40例重型颅脑损伤死亡原因分析

目的 分析40例GCS3～8分的重型颅脑损伤死亡原因。方法:对我院1989年3月至1999年6月收治的40例重型颅脑损伤病人进行回顾性分析。结果:40例重型颅脑损伤死于颅内血肿13例,脑挫裂伤合并颅内血肿12例,广泛性脑挫裂伤10例,急性弥慢性脑肿胀2例,原发性脑干损伤3例。结论:重型颅脑损伤原因主要是严重的脑损伤及颅内血肿,各种原因的延误诊治及严重的并发症。因而,在院前、急诊手术室及术后监护病房等三个环节采取有效措施是抢救重型颅脑损伤的关键。     

老年人颅脑损伤的临床分析

目的 探讨老年人颅脑损伤的特点及治疗。方法 分析60岁以上老年人颅脑损伤58例临床资料。结果 致伤原因多为车祸及跌伤，其中轻型占36％，中型占28％，重型占36％，合并颅内血肿25例。治愈65．5％，残存19％，死亡15．5％。结论 指出损伤范围，是否合并颅内血肿及脑症等对预后有直接影响，严密观察、积极治疗、及时手术、处理合并伤及防治并发症是降低死亡率的有效措施。     

重型颅脑损伤的临床处理及死亡原因分析

目的分析重型颅脑损伤的临床治疗方法和死亡原因。方法回顾性分析48例重型颅脑损伤患者的临床资料,整理分析在治疗过程中的有效治疗措施及患者的死亡原因。结果 27例患者得到救治,恢复良好的患者主要是通过降低颅内压清除血肿手术治疗完成,患者的死亡原因主要为严重脑挫裂伤原发或继发脑干损伤、多脏器功能衰竭等。结论在重型颅脑损伤治疗过程中,需要加强对颅内压的降低及血肿清除等治疗,同时为患者做好全面检查和检测,防止并发症出现。     

重型颅脑损伤术中及术后死亡原因分析（附12例报告）

重型颅脑损伤术中及术后死亡原因分析（附１２例报告）王竹梅，岑汉杰重型颅脑损伤，是指广泛的脑挫裂伤、脑干损伤或颅内血肿，术中或术后死亡率较高。我院自１９８３年５月至１９８９年７月间施行手术治疗共１２４例。其中１２例于术中及术后短期内死亡（死亡率为９．１...     

外伤性颅内静脉窦损伤的手术治疗

颅内静脉窦损伤是颅脑外伤较少见但严重的并发症，是外伤早期导致病人死亡的重要原因之一。本院从1999年5月至2005年5月共手术治疗16例静脉窦损伤，获得满意效果，现报告如下。     

颅脑损伤术中并发非手术区颅内血肿再次手术17例

术中并发非手术区颅内血肿是神经外科术中严重的并发症,致残率和死亡率均较高。2000年1月至2008年4月．本院在颅脑损伤急诊术中并发非手术区颅内血肿需再次手术的17例,报告如下。     

重型颅脑损伤一侧去骨瓣减压术后对侧迟发颅内血肿临床分析和预防

目的分析重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿发生的原因并提出预防和处理的方法。方法回顾性分析本院经治的12例出现重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿患者的病例特点、治疗经过和预后情况,并结合文献对该手术并发症进行分析。结果 12例患者均行再次开颅手术清除对侧迟发性颅内血肿术。术前CT提示对侧合并颅骨骨折6例,术中出现术侧急性脑膨出并证实对侧迟发性血肿8例。术后3月随访,患者预后良好1例,中残3例,重残5例,死亡4例。结论重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿多发生在首次术后24小时内,对于术前CT提示存在对侧颅骨骨折、术中出现急性脑膨出等情况的患者,应当高度警惕该并发症的发生。及时的发现并手术治疗是争取良好预后的关键。     

老年重型颅脑损伤的诊断治疗(附28例报告)

目的:探讨老年重型颅脑损伤的发病率及临床特点。方法:回顾性总结28例老年重型颅脑损伤病例临床资料,对病情经过GCS评分,影像学检查及治疗等方面进行分析探讨。结果:老年重型颅脑损伤者病情复杂,并发症多,颅内血肿的发病率明显高于青壮年,颅内血肿以硬膜下血肿多见。结论:影响老年重型颅脑损伤疗效的因素复杂,且相互有叠加效应,预后差。提高抢救成功率的关键是早期诊断、治疗。     

