重型颅脑损伤手术中急性脑膨出的原因分析及救治

目的探讨重型颅脑损伤手术中急性脑膨出形成的原因及采取的救治措施。方法回顾性分析我科2009年1月-2013年1月重型颅脑损伤术中急性脑膨出的37例患者临床资料，总结脑膨出的原因，术中处理对策及预后。结果37例脑膨出病例中，迟发型对侧出血的25例，弥漫性脑肿胀12例。迟发型对侧出血中，硬膜外血肿19例，脑挫伤伴脑内血肿6例。对侧硬膜外血肿给予再次手术16例，对侧脑挫伤及脑内血肿给予再次手术5例。术后6个月随访，根据COS评分，恢复良好8例，中残7例，重残2例，植物生存2例，死亡18例。结论对于重型颅脑损伤手术病人术前要做好充分的准备，选择适当手术时机和正确手术方式，若术中出现急性脑膨出时如条件允许应尽快复查头颅CT明确诊断，如有迟发性血肿积极二次手术，可提高患者生存率及预后。

The causes and management of acute intraoperative encephalocele in patients with severe trau- matic head injury

Objective To analyze the causes and treatment of acute encephalocele in pa- tients during operation with severe traumatic head injury. Methods The clinical data were collect- ed and analyzed for 37 patients with severe head injuries who suffered acute intra--operative en- cephalocele. Patient outcome is reported according to the Glasgow Outcome Scale （GOS） at 6 months. Results Among these patients, 12 cases showed severe brain swelling and 25 cases dem- onstrated delayed contralateral intracranial hematoma after surgery,of which there were 19 cases of and. There were 16 cases of epidural hematoma and 5 cases of cerebral hemorrhage received de- layed surgery with hematoma evacuation. According to the Glasgow outcome score （GOS）, there were a favorable prognosis （n=8）, moderate disabilities （n=7） and severe disability （n=2）, whereas 18 patients （48. 6%） died and 2 patients in a vegetative state. Conclusion There is a high percentage of surgery and worsening on computed tomographic scans in patients with severe head injury,The probability of acute intra--operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The causes for acute en- cephalocele should be analyzed, and in view of different causes, targeted therapy can effectively.