脑挫裂伤水肿转归时间的探讨

Exploring Time Course of Brain Edema after Cerebral Contusion and Laceration

目的总结脑挫裂伤后脑水肿发展与消退的时间,为临床治疗提供依据。方法我院4年来收治的脑挫裂伤的患者174例,至少每3d复查一次CT,根据CT影像表现作为观察脑水肿的指标,记录脑水肿随时间演变的过程。结果所有病例脑水肿在3d内达到高峰,但水肿高峰持续时间存在差异,病程中脑水肿的高峰持续时间3～5d7例,6～8d34例,9～11d112例,12d以上21例。脑水肿高峰持续时间与脑水肿严重程度和挫裂伤的严重程度有显著关系。结论大部分脑挫裂伤脑水肿高峰时间比过去我们认识的要长,故使用控制脑水肿药物的时间应适当延长,特别是严重颅脑损伤患者,并应根据不同情况选择脱水剂。

Objective To explore the evolving and vanishing time of brain edema after contusion and laceration in order to provide the guidance for clinically treating the brain edema. Methods The brain edma were judged according to a CT scan at least every 3 days in 174 patients with cerebral contusion and laceration. The change in the brain edema with the lapse of time were re-corded and analyzed. Results The brain edema in all the patients reached to the peak in 3 days after trauma, but the time of the brain edema peak was different among the patients. The peak of the brain edema lasted 3～5 days in 7 patients, 6～8 days in 34, 9～11 days in 112 and more than 12 days in 21. The time of the brain edema peak were significantly associated with the severity of trauma and brain edema. Conclusion The time of the brain edema peak revealed by the present study were longer than that we knew before in most of the patients with cerebral contusion and laceration; therefore the dehydrating agents should be longer administered and carefully selected according to their condition in the patients with cerebral injury, especially in one with severe brain contusion and laceration.