%;其他全身合并症8%;原发脑干损伤6%;急性失血性休克4%.而由顽固性高颅压脑疝导致的死亡病例数主要集中在伤后前2 d内,占58%.133例急救手术减压后的死亡均因术后二次出现顽固性高颅压所致.结论 由多种因素导致的顽固性高颅压是急性期死亡的主要原因,及时准确地发现顽固性高颅压的原因,早期预防是降低重型颅脑创伤死亡率的关键.

Clinical analysis of 326 cases of early death of acute closed craniocerebral trauma

Objective To summarize the clinical characteristics and management of cases of early death of acute closed craniocerebral trauma. Methods The clinical data of 326 early death ( within 1 week) cases of acute closed severe traumatic brain injury were studied retrospectively to identify the main causes of death in acute phase. Results The main causes of early death were refractory high intracranial pressure because of intracranial hematoma, cerebral ischemia, cerebral edema. The main causes of early death included: Refractory intracranial hypertension leading to brain herniation (82％), other systemic complications (8％) , primary brain stem injury( 6％ ) and acute hemorrhagic shock(4％). 58％ death due to refractory intracranial hypertension occured within 2 days. The cause of 133 postoperative death was refractory intracranial hypertension. Conclusions The main cause of early death of acute closed craniocerebral trauma is refractory intracranial hypertension. It is very important to find the cause of refractory intracranial hypertension for early prevention and therapy.