3489例外伤性颅内血肿的诊治经验

外伤性颅内血肿在颅脑损伤中是一种常见而严重的继发性损害。我院在21年中(1958～1979)共收治经手术证实的颅内血肿3489例,占同期颅脑损伤住院人数的19.8%。现对其诊断及治疗的某些经验作一总结。     

非外伤性颅脑手术中急性脑膨出的诊治

目的　探讨非外伤性颅脑手术中急性脑膨出的发生原因和防治措施。方法　回顾性分析 10例颅脑手术中出现急性脑膨出病人的临床资料。结果　 10例术后恢复良好 8例 ,中残 1例 ,死亡 1例。结论　非外伤性颅脑手术中急性脑膨出的原因有颅内血肿形成、脑牵拉损伤及脑缺血缺氧 ;维持平稳麻醉、避免过度降低颅压和脑牵拉 ,及时探查处理颅内血肿改善脑血供是防治急性脑膨出的有效措施。     

Minor,moderate and severe head injury

Summary The future role of the neurosurgeon in the management of head injury is reviewed in terms of the care of patients with minor, moderate and severe head injuries. In minor head injury it is predicted that there will be increasing pressure on the neurosurgeon to undertake the management and follow-up of all patients who have sustained head injury, and this will place a considerable additional load on each neurosurgical unit. This is based on a survey of 1919 head injuries admitted in one calendar year (1981), consisting of 93 severe injuries (GCS < 8), 210 moderate injuries (GCS 8–12), and 1616 minor injuries (GCS 13/14). In moderate injuries CT will assume a major role in detecting hematoma early and identifying contusions. There may yet be a role for steroids in these cases and there should be a greater use of neurorehabilitation, instead of the current overemphasis on the severely injured. In severe injury future efforts will be to prevent early secondary insults and to find better methods of controlling raised intracranial pressure.     

Clinical analysis of 28 children suffering from intracranial hematoma and multiple injuries following traffic accidents

Objective: To evaluate the result of diagnosis and treatment of intracranial hematoma and multiple injuries caused by road traffic accidents. Methods: Twenty-eight patients, aged from 1 to 14 years, receiving craniotomy and other surgical treatments were retrospectively reviewed. Results: Among the 28 cases, 23 cured with the recovery rate of 82.3%, 2 had a sequel of moderate disability, and 3 died from severe brain injury, hemorrhagic shock, and other visceral complications. The clinical sympotoms and signs were severe and perplexing. The major characters included: severe head injury, usually combined by multiple injuries, and easy of access to missed diagnosis and misdiagnosis. Conclusions: The occurrence of infection is high after traffic accidents as a result of depression of humoral and cellular immunity, long-term bed rest, and fractures of limbs. Hence, on the basis of maintaining vital signs, the management of primary wound is essential to reduce infection and underlying death. In addition to the management of brain injury, concurrent injuries should also be highlighted so as to reach a good result for their patients.     

Clinical experience of the management for the most severely head—injured patients with GCS score of 3

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Peri—operative treatment of most severely head—injured patients

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Outcome of 2 284 cases with acute traumatic brain injury

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＲｏｎｇｇａｎｇＨｏｓｐｉｔａｌ ,Ｓｈｅｎｚｈｅｎ5 18116 ,Ｃｈｉｎａ (ＺｈａｎｇＪａｎｄＺｈｏｎｇＴＡ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＣｈａｎｇｚｈｅｎｇＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＮｅｕｒｏｓｕｒｇｅｒｙＩｎｓｔｉｔｕｔｅ ,Ｓｈａｎｇｈａｉ 2 0 0 0 0 3 ,Ｃｈｉｎａ(ＪｉａｎｇＪＹ ,ＹｕＭＫａｎｄＺｈｕＣ)ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ (ＴＢＩ) ,ａｃｏｍｍｏｎｃｌｉｎｉｃａｌｐｒｏｂｌｅｍｆｏｒｎｅｕｒｏｓｕｒｇ…     

