重型颅脑损伤术中急性脑膨出的治疗

目的探讨重型颅脑损伤术中急性脑膨出形成的各种因素以及应取何种有效的防治措施。方法对我科自1993年1月至2004年6月的43例术中出现急性脑膨出的患者进行回顾性分析,总结其形成原因及易发征象,比较各种防治措施的疗效。结果术中迟发性颅内血肿的形成、急性弥漫性脑肿胀、长时间脑组织缺血缺氧、长时间脑疝和低血压等是重型颅脑损伤术中急性脑膨出的主要原因。本组病例恢复良好4例(9.3%),中残4例(9.3%),重残11例(25.6%),死亡24例(55.8%)。结论针对不同病因采取相应的防治措施,彻底清除颅内血肿、大骨瓣去除充分减压、改善脑供血供氧、降低颅内压、控制血压等是预防及治疗术中脑膨出的有效措施。从而提高重型颅脑损伤术中脑膨出的疗效,改善预后。

Treatment of acute encephalocele during Severe brain injury operation

Objective To study effective treatment of acute encephalocele during severe brain injury operation. Methods Forty-three patients suffering from acute encephalocele preventions measures from January 1993 to June 2004 were analyzed retrospectively. Many possible etiological factors and signs were summarized. All kinds of measurements of preventions measures and treatment were compared. Results Major causes of acute encephalocele included late intracranial hemetoma, acute diffused cerebral swelling, prolonged cerebral ischemia and hypoxia, cerebral herniation and hypotension.Good recovery occurred in 4 patients (9.3%), moderate disability in 4 patients (9.3%), severe disability in 11 patients (25.6%), death in 24 patients (55.8%).Conclusion It is useful to take different measurements according to different causes such as complete clearance of hematoma, adequate reduction of intracranial pressure, blood pressure control, improvement of blood and oxygen supplies to the brain. These measures will improve efficacy of treatment and prognosis for intraoperative acute encephalocele after severe brain injury.