重型颅脑损伤术中急性脑膨出原因分析与对策

目的：探讨重型颅脑损伤患者开颅术中急性脑膨出的原因与防治措施。方法回顾分析2010年6月至2014年1月38例术中出现急性脑膨出的重型颅脑损伤患者的临床资料。结果迟发颅内血肿、术中弥漫性脑肿胀、严重的脑挫裂伤、外伤性的大面积脑梗死、术中低血压或低氧血症、气道梗阻、外伤性颈内动脉闭塞等是其发生的主要原因，根据GOS评分，术后6个月恢复轻残8例(21．1%)，中残7例(18.4%)，重残5例(13．2%)，植物状态3例(7.9%)，死亡15例(39.5%)。死亡原因：原发脑干损伤3例，慢性全身衰竭3例，多器官功能衰竭9例。结论术前详细了解受伤机制，认真研究影像学资料对术中脑膨出的预判具有重要意义；针对不同病因采取相应的措施，提高治疗效果，改善患者的预后。

Reason analysis and strategies of acute encephalocele in severe cerebral injury

Objective To analyse the reasons and control measures of acute encephalocele in craniotomy among severe cerebral inju-ry patients. Methods The clinical data of severe cerebral injury patients with acute encephalocele in 38 operations from June, 2010 to Janu-ary, 2014 were retrospectively analyzed. Results The primary reasons of acute encephalocele were delayed intracranial hematoma, PADBS in operation, severe contusion and laceration of brain, traumatic massive brain infarction, hypotension or hypoxemia during operation, airway obstruction and traumatic ICAO etc. According to GOS score, mild disability occurred in 9 cases of the patients who were recovered (21. 1%), medium disability in 7 cases(18. 4%), severe disability in 5 cases(13. 2%), vegetative state in 3 cases(7. 9%) and death in 15 cases(39. 5%). Causes of death were as follows:3 cases of PBSI, 3 cases of chronic systemic failure, and 9 cases of MOF. Conclusion An overall understanding of injury mechanism before operation, careful study of the key significance of iconography data on prognosis of en-cephalocele, and employment of corresponding measures on the basis of various pathogenesis are important in improving the therapeutic effect and prognosis of patients.