颅脑损伤术中急性脑膨出原因63例分析

目的 探讨颅脑损伤手术中急性脑膨出的原因。方法 对手术中脑膨出的63例颅脑损伤病人进行回顾性分析。结果 异位血肿34例,手术窗过高6例,脑无氧或严重缺氧损害18例,膀胱过度充盈3例,呼吸末正压通气2例。结论 淤血性脑肿胀手术窗选择不当、异位颅内血肿形成、脑缺氧造成的弥漫性脑肿胀是颅脑损伤术中脑膨出的三大主因。选用标准外伤大骨瓣;术中或术后立即复查CT,及时发现并清除新形成的异位颅内血肿;强调创伤现场心肺复苏,避免术前窒息,缩短术前颅高压的时间,减轻低血压和气道不畅造成的脑缺氧损害,能降低脑膨出的发生率和死亡率。

The causes and treatment of acute intraoperative encephalocele in head - injured patients (report of 63 cases)

Objective To summarize the causes of acute intraoperative encephalocele in head- inured patients. Methods 63 cases head injured patients with acute intraoperative encephalocele were analysed retrospectively.Results 34 led by intracranial heamatomain in other place,6 caused by unfit operative-area, 18 produced by the injury of cerebral anoxia or serious hypoxia,3 high extent cystauxe,2 positive pressure in the breathing end.Conclusion Unfit operative- area in patients with brain venous stagnation,intracanial heamatoma in other place,acute diffuse brain swelling caused by cerebral anoxia or serous hypoxia were the main three causes of intraoperative encephalocele. Using standard large trauma craniecto-my;taking cranium CT- scan just in or past the operation in order to discover and remove the delayed intracranial heamatomas in time;emphasizing present emergency treatment, avoiding asphyxia, shortening the time of high introcranial presure, reliving the hypoxia damage caused by hypotension and cramped respiratory passage can decrease the attack rate and the mortality rate of intraoperative encephalocele.