颅脑损伤术后再出血临床分析

目的:探讨颅脑损伤颅内血肿术后再手术原因,减少再次手术,提高颅脑损伤救治成功率。方法:回顾性分析我院55例颅脑损伤颅内血肿清除术后再手术的原因及其导致再手术影响因素。结果:再手术的原因为迟发性血肿21例(36%)、止血不彻底10例(18%)、术中低血压7例(12%)、凝血障碍6例(11%)、骨窗过小5例(9%)、脑梗死5例(9%)。结论:广泛性脑挫裂伤伴颅骨折为术后颅内再出血手术的高危因素,而首次手术要彻底清除挫碎失活脑组织、直视下彻底止血、术中维持正常血压、对凝血障碍患者术中及时输入新鲜血浆、冷沉淀、血小板及时补充凝血因子可以减少再手术的可能。

Traumatic brain injury Clinical analysis of postoperative bleeding

Objective:To investigate the intracranial hematoma after traumatic brain injury causes of re-operation,reduce re-operation,improve the success rate of treatment of traumatic brain injury.Methods:A retrospective analysis of 55 cases in our hospital intracranial hematoma after traumatic brain injury reoperation of the causes and factors leading to re-operation.Results:Reoperation because of delayed hematoma in 21 cases (36%),bleeding is not completely in 10 patients (18%),intraoperative hypotension in 7 patients (12%),coagulation disorder in 6 cases (11%),bone window is too small in 5 cases (9%),cerebral infarction in 5 cases (9%).Conclusion:Extensive Cerebral contusion with skull fracture is the risk factor of rebleeding after intracranial surgery.In the first operation,Remove broken inactivation brain tissue thoroughly,complete hemostasis under direct vision,surgery to maintain normal blood pressure,surgery on blood coagulation disorders in a timely infusion of fresh plasma,cryoprecipitate and platelets to replenish clotting factor can reduce the possibility of re-operation.