颅脑外伤的手术时机探讨

目的对颅脑外伤的手术时机进行探讨,以提高颅脑外伤的治疗效果。方法将66例颅脑外伤病例,主要以颅脑外伤意识进行性改变的不同程度及瞳孔的变化分为两组,结合头颅CT表现,对比分析两组病例在不同的手术时机行手术的治疗效果。Ⅰ组35例,在昏迷前、患侧瞳孔无改变或稍有改变,但瞳孔对光反射仍灵敏时行手术治疗。Ⅱ组31例,在昏迷后、除2例瞳孔无异常,余均伴一侧或双侧瞳孔散大时行手术治疗。结果Ⅰ组:良好34例(97.1%),中残1例(2.9%)。Ⅱ组:良好8例(25.8%),中残7例(22.6%),重残5例(16.1%),死亡11例(35.5%)。两组良好率、病死率比较,有显著的统计学意义(P<0.01)。结论颅脑外伤合并颅内血肿病例,宜在清醒时或在昏迷前,瞳孔散大前手术,其效果极好;病情进展至昏迷伴瞳孔散大者预后明显变差。

The Approach of Operation Opportunity about Craniocerebral Trauma

Objective Approach of operation opportunity about craniocerebral trauma,in order to increase the therapeutic efficacy of craniocerebral trauma. Method According to the level of awareness change of craniocerebral trauma patients and pupil change, 66 patients divide into 2 groups（ Ⅰ group, 35 cases, before coma the patients pupil no change or little change, operation while the patients pupil light reflex is sensitive; Ⅱ group, 31 cases, after coma 2 patients pupil no abnormalities, and others operation opportunity is when the patients one or two mydriasis）, to analysis the therapeutic efficacy by different operation opportunity. Result Ⅰ group： 34 patients is outcome well after operation（97.1%）, midrange disability 1 case（2.9%）; 11 group： 8 patients is outcome well（25.8%）, midrange disability 7 cases（22.6%）, serious disability 5 cases（16.1%）, and death 11 cases（35.5%）.Rate of outcome well and case fatality is statistical significance（P〈0.01）. Conclusion The craniocerebral trauma complic intracranial hematoma patients, operation outcome is well while patients clear-headed, before coma or mydriasis; outcome is bad while patients coma and mydriasis.