重型颅脑损伤临床救治经验

目的 回顾性研究重型颅脑损伤(SCCI)患临床救治经验，探讨有效的治疗措施与方法，以改善患的预后。方法 分析3310例SCCI患的致伤原因、临床特征、诊断方法、抢救措施、手术方式及预后状况。结果 本组病例致伤原因主要为交通事故伤和高处坠落伤，损伤类型最常见为硬膜下血肿，其次为硬膜外和多发性血肿。临床表现主要为意识障碍、锥体束征和瞳孔改变。采用手术、药物等综合疗法。本组治愈、好转2410例(72．8％)，死亡645例(19．5％)。结论 早期诊断和及时手术减压、术中妥善脑保护、维持有效的脑灌注压、加强术后的监护和防治并发症，是提高SCCI患救治成功率和改善其生存质量的重要手段。

The clinical experience of treatment for the severe craniocerebral injury

Objective A retrospective clinical study for the severe craniocerebral injury (SCCI) has been made to explore effective treatments in order to improve outcomes.Methods The causes and types of trauma, the clinical characteristic, the modalities of diagnosis and operation, and prognosis of 3 310 cases with SCCI were reviewed .Results Traffic accident injury and fall were the main cause. The main types of SCCI were subdural, extradural and multiple intracranial hematomas. Most of the patients showed unconsciousness, pyramidal signs and pupil changes. The therapeutic measures included surgery and medications. The cure rate and improvement were 72.8 % (2 410 cases ), and the mortality rate was 19.5% ( 645 cases ) in our group.Conclusion Early diagnosis and timely operative decompression, maintenance of the effective cerebral perfusion pressure, proper brain protection during operation, competent special care in ICU and decreasing the complications after operation are important measures to achieve good recovery and to improve the survival quality for the patients with SCCI.