血管内栓塞联合开颅减压及血肿清除术治疗颅内动脉瘤破裂12例分析

【摘要】〓目的〓探讨通过血管内栓塞术后结合开颅减压术的方法治疗Hunt-Hess分级III-IV级合并颅内血肿的脑动脉瘤破裂病人的可行性和临床价值。方法〓选取2009年3月~2014年2月于我院治疗的颅内动脉瘤破裂出血病人共12例。符合以下条件:①自发性蛛网膜下腔出血合并颅内血肿形成;②Hunt-Hess分级在III-IV级;③头颅CT扫描显示脑中线移位>0.5 cm但<1.0 cm;④经过脑血管造影发现颅内动脉瘤并成功栓塞,然后转手术室再行减压手术。结果〓本组无死亡病例。12例患者术后3个月~1年得以随访,按GOS评分进行疗效评价,5分7例,4分2例,3分2例,2分1例。结论〓合理应用神经放射介入技术和外科手术,对合并血肿的脑动脉瘤破裂出血病人是另一种治疗选择。     

The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial

Summary Treatment resistant intracranial hypertension after severe head injury has a very high mortality with conventional therapy such as hyperventilation and mannitol infusions. In this report, we describe the use of large doses of thiopental as a means of treating such swelling.From a consecutive series of 107 severe head injuries with a Glasgow Coma Score (GCS) of 6 or below, we selected all patients below 40 years age with a progressive increase in intracranial pressure (ICP) to 40 mm Hg.The first 16 patients (mean age 20 years, mean GCS 4.3) were treated with deep barbiturate coma and hypothermia (32–35 degrees Celsius) until stable lowering of ICP was achieved. The next 15 patients received conventional intensive care and were in other respects very similar to the barbiturate group (mean age 26, mean GCS 5.2).After 9–12 months the outcome was classified according to the Glasgow Outcome Scale (GOS). Therapy with barbiturate coma resulted in 6 good/moderate outcomes, 3 severe and 7 dead/vegetative. Conventional treatment resulted in 2 good/moderate outcomes and 13 dead/vegetative.This is a highly significant difference and cannot easily be explained by more severe injuries or complications in the conventional group. Superior control of ICP was achieved by large doses of thiopental and the final outcome was better.     

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Ourhospitalhadadmittedandtreated2 16 5casesofcraniocerebraltraumacomplicatedwiththoraco abdomialinjuriesbetweenJuly 1993andJune 2 0 0 3.Aretrospectivestudywascarriedouttoexploretheoptimaltreatmentforcraniocerebraltraumacomplicatedwiththoraco abdominalinjuries.METHODSClinicaldataAtotalof 2 16 5cases (112 5malesand 10 4 0females)ofcraniocerebraltrauma (CCT)complicatedwiththoraco abdomialinjurieswereincludedinthestudy (averageage ,35 .5 years) .Causesofinjuriesweretrafficaccidentin 1384 (6 3…     

Clinical analysis of craniocerebral trauma complicated wiht thoracoabdominal injuries in 2 165 cases

OBJECTIVE: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. METHODS: A total of 2165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. RESULTS: After treatment, 2024 (93.49%) cases survived and the other 141 (6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 (46.71%) and 53 (24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%-65.96% and 28.57% respectively, indicating a significant difference (P<0.05). CONCLUSIONS: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.     

The use of a fiberoptic intracranial pressure monitor in clinical practice

Four years of clinical experience with a fiberoptic intracranial pressure monitor are presented. One hundred forty patients were monitored, of whom 80 had increased intracranial pressure. Of the patients with nontraumatic intracerebral hematoma and subarachnoid hemorrhage, 100% had increased pressure. Forty-seven of 69 patients with head injuries had elevated pressure; of these, 28 had pressure significant enough to require therapy. Both the patients with head injuries and those with nontraumatic hemorrhage were more effectively treated by using the results of pressure monitoring to determine when therapy was required and to indicate the response of the patient to that therapy. Despite the evidence, monitoring of intracranial pressure is not routine due to a lack of acceptance and effectiveness. To overcome such problems, a system must meet the criteria of ease of insertion, reliability, and lack of complications. These criteria are fulfilled by the fiberoptic system presented.