急性颅脑损伤术中脑膨出原因及治疗(附31例报告)

Causes of Acute Intraoperative Encephalocele in Patients with Craniocerebral Injury and Treatment Experience(a report of 31 cases)

目的探讨颅损伤手术中急性脑膨出的原因及预防、治疗措施。方法对手术中脑膨出的31例颅脑损伤病人进行回顾性分析。结果迟发性颅内血肿形成、脑缺氧造成的弥漫性脑肿胀、手术切口及硬膜切口选择不当,是颅脑损伤手术中膨出的主要原因。膀胱过度充盈等也是术中脑压升高的重要原因。术前术中尽量避免或减轻脑缺氧、选用规范的开颅切口、及时发现并清除迟发性颅内血肿,是预防和治疗脑膨出的关键;术中控制性降压、使用脱水剂、适当过度通气对控制某些脑膨出有一定效果。结论尽量缩短术前颅高压的时间、避免低血压和窒息、规范开颅、术中或术后立即 CT 复查发现脑膨出原因,是降低脑膨出发生率和死亡率的关键。

Objective To research the cause of acute intraoperative encephalocele in patients with craniocere- bral injury and protective and treatment measures.Methods 31 head-injury patients with acute intraoperative encephalocele were analysed retrospectively.Results Delayed intracranial hematoma,acute diffuse brain swell- ing caused by cerebral anoxia,unfit field of operation and incision of dura mater were the main causes of intraopera- tive encephalocele.The excessive filling of the bladder was also the cause of high brain pressure in operation.To avoid or relieve cerebral anoxia before operation,select eligible craniotomy incision,and remove delayed intracranial hematoma in time was the key to prevention and treatment of encephaloeele.Intraoperative control lowering of pres- sure,using dehydrant,proper hyperventilation had some effect on controlling encephalocele.Conclusion Making every endeavor to shorten the time of preoperative intracranial hypertension,avoiding hypotension and asphyxia,nor- mal operative incision,and intraoperative or postoperative CT examination are the key to lowering the incidence rate and mortality of encephalocele.