重型颅脑损伤术中急性脑膨出的临床分析及术中对策

目的探讨重型颅脑损伤开颅手术中急性脑膨出的形成原因及术中对策。方法回顾分析59例术中出现脑膨出的重型颅脑损伤病人的受伤机制、临床表现、CT特征，总结脑膨出形成原因。结果按GOS标准，治疗后6个月评定治疗效果，恢复良好13例，中残15例，重残8例，死亡23例。结论迟发性颅内血肿、急性脑肿胀、低血压、脑缺氧、长时间脑疝是重型颅脑损伤术中急性脑膨出的主要原因，正确判断脑膨出的性质，采取相应的术中对策是治疗术中脑膨出的有效措施。

Analysis of acute intraoperative encephalocele and surgical treatment in patients with severe head injury

Objective To explore the cause of acute intraoperative encephaiocele and its operative methods in the patients with severe head injuries. Methods The injury mechanism, clinical manifestations and CT data of 59 patients with acute encephalocele during the surgery for severe head injuries were analysed retrospectively. Results According to GOS of 59 patients with acute intraoperative encephalocele 6 months after the surgery, 13 recovered well, 15 moderately disabled, 8 severely disabled and 23 died. Conclusions The main causes of the acute intraoperative encephalocele include delayed intracranial heamatoma, acute brain swelling, hypotention, cerebral anoxia, and longterm brain herniation in the patients with severel head injuries. The correct diagnosis and operative treatment for intraoperative encephalocele can significantly reduce the mortality and disability.