创伤性天幕裂孔疝前驱期特征性临床征象分析

Analyses of Clinical Prodromata of Traumatic Hiatal Hernia of Tentorium Cerebelli

目的总结创伤性天幕裂孔疝前驱期特征性的临床征象,以提高此类患者的疗效。方法回顾分析我科近5年425例脑疝发生前2h内的临床表现和辅助检查特点,并与同期390例未发生脑疝的重型颅脑损伤患者进行对比分析。结果脑疝组患者在脑疝发生前昏迷加深、尿失禁、侧脑室或侧裂和脑基底池受压变窄呕吐、明显躁动、生命体征的改变及ICP>20mmHg的发生率明显高于非脑疝组患者,两者相差非常显著。结论重型颅脑损伤早期,意识障碍程度加深、呕吐、躁动且有尿失禁及侧脑室或侧裂和脑基底池受压变窄是脑疝前驱期特征性临床征象,为早期开颅手术的指征。

Objective To summarize the clinical prodromata of traumatic hiatal hernia of tentorium cerebelli in order to enhance the curative effect on the patients with hiatal hernia. Methods The clinical data of 425 patients with craniocerebral injury within 2 hours before herniation analysred retrospectively and were compared with those of 390 patients with craniocerebral injury in whom the cerebral hernia did not occurred. Results The rates of coma deepening, urine incontinence, press and distortion of the lateral ventricles and basal cistern, vomiting, moving restlessly, change in the vital sign and ICP>20 mmHg were significantly higher before herniation in the patients with hernia than those in the patients without hernia after the craniocerebral injury. Conclusion The coma deepening, urinal incontinence, press and distortion of the lateral ventricles and basal cistern on CT, vomiting, moving restlessly are the prodromata of the hernia and the operative indication in the patients with severe craniocerebral injury.