外伤性弥漫性脑肿胀术中急性脑膨出防治体会

目的探讨弥漫性脑肿胀患者术中急性脑膨出的防治措施。方法回顾性分析我科手术治疗的150例外伤后弥漫性脑肿胀患者的临床资料。结果术中有42例出现急性脑膨出，发生率28．0％，其中有13例低血压，29例低氧血症，17例发生了迟发性血肿。术后半年随访，仅8例死亡，病死率18．8％。结论对外伤性弥漫性脑肿胀患者早期实施手术，及时纠正低氧血症和低血压以及呼吸机的合理应用是预防术中急性脑膨出的重点。治疗的关键是采用标准脑外伤大骨瓣开颅、控制性降低血压、普鲁泊福麻醉镇静、过度换气、亚低温和及时清除迟发性血肿。

Prevention and treatment of acute intraoperative encephalocele in patients with diffuse brain swelling

Objective To summarize the prevention and treatment of acute intraoperative encephalocele in patients with diffuse brain swelling.Methods Clinical data of 150 cases of traumatic diffuse brain swelling were retrospectively analyzed.Results 42 cases suffered from acute intraoperative encephalocele,with the incidence rate of 28.0%,13 cases suffered from hypotension,29 from hypoxia and 17 from delayed hematoma.Half-year follow up found that only 8 cases died after operation,with fatality rate of 18.8%.Conclusion Early craniotomy,correcting hypoxia and hypotension,early assistant ventilation are of main prophylactic offects methods of the acute intraoperative encephalocele.The key of treatment to acute intraoperative encephalocele is standard large trauma craniotomy,controlled hypotension,propofol anesthesia,hyperventilation,mild hypothermia and timely elimination of delayed intracranial hematoma.