颅脑损伤合并腹部闭合性创伤的诊断与治疗(附102例报道)

An analysis on the diagnosis and treatment of 102 cases with closed abdominal injury associated cerebral trauma

目的总结颅脑损伤合并腹部闭合性创伤诊断和治疗经验,以期提高外科危急重症的抢救成功率。方法回顾性分析1994～2004年收治的颅脑损伤合并腹部闭合性创伤102例患者。结果85例行急诊手术抢救,17例非手术保守治疗;85例手术患者中,75例急诊行剖腹探查术,急诊行颅脑手术者68例,腹脑同时手术者58例;68例开颅患者术前均CT检查确诊;85例手术者死亡16例,病死率18.8%,17例非手术者中8例死于创伤后6小时内,死亡率47.1%。结论诊治腹部创伤的同时,应重视颅脑外伤的早期诊断,并应根据伤情的主次选择手术主次,条件允许者可同时开腹开颅;准确判断病情,有手术指征者,应尽快进行手术,避免失去手术抢救机会。

Objective To summarize the experience of patients with abdominal injury associated cerebral trauma in order to improve the rescuing achievement radio of surgical severe cases, Methods 102 pafientn with severe closed abdominal injury associated cerbral trauma hospitalized in 1994-2004 years were analyzed retrospectively, Results 85 cases were performed emergency operation and 17 cases got expectant treatment, Among them,75 cases were performed abdominal exploration operation. 68 cases were performed cerebral operation, and 58 cases were operated on abdomen and encephalon simultaneously 68 cases who got skull open were diagnosed with CT check, The case fatality rate of operation is 18.8% but the death rate of expectant treatment is 47.1%. Conclusions To deal with the patients with cerebral trauma, special attention must be paid to the early diagnosis of associated abdomen injury simultaneously. It is important to arrange operating procedure according to what is prime or next important condition. It is appropriate to arrange operation on abdomen and encephalon simultaneously. In order not to lose operating opportunity, the most vital factor is to judge the state accurately.