284例重及特重型颅脑创伤的手术疗效分析

目的 探讨重及特重型颅脑创伤不同时间的手术疗效.方法 本组284例患者全部行开颅血肿清除和/或去骨瓣减压术.其中超早期(3～6 h)手术201例,占70.8%;早期(7～12 h)手术63例,占22.2%;晚期(13～24 h)手术加例,占7.0%.结果 本组病例中3～6 h手术201例,死亡58例(28.2%);7～12 h手术63例,死亡20例(31.7%);13～24 h手术20例,死亡8例(40.0%).按出院时格拉斯哥预后评分(GOS)评估疗效:良好130例占65.7%,中残36例占18.2%,重残23例占11.6%,植物生存9例占4.5%,死亡86例占30.3%.结论 重及特重型颅脑创伤,伤势重,伤情复杂,病情变化快,病死率高;强调现场与院前抢救技术的熟练和救治系统的质量保证是成功的关键;同时要加强多器官继发性损害的治疗,预防并及时准确处理各种并发症.

Analysis of 284 severe and specially severe brain injury cases

Objective To discuss our experience of treatments of 284 cases of severe and specially severe traumatic brain injury at different stages.Methods Two hundred and eighty-four cases were treated with craniotomy hematoma clearance and/or decompressive craniectomy.Among them,201(70.8%)cases were given super-early stage(3～6 h)operations,63(22.2%)cases had early stage(7～12 h)operations,and 20(7.0%)cases had advanced stage(13～24 h)operations.Results Fivty-eight(28.2%)of super early stage operation patients were dead,20(31.7%)of early stage operation were dead,and 8(40.0%)of advanced stage operation were dead.According to the therapeutic evaluation at the time of hospital discharge(GOS),there are 130(65.7%)cases cured,36(18.2%)cases moderately disabled,23(11.6%)serious disabled,9(4.5%)in vegetative state,86 (30.3%)cases died.Conclusion Severe and specially severe traumatic brain injury are characterized by serious damage,complex conditions,rapid change and high mortality.It is important to emphasize the skills of both on site and pre-hospital first-aid.Meanwhile,hospital therapies should aim at secondary multi-organ damages,following complications.