创伤后迟发性脑肿胀的临床特点与治疗

目的 探讨创伤后迟发性脑肿胀的临床特点、发病机制与治疗。方法 回顾性分析1998年1月～2005年6月年收治的17例迟发性脑肿胀患者的临床特点和救治情况。结果 所有颅脑损伤患者采用保守治疗后均有好转，但于伤后5-10d出现恶化，CT复查有脑肿胀，经加强综合脱水等治疗后16例治愈，1例死亡。结论 迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下薄层血肿及早期CT有脑肿胀者。其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。此类患者病情隐蔽性强，应加强观察、积极行CT复查，如能早期明确诊断，保守治疗多数效果良好。

Clinical characteristics and treatment of delayed traumatic brain swelling CHEN Xiao-dong,

Objective To analyze retrospectively the clinical characteristics, pathogeny and therapy of the delayed traumatic brain swelling. Methods Seventeen typical cases admitted 1998.1-2005.6 were reviewed and analyzed retrospectively concerning the clinical characteristics and therapies. Results The condition of all cases got improvement after nonoperative treatment, but worsened approximately 5 to 10 d after injury, and repeated CT scanning demonstrated severe brain swelling. After conservative management based on dehydration 16 were cured and 1 died. Conclusion Delayed traumatic brain swelling is inclined to occur in contrecoup brain injury, and especially accompanied with SAIl, thin subdural hematoma and brain swelling showed in early CT scanning. The mechanism is related to delayed cerebral vasospasm, microcirculation disorder, cerebral hyperemia, and decreasing effect of mannitol. Neurological deterioration of these patients was difficult to be found early, and dynamic CT scanning is especially important to diagnosis. Satisfactory curative effects can be achieved on the basis of early diagnosis and appropriate conservative therapy.