颅脑外伤术中脑膨出的分型研究及综合治疗

目的探讨颅脑外伤患者开颅术中发生急性脑膨出的分型及综合治疗。方法将本院自2005年5月~2010年5月开颅手术中发生脑膨出的66例患者分5型：对侧硬膜外血肿型（Ⅰ型）,窦汇区硬膜外血肿型（Ⅱ型）,对侧额颞部硬膜下血肿、脑挫伤型（Ⅲ型）,大面积脑梗死型（型）,弥漫性脑肿胀型（Ⅴ型）。分析各型临床特点,采用综合治疗措施。结果根据伤后6个月GOS预后评分判断预后,Ⅰ型GOS 1患者7例,GOS 2~3患者1例,GOS 4~5患者6例;Ⅱ型GOS 1患者4例,GOS 2~3患者1例,GOS 4~5患者1例;Ⅲ型GOS 1患者7例,GOS 2~3患者2例,GOS 4~5患者1例;Ⅳ型GOS 1患者9例,GOS 2~3患者2例,GOS 4~5患者1例;Ⅴ型GOS 1患者22例,GOS 2~3患者2例,GOS 4~5患者0例。经过Ridit分析,认为5型之间的预后差异有高度的统计学意义（P〈0.01）。结论颅脑外伤术中脑膨出的分型能反映临床特点及预后,对临床治疗起到重要的指导意义,并提高早期预后判断的准确性和可靠性。

Typing and comprehensive treatments of intraoperative encephalocele in patients with brain injury

Objective To explore typing and comprehensive treatment of acute encephalocele in craniotomy of patients with brain injury.Methods A total of 66 patients who had encephalocele in the course of craniotomy from May 2005 to May 2010 in our hospital were divided into five types,namely,contralateral epidural hematoma（typeⅠ）,posterior fossa epidural hematoma（typeⅡ）,contralateral subdural hematoma and contusion（type Ⅲ）,massive cerebral infarction（typeⅣ） and acute diffuse brain swelling（typeⅤ）.Clinical features of various types and comprehensive treatments were analyzed.Results Six months after injury,Glasgow Outcome Scale（GOS） was used for prognosis.Consequently,there were 7 patients with type Ⅰ GOS1,1 patient with GOS 2-3,6 patients with GOS 4-5,4 with type Ⅱ GOS1,1 patient with GOS2-3,1 patient with GOS 4-5,7 patients with type Ⅲ GOS1,2 with GOS2-3,1 patient with GOS 4-5,9 patients with type IV GOS1,2 with GOS 2-3,1 patient with GOS 4-5, 22 patients with type V GOS1,2 with GOS 2-3 and no patients with GOS 4-5.Ridit analysis revealed the differences in the prognosis between the 5 types of encephalocele was of statistical significance（P0.01）.Conclusion The typing of intraoperative encephalocele can reflect the clinical features and prognosis,which can guide clinical treatment and improve the accuracy and reliability of early judgment of prognosis.