重型颅脑损伤的手术治疗

目的探讨重型颅脑损伤梯度减压的手术方法对预防术中脑膨出、降低死亡率及致残率的效果。方法对100例重型颅脑损伤患者采用分次减压手术方式及去骨瓣后，硬膜与颞肌筋膜瓣减张缝闭硬膜切口方法。结果40例脑肿胀患者术中脑嘭出6例占15．0％，死亡19例占47．5％；60例脑内血肿病人未发生脑膨出，死亡12例占20％。结论脑外伤后脑血管调节麻痹及血肿压迫继发脑水肿易造成脑膨出.术中分次减压降低了骨窗部位脑组织的顺应性，从而降低了局部的压力梯度，避免脑血管急性扩张，能有效防止脑膨出，降低死亡率及致残率。

Operative therapy of severe cranial brain injury

Objective To investigate the method of grading decompression operative in severe cranial brain injury in preventment brain protrusion during operation , the effect of decreasing mortality and disable rate .Methods 100 cases of severe cranial brain lesion use step decompression operative method and after rid up of bone flap , dural and temporal muscle facial flap decompression suture of dural incision . Results 6 cases out of 40 cases brain swelling happened brain protrusion during operation take up 15.0 % , 19 cases died , dominate 47.5 % , 60 cases intracranial hematoma do not have brain protrusion , 12 cases died occupied 20% .Conclusion Brain vascular control paralysis and hematoma pressure secondary brain edema after brain injury easy to have brain protrusion formation , grading decompression in operation , decrease bone window location brain tissue compliance in order and decrease local pressure grading , avoid acute dilatation of brain blood vessel , effectively prevent brain protrusion, decreasing mortality and disable rate .