应用标准外伤大骨瓣减压术治疗特重型颅脑损伤

目的探讨标准外伤大骨瓣减压术治疗特重型颅脑损伤的疗效。方法83例特重型颅脑损伤患者均采用美国标准外伤大骨辨减压术治疗,同时重视早期脑保护,维持内环境稳定,重视早期亚低温治疗、营养支持及微循环改善。术后随访1个月至12个月,根据格拉斯哥预后积分评分法评定疗效。结果良好17例(20.48%),中残11例(13.25%),重残18例(21.69%),植物生存9例(10.84%),死亡28例(33.74%)。28例死亡患者中21例术前已出现呼吸不规则或异常,7例术中急性脑膨出,术后均死亡。存活55例中,8例出现脑积水行"脑室-腹腔分流术,"7例伴外伤性癫痫。结论标准大骨瓣减压术可充分降低颅内压,是治疗特重型颅脑损伤的有效手术方法。

Standard trauma decompression of greater bone flap for severe craniocerebral injury

Objective To study the curative effect of standard trauma decompression of greater bone flap in treating severe craniocerebral injury. Methods 83 cases with severe craniocerebral injury were treated with american standard trauma decompression of greater bone flap. Meanwhile special attention should was paid to the protection of the brain in the early period, stable internal environment was maintained, and subhypothermia treatment, nutrition support and improvement of microcirculation were taken into consideration. The following-up after operation were done from the first month to the 12^th month, and then the curative effect was evaluated by glasgow outcome scale grading system. Results 17 cases were in good condition （20.48%） ; 11 cases were moderate disabled（ 13.25% ） ; 18 cases were severely disabled（21.69% ） ; 9 cases were in plant surviving condition（ 10.84% ） ; 28 eases resulted in death（33.74% ）. Dicoria was over 2 h in the 28 dead cases,among which 21 cases were with irregular or abnormal breath,and 7 cases were with acute encephalocele,all dead after operation. As to the 55 surviving cases, hydrocephalus appeared in 8 cases and shunt was done from ventricles of brain to the abdominal cavity, traumatic epilepsy appeared during operation in 7 cases. Conclusion Standard trauma decompression of greater bone flap can greatly reduce the intracranial pressure. It is the effective surgery in treating severe craniocerebral injury.