重型颅脑损伤开颅术中急性脑膨出的防治

目的 探讨重型颅脑损伤患者开颅术中急性脑膨出的原因及防治措施.方法 回顾性分析43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 本组病人术中急性脑膨出的原因包括迟发性颅内血肿21例,弥漫性脑肿胀13例,长时间脑疝(2 h以上)4例,外伤性大面积脑梗死3例,术中低血压或低氧血症2例.出院后半年按GOS评定预后:恢复良好14例,重、中残6例,植物生存3例,死亡20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;针对不同病因的综合治疗有助于改善患者预后及降低患者死亡率.

Treatment of intraoperative acute encephalocele in patients with severe traumatic brain injury

Objective To explore the causes and management of intraoperative acute encephalocele in the patients with severe traumatic brain injury. Methods The clinical data of 43 patients with severe traumatic brain injury who had acute encephalocele during the surgery were analyzed retrospectively. The prognoses were assessed by GOS in all the patients 6 months after the discharge from hospital. Results The causes of intraoperative acute encephalocele included delayed intracranial hematomas in 21 cases, posttraumatic diffuse brain swelling in 13, mass cerebral infarction in 3, intraoperative hypotension or hypoxemia in 2 and hernia lasting more than two hours in 4. Of 43 patients, 14 were recovered well, 6 moderately or severely disabled, 3 vegetatively survived and 20 died. Conclusions Careful understanding of the traumatic mechanism and head CT data is important to the predicting intraoperative acute brain encephalocele. Comprehensive treatment directed at the causes of encephalocele can improve the prognoses and decrease the mortality in the severe traumatic brain injury patients with introperative acute encephalocele.