重型颅脑损伤术中严重低血压分期手术处理

目的探讨重型颅脑损伤术中严重低血压分期手术的临床意义。方法回顾分析24例重型颅脑损伤术中严重低血压，简化急诊手术，生命体征平稳定后，再次开颅手术的病例，探讨术中低血压的原因，终止手术的必要性以及再次手术的意义。结果本组24例均二次手术，首次手术后6～54h，平均18．5h血压恢复平稳，两次手术间隔7～72h，平均34h；死亡率20．8％，轻残及良好率58.3％，重残率12．5％，植物生存率8.3％。结论合并伤是重型颅脑损伤低血压的主要原因，分期手术处理对减轻继发性脑损害的发生发展，对病人神经功能的良好恢复起着重要作用。

Staged surgical treatments of severe hypotension (low blood pressure) during operation of severe craniocerebral injury

Objective To investigate the treatment of severe hypotension during the operation of severe craniocerebral injury. Methods A retrospective review was conducted over the surgical treatment of 24 cases of severe craniocerebral injury with low blood pressure during operation, who received craniotomy again after predigesting the emergency operation and their vital signs were stabilized, so as to discuss the reasons of low blood pressure during operation, the necessity of stopping surgery as well as the significance of second operation. Results A second operation was undergone on all of the 24 patients. 6 to 54 hours (the mean was 18.5 hours) later the blood pressure was recovered after the first operation. The intervals between two operations ranged from 7 to 72 hours, the mean about 34 hours. The mortality rate was 20.8 %, the rate of good recovery and slight lameness was 58.3%, the rate of severe lameness was 12.5 %, and vegetative 8.3 %. Conclusion Complicated non -brain injuries were the primary reason to cause shock during the operations of severe craniocerebral injury. Staged operation was propitious to lighten the second brain injury and recover the neural function of patients.