急性颅脑损伤手术救治516例

目的 总结急性颅脑损伤手术救治经验和教训。方法 回顾性分析2001年1月-2004年12月手术治疗急性颅脑损伤516例，其中单纯颅骨粉碎凹陷性骨折56例，脑挫裂伤和（或）脑内血肿138例，硬膜外血肿122例，硬膜下血肿126例，弥漫性脑肿胀48例，开放性颅脑损伤18例，其他8例。均在全身麻醉下行常规骨窗骨瓣或标准大骨瓣开颅术。按格拉斯哥预后评分（GOS）进行预后判断。结果 本组行单纯性挫裂伤和（或）血肿清除术170例，同时行常规颞肌下减压79例，标准外伤大骨瓣减压194例，其他术式73例，伤后3～6个月恢复良好304例（58．9％），中残66例（12．8％），重残72例（13．9％），植物生存12例（2．3％），死亡62例（12．0％）。结论 颅脑损伤的手术是急性颅脑损伤救治工作的重点，在颅脑损伤手术救治原治的前提下应对患者进行个体化手术治疗。

Surgical treatment of 516 cases with acute traumatic brain injury

Objective To summarize the experience and lesson of surgical treatment of acute traumatic brain injury.Methods A total of 516 cases with acute traumatic brain injury treated surgi- cally from January 2001 to December 2004 in our hospital were analyzed retrospectively.Of all,there were 56 cases with simple comminuted depressed fractures,138 with brain contusion and laceration and/ or intracerebral hematoma,122 with epidural hematoma,126 with suhdural hematoma,48 with diffuse brain swelling,18 with open brain injuries and eight with other kind of injury,all of whom were treated with standard large eraniectomy under general anaesthesia.The treatment results were evaluated by Glas- cow Outcome Scale(GOS).Results Of all,standard large craniectomy was performed in 194 cases, of which 304 cases(58.9%)were with good recovery,66(12.8%)with moderate deficit,72(13.9%) with severe deficit,12(2.3%)under persistent vegetative status and 62(12.0%)died 3-6 months after surgery.Conclusions More attention should be paid to surgery for traumatic brain injury.Individual surgical treatment should be performed under surgical principles.