GCS 3～5分幕上单纯硬膜外血肿病人的救治

目的探讨GCS3～5分特重型颅脑伤中幕上单纯硬膜外血肿病人的救治方法。方法脑外伤致GCS3～5分幕上单纯硬膜外血肿共28例，其中A组10例采用单纯血肿清除术，B组18例采用血肿清除及大骨瓣减压术，术后早期行小剂量多次脱水以及扩血管药物、高压氧等治疗。术后24h复查CT。结果A组病人均出现严重脑梗塞以及脑水肿，死亡9例(90％)，B组病人也全部出现脑水肿，其中10例出现脑梗塞。但大部分病例较A组程度轻，严重脑梗塞以及脑水肿6例(33％)均死亡。结论GCS3～5分特重型颅脑伤单纯硬膜外血肿病人术后脑水肿及脑梗塞发生率极高．故应行大骨瓣减压术，术后早期给予小剂量多次脱水及血管扩张药等，可明显降低病人死亡率。

Treatment of purely supratentorial epidural hematoma with GCS 3～5

Objective To investigate the more effective method in the treatment of purely supratentorial epidural hematoma patients with GCS 3~5. Methods In 28 cases of purely epidural hematoma with GCS 3~5,10 cases in group A were treated by simple evacuation of epidural hematoma, while 18 cases in group B by evacuation of epidural hematoma with large decompressive craniotomies as well as small-dose and repetitious dehydrating agents, vasodilators and hyperbaric oxygen therapy after the operation. All cases were given CT scanning at 24 hour after surgery. Results In group A, all patients presented with severe cerebral infarction and cerebral edema, and 9 patients (90%) died. In group B, all patients also developed cerebral edema and 10 cases got cerebral infarction, most of which are milder than group A. 6 patients (33%) died. Conclusion The large decompressive craniotomy is an effective method of treating purely supratentorial epidural hematoma patients with GCS 3~5. Early postoperative administration of small-dose and repetitious dehydrating agents, vasodilators and hyperbaric oxygen therapy can markedly decrease the mortality rate.