156例重型颅脑损伤救治体会

目的总结重型颅脑损伤救治经验及影响其预后的因素。方法对我院1996年以来救治的156例重型颅脑损伤的临床资料进行回顾性分析。结果按格拉斯哥预后评分(GOS)分为良好、中残、重残、植物生存和死亡。结论重型颅脑损伤病情危重、发展快、死亡率高,其死亡率与格拉斯哥昏迷评分(GCS)评分、基底池受压程度、中线移位有关。提高疗效应根据以下11个方面:(1)建立创伤救治体系与实施颅脑创伤早期专科救治;(2)保持呼吸道通畅;(3)对颅脑创伤患者进行CT检查并跟踪观察中脑周围池的变化;(4)病因治疗;(5)充分重视大骨瓣减压的效果;(6)冬眠低温治疗;(7)充分重视高血糖对预后的影响;(8)低氧血症和低血容量的防治;(9)防治脑血管痉挛;(10)早期应用纳络酮;(11)尽早应用高压氧疗。

Treatment experience of severe cranioeerebral trauma in 156 cases

Objective To summarize the treatment experience of severe craniocerebral traumas and the factors on the prognosis of patients.Methods The retrospective analyses were made on 156 cases of severe craniocerebral traumas in Puyang traditional Chinese Medicine Hospital,from 1996 to now.Results According to GCS score,the patients were divided into five groups.Good outcome,Medium-deformity,Severe-deformity,Vegetative state,death.Conclusions The patients of severe craniocerebral traumas were in a bad way,the course of the disease's progress was fast,the mortality rate were high.The mortality rate was relevant to:the GCS score,the degree of the basal cistern compression and the shift of the midline.The following 11 aspects could improve the curative effect:1.The foundation of injury curing system and craniocerebral injury's early treatment did by the neurosurgery;2.To keep airway smoothly;3.Do CT to patients who had head injure,establish the CT Changes of midbrain and perimesencephalic cistern.4.Pathogeny therapy;5.Give enough recognition about decompressive craniectomy with large bone flap resection;6.Hypothermia and hibernation therapy;7.Give enough recognition about hyperglycemia on the prognosis of patients;8.Hypoxemia and hypovolemic's prevention and cure;9.Cerebral vasospasm's prevention and cure;10.Nalocone should be used early;11.Hyperbaric oxygenation should be used as soon as possible.