特重型颅脑损伤术中急性脑膨出的救治体会

目的探讨特重型颅脑损伤患者术中急性脑膨出的原因及防治方法。方法回顾性分析2l例特雨型颅脑损伤标准外伤大骨瓣开颅术中急性脑膨出患者的临床资料，18例患者术后寸即复查头部CT，发现迟发性颅内血肿7例，远隔部位原有血肿扩大4例，弥漫性脑肿胀6例，人而积脑梗塞1例。单侧开颅7例，双侧开颅14例；其中6例行内减压术。结果疗效评定采用GOS评分：4分（中度病残）4例，3分（重度病残）5例，2分（植物生存）3例，1分（死亡）9例。结论术中急性脑膨出的主要原因是对侧迟发性颅内血肿和弥漫性脑肿胀，积极寻找脑膨出的原因并及时止确的处理直接关系到患者的预后。

Management of acute cephalocele during operation for especially severe craniocerebral injury

Objective To explore the cause, treatment and prevention of acute cephalocele during operation for especially severe eraniocerebral injury. Methods The clinical data of 21 cases with acute cephalocele during operation for especially severe craniueerebral injury were retrospective analyzed. A total of 18 cases were rechecked by CT scan ＇after operation immediately,in which delayed iutraeranial hematomas were detecled in 7 cases,expanded intracranial hematoma at remote site in 4 cases, acute diffuse cerebral swelling in 6 cases and massive cerebral infarction in 1 case. There were 7 patients subjected to unilateral craniotomy,and 14 patients subjected to bilateral craniotomy; Among them 6 cases received internal decompression. Results According to Glasgow scoring system,4 patients had moderate disability（ score 4） ,5 patients had severe disability（ score 3 ） ,3 patients were in vegetative state （score 2）, and 9 patients died（ score 1 ）. Conclusion The major causes of acute cephaloeele during operation are eontralateral de- layed intracranial hematoma and diffuse cerebral swelling. The prognosis can be improved through early etiological diagnosis and appropriate management.