基层医院特急性外伤性颅内血肿78例救治体会

目的　探讨基层医院特急性 (伤后 3h内 )外伤性颅内血肿的救治体会。方法　将近 9年来收治特急性外伤性颅内血肿 78例作临床分析。结果　手术治疗 66例 ,死亡 1 8例 (2 7.2 7% )。出院时格拉斯哥预后评分 (glasgowoutcomescaleo ,GOS)恢复良好 37例 ,预后不良 2 9例 ,其中脑疝早期 7例均手术治疗 ,恢复良好 6例 ,预后不良 1例。脑疝中期 2 9例均手术治疗 ,恢复良好 2 2例 ,预后不良 7例。脑疝晚期 42例中手术 30例 ,恢复良好 9例 ,预后不良 2 1例 ,非手术 1 2例全部死亡。结论　特急性外伤性颅内血肿在脑疝早期及中期及时手术效果良好 ,脑疝晚期手术效果不佳 ,死亡率及致残率极高 ,及时手术及术后包括亚低温治疗在内的综合治疗是抢救成功的关键

CLINICAL ANALYSIS OF 78 CASES WITH TRAUMATIC INTRACRANIAL HEMATOMA

Objective\ To study into the treatment for the most acute traumatic intracranial hematoma (in 3 h) in basic hospital.Methods\ To have clinical analysed 78 cases of this disease in the past nine years.Results\ That among the 66 cases were operated and 18 patients died(27.27%). When discharged from hospital, 37 cases recovered well, and just 29 cases prognostic symptoms were unfavorable according to GOS(glasgow outcome scale). Among them 7 cases were operated on during the early stage of brain herniation, 6 cases recovered well except one. In the middle age of brain herniation , 29 cases were operated on among whom 22 cases recovered well except 7. During the later period 30 cases were operated on from the 42 cases , among whom 9 cases recovered well except 21.12 patients died without operations.Conclusion\ The effect of operations on the most acute traumatic intracranial hematoma is good in the early and middle period .Instead , in the late period the effect of operation is unfavorable , which may cause the death and disablement rate increasing .The timely operation and the composite cure after that including the sub-hypothermia treatment is the key to succeed in rescue.